The Integration of Medical, Behavioral, and Complementary Services The Primary Health Network Sharon, PA Diane Dado, LCSW Anita Booth, CRNP

The Center for Health and Well-Being Wellness Nutrition Chiropractic Acupuncture Gynecological Behavioral Health Complementary Medicine -Behavioral Health -Medical -Reiki -Massage -Exercise -Nutrition

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

Obesity Pain Diabetes Physical Anxiety Depression Emotional Integrated Health Care- It’s all connected Anxiety Stress Emotional Ulcer Headaches Sleep problems Physical Isolation Loss Social Depression Grief Hopelessness Emotional

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 2020 Contains 26 leading health indicators with 12 main topics At CHWB we are offering 8 out of the 12 topics Access to health services Mental Health Nutrition Tobacco Substance Abuse (screening, education, and referral) Physical Activity, Obesity, DM Clinical preventative services-osteoporosis, cancer screening Reproductive & Sexual Health-adolescent health, family planning

Patient Centered Medical Home Taking Care of the Patient Patient smoking diabetes Hypertension obesity Acute/Chronic Pain Fibromyalgia Osteoporosis Depression 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 disease Hypertension DM type 2

Diabetes 1.Fasting plasma glucose >126mg/DL 2.2HR glucose tolerance test >200mg/DL 3.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 – 1 st degree relative DM – High risk race/ethnicity – Women delivering a baby >9lbs/ Gestational DM – HTN, HDL 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 Hypertension SystolicDiastolic Pre-hypertension Stage Stage 2>160>100

JNC 7 guidelines Risk factors for cardiovascular disease Includes: DyslipidemiaDM ObesitySmoking AgeSex SmokingRenal dysfunction increased 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 modifications ModificationRecommendationApprox. SBP reduction range Weight ReductionMaintain normal body weight (BMI < mmg/Hg/10 kg wt loss Adopt DASH eating planFruits, vegetables, low-fat dairy products, low sat. fat 8-14 mmHg Dietary sodium reductionReduce to 2.4g sodium or 6g NaCl 2-8 mmHg Physical activityRegular 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 PCP Patient Life style modifications team Behavioral Health smoking DM HTN obesity Chronic Pain Fibromyalgia Depression

Patient Centered Medical Home Life Style Modification Team Patient “GATEKEEPER” smoking DM HTN obesity Chronic Pain Fibromyalgia Massage Hypno/Reiki Nutrition Chiropractic Acupuncture Behavioral Health Exercise

Integrated Approach to Anxiety Muscle tightness Patient “Anxiety ” Isolation Depression Hypno/Reiki Meditation group Therapy, RX Exercise 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 Network (724) Anita Booth, CRNP The Primary Health Network (724)

In Their Own Words