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 nonmainstream approach
together with conventional
medicine.
Alternative
• refers to using a nonmainstream 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 wellbeing and not merely the absence of
disease or infirmity." (1948 WHO
Constitution)
Integrated Health Care
Integrated Health CareIt’s all connected
• Obesity
• Pain
• Diabetes
Emotional
• Anxiety
• Depression
Physical
• Anxiety
• Stress
Emotional
• Isolation
• Loss
Social
Emotional
• Depression
• Grief
• Hopelessness
Physical
• Ulcer
• Headaches
• Sleep problems
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
Acute/Chronic
Pain
Dyslipidemia
Depression
Osteoporosis
Fibromyalgia
smoking
Patient
Anxiety
diabetes
obesity
Hypertension
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
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
Hypertension
Systolic
Diastolic
Pre-hypertension
120-139
80-89
Stage 1
140-159
90-99
Stage 2
>160
>100
JNC 7 guidelines
Risk factors for cardiovascular disease
Includes:
Dyslipidemia
DM
Obesity
Smoking
Age
Sex
Smoking
Renal 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
Modification
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
4-9mmHg
least 30 min day/most days
a wk)
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
Fibromyalgia
smoking
Chronic
Pain
Patient
Depression
DM
HTN
obesity
Life style
modifications
team
Behavioral
Health
Patient Centered Medical Home
Life Style Modification Team
Chronic
Pain
smoking
Patient
DM
Fibromyalgia
HTN
obesity
Chiropractic
“GATEKEEPER”
Acupuncture
Behavioral
Health
Massage
Exercise
Hypno/Reiki
Nutrition
Integrated Approach to Anxiety
Muscle tightness
Sleep
Problems
Patient
Isolation
Depression
“Anxiety ”
Therapy, RX
Massage
Exercise
Hypno/Reiki
Meditation
group
Why this model?
• Parallels PCMH features:
 Enhanced access
 Whole person care orientation
 Coordinated and/or integrated
care
Questions?
• Diane Dado, LCSW
• Anita Booth, CRNP
The Primary Health Network
[email protected]
(724) 704-7413
The Primary Health Network
[email protected]
(724) 704-7413
In Their Own Words
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Integration of Medical/Behavioral Health & Complementary Medicine