The Integration of Medical, Behavioral, and Complementary Services

The Primary Health NetworkSharon, PA

Diane Dado, LCSWAnita Booth, CRNP

The Center for Health and Well-Being

Complementary Vs. Alternative Medicine

Complementary • refers to using a non-

mainstream approach together with conventional medicine.

Alternative• refers to using a non-

mainstream approach in place of conventional medicine.

Nutrition, massage, reiki, yoga, acupuncture, herbal,chiropractic services, hypnosis, meditation, Qigong

Integrative Medicine

• “Healing-oriented medicine that re-emphasizes the relationship between the patient and the provider and integrates the best of complementary and alternative medicine with the best of conventional medicine.” (Institute of Medicine)

World Health Organization:Definition of Health

• "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." (1948 WHO Constitution)

Integrated Health Care

Integrated Health Care-It’s all connected

Evidenced- based medicine

Exercise: Weight loss, Depression, Hypertension, Anxiety

Reiki/Hypnotherapy: Stress, Chronic Pain, Anxiety, Smoking cessation

Group/Socialization: Depression, improved health outcomes, increased motivation

Healthy People 2020

• A set of goals and objectives with 10 year targets designed to guide health promotion and disease prevention

• Provides science based benchmarks to track and monitor progress

• It is a tool for strategic management by the federal government, states, communities, and many other public and private-sector partners.

Healthy People 2020Contains 26 leading health indicators with 12 main topics

At CHWB we are offering 8 out of the 12 topicsAccess to health servicesMental HealthNutritionTobacco Substance Abuse (screening, education, and referral)Physical Activity, Obesity, DMClinical preventative services-osteoporosis, cancer screeningReproductive & Sexual Health-adolescent health, family planning

Patient Centered Medical Home

Taking Care of the Patient

Patient

smokingsmoking

diabetesdiabetes

HypertensionHypertensionobesity

Acute/Chronic Pain

Acute/Chronic Pain

Fibromyalgia

OsteoporosisOsteoporosisDepressionDepression

Anxiety

Dyslipidemia

Fibromyalgia/Pain

• Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.

• Tender points: Back of the head Between shoulder blades Top of shoulders Front sides of neck Upper chest Outer elbows Upper hips Sides of hips Inner knees

Fibromyalgia treatment

• Medications-Analgesics, Antidepressants, anti-seizure

• Therapy- individual and group mental health therapy

• Lifestyle and Home remedies- stress reduction, physical activity, nutritional changes

• Alternative medicine- acupuncture, yoga, massage therapy

Obesity

As of June 2013, AMA has recognized obesity as a disease

-Increases risks of:CV diseaseHypertensionDM type 2

Diabetes

1. Fasting plasma glucose >126mg/DL2. 2HR glucose tolerance test >200mg/DL3. HBA1C>6.5%

Who should be screened-Age 45 years of age with no risk factors-Overweight BMI >25+1 of following risk factors– Physical inactivity– 1st degree relative DM– High risk race/ethnicity– Women delivering a baby >9lbs/ Gestational DM– HTN, HDL <35, TG>250– PCO– HBA1C>5.7 previous testing– CVD

Glucose Intolerance

Goals:– Target Loss 7% total body weight– Increase physical activity • 150min/wk moderate activity

– Consider Metformin to prevent DM type 2• BMI >35, less then 60 y.o., Gestational DM

JNC 7 guidelines

HypertensionSystolic Diastolic

Pre-hypertension 120-139 80-89

Stage 1 140-159 90-99

Stage 2 >160 >100

JNC 7 guidelines

Risk factors for cardiovascular diseaseIncludes:

Dyslipidemia DMObesity SmokingAge SexSmoking Renal dysfunctionincreased BP

Barriers to BP goals

• Insufficient attention to health education by health care practitioners

• Lack of reimbursement for health education• Lack of access to places for physical activity• Lack of exercise programs in schools• High cost of healthy foods/ High sodium in

restaurant foods

Life style modificationsModification Recommendation Approx. SBP reduction

range

Weight Reduction Maintain normal body weight (BMI <30

5-20 mmg/Hg/10 kg wt loss

Adopt DASH eating plan Fruits, vegetables, low-fat dairy products, low sat. fat

8-14 mmHg

Dietary sodium reduction Reduce to 2.4g sodium or 6g NaCl

2-8 mmHg

Physical activity Regular aerobic PA (at least 30 min day/most days a wk)

4-9mmHg

Moderation of alcohol consumption

No more than 2/day in men & 1/day women

2-4mmHg

Patient Centered Medical Home

It takes a TEAM

PCPPCP

Patient

Life style modifications

team

Life style modifications

team

Behavioral Health

Behavioral Health

smokingsmoking

DMDMHTN

HTN

obesity

obesity

Chronic PainChronic PainFibromyalgi

aFibromyalgi

aDepression

Patient Centered Medical Home

Life Style Modification Team

Patient

“GATEKEEPER”

smokingsmokingDMDM HT

NHTN

obesity

obesity

Chronic PainChronic Pain

Fibromyalgia

Fibromyalgia

MassageMassage

Hypno/Reiki Nutrition

ChiropracticChiropractic

Acupuncture

BehavioralHealth

Exercise

Integrated Approach to Anxiety Muscle tightnessMuscle tightness

Patient

“Anxiety ”

Isolation Isolation DepressionDepression

Hypno/Reiki Meditation group

Therapy, RX

Exercise

Sleep Problems

Sleep Problems

Massage

Why this model?

• Parallels PCMH features: Enhanced access Whole person care orientation Coordinated and/or

integrated care

Questions?

• Diane Dado, LCSW

The Primary Health NetworkDdado@primary-health.net(724) 704-7413

• Anita Booth, CRNP

The Primary Health NetworkAbooth@primary-health.net(724) 704-7413