Health Promotion and Wellness: Relevance and Implementation Strategies

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Health Promotion and WellnessRelevance and
Implementation Strategies

• Circle of Life
• www.CircleofLife.net

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The Circle of Life
Self-Inquiry Assessment Form
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Trends in Health Care

• Wellness and health promotion
• Disease management
• Complementary medicine
• Parish nursing
• Cluster services

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Methodology

• Provide opportunities that are
• Experiential
• Relevant
• Life inspiring
• Community building
• Leverage practical, applied spirituality
• Tools
• Support
• Assistive Accountability

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Utilization Frequency and Cost
COST
Medical Care
Prevention and Health Enhancement Programming
Self Care and Citizen Self Reliance
FREQUENCY
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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

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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

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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

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Chronic IllnessJAMA, 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.

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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

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Medical Error - Iatrogenic Illness

• 1988 Rand Corporation -
• 25 of heart, stroke, pneumonia deaths
• 1991 Time Corp-
• 80,000/year 2x annual auto deaths
• 1994 JAMA, 2721851-1857 - Leape, et al
• 180,000 deaths per year
• 1997 Harris Poll - 100 million have experienced
  or know someone who has

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1999 - 2000 Congressional Hearing Medical
ErrorInstitute 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

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An Act of Congress Created The Office of
Alternative Medicine (OAM)

• It was then upgraded to
• The National Center for Complementary and
  Alternative Medicine

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Complementary and Alternative Medicine - CAM

• The Economics
• 13 Billion, 1991
• 54 Billion, 1997

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Between 1990 and 2000

• The budget of NCCAM was increased 3000

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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.

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The House Task Force on Guiding Principles for
Health Care

• Two Key principles
• Health Creation
• Self-Healing and Self- Managed Care

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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

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70of disease is preventable

Healthy People 2000, DHHS, 1991,
91-50213
National Center For Health
Statistics, DHHS, 1992, 92-1232

• 8 of 9
• causes of disease are
• preventable
• New
  England Journal of Medicine, Fries, Koop, et al,
  329321-325, 7/93

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Chain of Causation

• 10 Leading Causes of Death 9 Actual Causes of
  Death Root Causes of Death
• 1. Heart Disease Tobacco Lack of information
• 2. Cancer Diet/activity patterns Lack of life
  skills
• 3. Cerebrovascular disease Alcohol Lack of
  connection
• 4. Accidents Microbial agents External
  internal stress
• 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
• 10. HIV/AIDS Meaningless existence
• Columns 1 2 -- Journal of the American
  Medical Association, McGinnis and Foege,
  2702207-2212, 11/93
• Column 3 - Health Action

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• 10
• Leading
• Causes
• of
• Death

• Heart disease
• Cancer
• Cerebro-vascular disease
• Negative drug interactions
• Accidents
• Medical error
• COPD, Pneumonia flu
• Diabetes
• Suicide
• Liver disease

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• 9
• Actual
• Causes
• of
• Death

• Tobacco
• Diet/activity patterns
• Alcohol
• Microbial agents
• Toxic agents
• Firearms
• Sexual behavior
• Motor vehicles
• Illicit use of drugs

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• Root
• 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

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In 1990 and 97, Eisenburg, 1

• 34/56 of Americans used unconventional health
  care methods
• 400/800 million visits to unconventional
  providers13.7 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

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In 1990 and 97, Eisenburg, 2Some 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,
  328246-252, 1/93

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In 1990 and 97, Eisenburg, 3The 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,
  328246-252, 1/93 and 97

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Archives of Internal MedicineStress Heart
DiseaseBlumenthal, et al, October, 1997Duke,
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

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Ornish Programfor 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.

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How?

• The Circle of Life program
• - Personal Health Assessment
• Self-Enhancement
• System (PHASES)

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The Circle of LifePersonal Health Assessment
Self-Energizing System

• The Circle of Life system has 7 phases
• 1. Assess, self inquiry, data capture Assessment
  Phase
• 2. Evaluate, discuss findings Exploration Phase
• 3. Develop healthy living program Personal
  Planning Phase
• 4. Individual implementation Action Phase
• 5. Support and accountability Support Phase
• 6. Re-evaluation, measure outcome Re-evaluation
  Phase
• 7. Course correction Re-design Phase

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• Who
• provides
• coaching
• Support
• Group
• facilitation

• Health educators
• Parish nurses
• Ministry professionals
• Social services
• Counselors, therapists
• Occupational therapists
• Physical therapists
• Human resources staff
• Health consultants
• Citizens, lay-persons

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• 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
• Assesses
• Supports
• Action in
• 12 Areas

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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

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Comprehensive Delivery
The Public
Consultation
Consultation
Self Inquiry
Personal Plan
Diagnosis
Diagnosis
Personal Action
Treatment
Treatment
Group Support
Health Promotion
Conventional Medicine
Complementary Medicine
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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.