The bio psychosocial model of care
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Transcript of The bio psychosocial model of care
The Patient’s JourneyAnd its Relevance to the Patient-Centered
Medical Home
Presenters:R. Brent Wright, MD, MMM
Vice Chair for Rural Health
Associate Professor
University of Louisville-Glasgow
Family Medicine Residency
Dept Family/Geriatric Medicine
Diane Perry-Adler, MS
Licensed Psychological
Practitioner
Clinical Instructor
University of Louisville-Glasgow
Family Medicine Residency
Overview
Introduced into clinical medicine in 1977 by George
Engle
Examines the various determinants of behavior
Closely related to the Sick Role concept pioneered by
Talcott Parsons in the 1950’s
Sick Role Concept
• Talcott Parsons, a sociologist, was concerned with how the sick person is related to the whole social system, and what the sick person’s function is within that system.
• His ideas were formulated upon a belief that social practices should be seen in terms of their function in maintaining order and structure in society
• Four characteristics, two involving rights and two involving responsibilities
Rights
1. The sick person is exempt from carrying out normal social roles
a) Varies in degree
b) The more severe the illness the greater the exemption
2. People in the sick role are not responsible for their plight
a) The situation is beyond their control
b) They are not blamed for their illness.
Responsibilities
1. The sick person is expected to get well; sickness is
temporary and undesirable.
2. The patient is obliged to be compliant.
The Bio-Psychosocial
Model
• The BPM model posits – an individual and his/her
response to illness is impacted by and impacts biological,
psychological, and social factors.
The Bio-Psychosocial
Model
• If illness is defined as some loss of adaptability, resulting
in physical or psychological distress, then we recognize
the importance of coping/defense mechanisms to manage
illness states.
The Bio-Psychosocial
Model
• Patterns of response are individualized
• Patterns are unique to the individual
For some patients, identification of
primary symptoms appropriate treatment return to
adaptive functioning.
The Bio-Psychosocial
Model
• Other patients require simultaneous treatment of different
factors contributing to the illness in order to return to
illness resolutions.
Behavioral Determinants of Illness
Individual
Psychosocial
(intra psychic)
Social
(inter personal)
Environmental
(extra personal)
Spiritual/
Cultural
Somatic
(disease/organic)
The BPM model allows the care giver to
individualize treatment with these
facors taken into consideration.
• The biology of the disease process
• The patient’s individualized response
• The social factors which may interfere with or enhance
the response to treatment.
THEORY
DB PCMH
Bio-Psychosocial Model (BPM) drives the alignment of the of the Patient
Centered Medical Home (PCMH) and the Determinants of Behavior (DB)
BPM
What Makes a Patient
Centered Medical Home?
1. Comprehensive Care – the PCMH is accountable for
meeting the large majority of each patient’s physical and
mental health care needs, requiring a team of providers.
2. Patient Centered – relationship-based with an
orientation toward the whole person.
• A partnership with patients and their families
• Understanding and respecting the patient’s unique needs,
culture, values, and preferences.
What Makes a Patient
Centered Medical Home?
3. Coordinated Care – care is coordinated across all
elements of the broader health care system including
specialty care, hospitals, home health, community
services and supports to build clear and open
communication among patients, families, the medical
home, and members of the broader healthcare team.
What Makes a Patient
Centered Medical Home?
4. Accessible Services – services delivered with shorter wait times for urgent needs, enhanced in-person hours, around the clock telephone or electronic access to a member of the care team, and alternative methods of communication such as email telephone care. The medical home is responsive to patients’ preferences regarding access.
5. Quality and Safety – a commitment to quality and improvement is demonstrated by the following:• Using evidence-based medicine and clinical decision support tools
• Using performance measurement and improvement
• Measuring and responding to patient experiences and satisfaction
• Practicing population health management
BIO
PSYCHO
SOCIAL
The Patient’s Journey
Sam
Psychosocial
• ? Chronic Schizophrenia
• Hx of unsuccessful MH tx
Social
• No family
• No close friends
• No social support
• Alienation of services
Environmental
• Lives alone
• Unsanitary conditions
• Poor Meal Planning
• Poor hygiene
Spiritual/Cultural
• Unknown except pt has kept local pawnshop/thrift store operating in the black.
Somatic
• Abd Aneurysm
• Hypertension
• Venus Insuf/ulcer
• Cellulitis
• Renal Cyst
• Onychonmycosis
Joe
Psychosocial
• PTSD; psychotic disorder
• Hx of abuse
• Trust issues
• Chronic anger
• Intellectual functioning
Social
• No contact with family
• 2 friends died w/i the yr.
• Socially isolated
Environmental
• No income
• Limited resources
• Can’t afford healthcare
• He and wife supported by father-in-law
Spiritual/Cultural
• Lost his faith
• People don’t care
• No involvement in community
• No interest
Somatic
• CAD
• SOA/COPD
• Hypertension
• Diabetes
• Multiple surgeries
• Fatty liver
• Constant dental pain
PCMH
BPM
DB
We cannot fill the check boxes on the PCMH until until we are in check with our own humanity.
RESOURCES/REFERENCES
• http://psychnet.apa.org
• www. AHRQ.gov. (Defining the PCMH) *Agency for Healthcare Research and Quality
• Bass, Christopher and Halligan, P. Illness Related Deception: Social or Psychiatric Problem? Journal of the Royal Society of Medicine. Vol 100 (2); Feb 2007; pp 81-84
• DeAngelis, Tori. Placing the Patient Front and Center. Monitor on Psychology. Vol 41; No 11; Dec 2010; p 42
• www.healthline.com (Illness and Sick Role Behavior)
• www.ncbi.nlm.nih.gov/NKB19927 (Genetic, Environmental, and Personality Determinants of Health Risk Behaviors) *National Library of Medicine
• www.ncbi.nim.nih.gov/pmc /articles/PMC 1228155
• Segall, Alexander. The Sick Role Concept: Understanding Illness Behavior. Journal of Health and Social Behavior. Vol 17, No 2; June 1976; pp 163-170
• Sobel, R. and A. Ingalls. Resistance to Treatment: Explorations of the Patients Sick Role. American Journal of Psychotherapy. Oct 1964; pp 562-573
PRESENTATION DESIGN:
NANCY VANDERVEERADMINISTRATIVE DIRECTOR
TJ SAMSON FAMILY MED CENTER