Transcript 70% of disease is preventable

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
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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
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5,000,000 drug complications/year
200,000 deaths/year
$4 Billion in medical costs per year
Medical Error Iatrogenic Illness
 1988
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25% of heart, stroke, pneumonia deaths
 1991
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Time Corp-
80,000/year = 2x annual auto deaths
 1994
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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
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Heart disease
Cancer
Cerebro-vascular disease
Negative drug
interactions
Accidents
Medical error
COPD, Pneumonia & flu
Diabetes
Suicide
Liver disease
10
Leading
Causes
of
Death
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Tobacco
Diet/activity patterns
Alcohol
Microbial agents
Toxic agents
Firearms
Sexual behavior
Motor vehicles
Illicit use of drugs
9
Actual
Causes
of
Death
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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
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33 in group support and stress management
 74%
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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
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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
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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:
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.