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Health Promotion and Wellness: Relevance and Implementation Strategies Circle of Life www.CircleofLife.net The Circle of Life Self-Inquiry Assessment Form Trends in Health Care Wellness and health promotion Disease management Complementary medicine Parish nursing Cluster services Methodology Provide opportunities that are: – Experiential – Relevant – Life inspiring – Community building Leverage practical, applied spirituality: – Tools – Support – Assistive Accountability Utilization Frequency and Cost COST Medical Care Prevention and Health Enhancement Programming Self Care and Citizen Self Reliance FREQUENCY What are the most important complementary services? Those that are safe, effective at a minimal cost: • Group health improvement activities - group education - support group, study group - exercise - mind/body - Yoga, Tai Chi, Qigong, meditation • Counseling or coaching - nutrition, informed choice • Proactive triage - nurse on phone, demand management Medical visits - 75% could be handled through self-care, 25% require contact with a provider (no visit), 10% require an office visit (physician or nurse practitioner). Health Decisions, Demand Management Donald Vickery, MD Of the $1 trillion in annual expenditures 33% is spent on care deemed to be avoidable. Piper Jaffray Research, Health Care Information Systems Industry, 6/97 Pressures in the System Challenge of Chronic Illness Negative Drug Reactions Iatrogenic Incidences Major % of disease is behavioral Immense media attention Anti-aging and longevity Alternative and complementary medicine Chronic Illness JAMA, C. Hoffman, et al, November, 1996 1970 - 21 family caregivers/85 year old 1987 - 76% of direct medical expenses 1996 - 7 of 10 admissions are for chronic illness 1996 - 99 million, 45% of population, $470 billion 2020 - 134 million, 60% of population, $685 billion 2030 - 6 family caregivers/ 85 year old Integration of complementary services that are safe and effective may help to resolve some of this challenge. Adverse Drug Reactions JAMA April, 1998, Lazarou, et al 1998 Major Causes of Death – Heart disease – Cancer – Adverse drug reactions 5,000,000 drug complications/year 200,000 deaths/year $4 Billion in medical costs per year Medical Error Iatrogenic Illness 1988 – 25% of heart, stroke, pneumonia deaths 1991 – Time Corp- 80,000/year = 2x annual auto deaths 1994 – Rand Corporation - JAMA, 272:1851-1857 - Leape, et al 180,000 deaths per year 1997 Harris Poll - 100 million have experienced or know someone who has 1999 - 2000 Congressional Hearing Medical Error Institute of Medicine • At least 44K to 98K deaths per year due to adverse medical events • More iatrogenic deaths than motor vehicle accidents, breast cancer, or AIDS • Medical mistakes cost between $17 billion and $29 billion per year An Act of Congress Created The Office of Alternative Medicine (OAM) It was then upgraded to The National Center for Complementary and Alternative Medicine Complementary and Alternative Medicine - CAM The Economics: • $13 Billion, 1991 • $ 54 Billion, 1997 Between 1990 and 2000 The budget of NCCAM was increased 3000% White House Commission on Complementary and Alternative Medicine Policy Added a new area to its investigation on self-care and self-healing because a strong theme in their testimony regarded personal health improvement through personal action. The House Task Force on Guiding Principles for Health Care Two Key principles: • Health Creation • Self-Healing and Self- Managed Care Health Futurists • Strongest move: Health Improvement as a key to Integrative or Complementary Medicine • Cost Pressures: Alternative Therapies are Cost Shifting Self-Care is Cost Cutting 70% of disease is preventable Healthy People 2000, DHHS, 1991, #91- 50213 National Center For Health Statistics, DHHS, 1992, # 921232 8 of 9 causes of disease are preventable New England Journal of Medicine, Fries, Koop, et al, 329:321325, 7/93 Chain of Causation 10 Leading Causes of Death of Death 1. Heart Disease 9 Actual Causes of Death Tobacco 2. Cancer Root Causes Lack of information Diet/activity patterns Lack of life skills 3. Cerebrovascular disease Alcohol Lack of connection 4. Accidents Microbial agents External & internal 5. COPD Toxic agents Low self-esteem 6. Pneumonia Firearms Hopelessness 7. Diabetes Sexual behavior Anger and frustration 8.. Suicide Motor vehicles Powerlessness and fear 8. Liver disease and cirrhosis Illicit use of drugs Economic despair stress Heart disease Cancer Cerebro-vascular disease Negative drug interactions Accidents Medical error COPD, Pneumonia & flu Diabetes Suicide Liver disease 10 Leading Causes of Death Tobacco Diet/activity patterns Alcohol Microbial agents Toxic agents Firearms Sexual behavior Motor vehicles Illicit use of drugs 9 Actual Causes of Death Lack of information Lack of lifestyle skills Lack of connection External & internal stress Economic despair Meaningless existence Low self-esteem Hopelessness Anger and frustration Powerlessness and fear Root Causes of Death In 1990 and 97, Eisenburg, 1 34%/56% of Americans used unconventional health care methods 400/800 million visits to unconventional providers$13.7 billion was spent 72%/35% of respondents did not inform their medical doctor New England Journal of Medicine, Eisenburg et al, 1/93 JAMA, Eisenburg, et al, 11/97 In 1990 and 97, Eisenburg, 2 Some of the therapies studied: Relaxation & meditation practices Weight-loss programs Mega-vitamin and herbal supplements Self-help and support groups Therapeutic imagery & spiritual healing Bio-feedback and hypnosis Chiropractic Acupuncture Massage New England Journal of Medicine, Eisenburg et al, 328:246-252, 1/93 In 1990 and 97, Eisenburg, 3 The less frequently discussed points: Only 10% of respondents used actual treatment provided by medical or licensed providers (Chiropractic, Acupuncture, Massage) Most utilized unconventional methods were health improvement activities Yoga, Tai Chi, meditation, support groups, etc New England Journal of Medicine, Eisenburg et al, 328:246-252, 1/93 and 97 Archives of Internal Medicine Stress & Heart Disease Blumenthal, et al, October, 1997 Duke, National Heart Lung and Blood Current annual stats, 13.5 million, $117billion 107 patients - 3 groups - Standard tx, + exercise, + support – 33 in group support and stress management 74% – – – reduction in risk for second cardiac event Standard tx - 30% second event Standard tx plus exercise - 21% second event Standard tx plus group support -9% second event Ornish Program for Recovery from Heart Disease, Prostate Cancer, etc. • Nutrition • Exercise • Stress Mastery • Group Support • 88% avoided future procedures, no additional adverse event rates compared to controls = safe/effective. • Cost to franchise $30K to $100K+, cost per participant $3K to $15. How? • The Circle of Life program - Personal Health Assessment Self-Enhancement System (PHASES) The Circle of Life Personal Health Assessment & Self-Energizing System The Circle of Life system has 7 phases: 1. Assess, self inquiry, data capture 2. Evaluate, discuss findings 3. Develop healthy living program Phase 4. Individual implementation 5. Support and accountability 6. Re-evaluation, measure outcome 7. Course correction •Assessment Phase •Exploration Phase •Personal Planning •Action Phase •Support Phase •Re-evaluation Phase •Re-design Phase Health educators Parish nurses Ministry professionals Social services Counselors, therapists Occupational therapists Physical therapists Human resources staff Health consultants Citizens, lay-persons Who provides coaching & Support Group facilitation Diet & nutrition Exercise & fitness Stress mastery Health care & self-care Relationships & family Work and career Financial health Humor, play & creativity Environment & nature Emotions & self-esteem Life purpose & service Spirituality & intuition Circle: Assesse s & Supports Action in 12 Areas Rich opportunities are already in most hospitals: 1. Physical therapy department 2. Health education department 3. Comprehensive cancer 4. Cardiac rehabilitation 5. Diabetes services 6. Rehabilitation medicine Comprehensive Delivery The Public Consultation Diagnosis Self Inquiry Personal Plan Consultation Diagnosis Personal Action Treatment Treatment Group Support Conventional Medicine Health Promotion Complementar y Monday Morning Begin to craft, from resources within the organization, programs and delivery pathways that maximize health improvement and complement already agreed upon clinical protocols. If necessary target this strategy in just one or two departments or at one or two diagnostic categories.