Terminology: wellness, maintenance, lifestyle and periodic and transformative or transformational care.
PRE-AMBLE:
Every practitioner wants the best for their patient or client? We want to help resolve and ameliorate pain and other symptoms. And more importantly we don’t want our patients to suffer the same symptoms again. We want to, in effect, fix and cure!
In this article I want to discuss the challenges of the ‘fix and cure’ model and why both allied and mainstream health care is steadily shifting to a more ‘transformative’ model.
Ameliorating symptoms in no longer enough. Pain returns, symptoms relapse and our patients keep presenting to practitioners with the same story!
Why? I believe this relates to a failure to manage our patients beyond pain or symptom resolution. A failure to support our patients by way of education and periodic care and a failure to adapt the treatment journey to fit a more maintenance or wellness approach.
After all our goal should be to not only resolve pain and symptoms but reduce the likelihood of relapse.
INTRODUCTION:
Modern healthcare is no longer a symptom and pain focus, cure and fix model. The patient is now demanding a shift from reactive care to a more proactive model and a re-orientation to wellness that could be of immense benefit to both patient and healthcare provider.[4]
HISTORY OF WELLNESS CARE:
Typically, wellness care has been the domain of alternative, wholistic and/or allied health professions, e.g. Chiropractic and Naturopathy however, in recent years it is being adopted in various forms by other professions including medical. Westernised medical models often promote the concept of treatment rather than prevention, limiting the helper’s ability to focus on wellness when working with clients/patients. [4] It is well-established that lifestyle factors strongly influence health. [3]
The nursing forum describes the problem as related to multiple chronic conditions combined with the complex social needs of individuals and families that often create unattainable goals of efficient and effective holistic care within primary care settings. It goes on to say, there is a recognised need for new approaches to address the intersection of the role of social determinants of health and the resulting impact on health care utilisation and outcomes as an approach to enhancing value‐based care. It proposes an innovative health and wellness model that complements the essential work of primary care providers as an adjunct to care delivery. [5]
One recent study revealed a significant gap between healthcare training and systems and patient care beyond symptom management. This particular study went on to say, ‘it is essential to have institutional, instructional reforms for need-based training, coordination between education, health care systems in various health systems to have health professionals who provide efficient, effective care. For appropriate health delivery, clinicians need the training providing bridged care, across systems, teams, in settings, time frames, responding to patients’ needs, expectations for wellness.’ [1] Vogel et al. says patient involvement in their health journey is paramount to improving clinical outcomes and aiding a cost effective approach. [2]
TRANSFORMATIVE CARE:
It is true the patient does not require the same type of treatment approach or frequency after the initial treatment period has ended. It is not true that every patient should be discharged at this point.
Transformative care is about literally transforming a patient from pain-focused thinking to a more empowered, wellness-focused thinking. In a fast paced world where many of us are still conditioned to ‘pop’ a pill rather than work hard on lifestyle changes, transformative care is a challenge and one that not every practitioner has the time or inclination to take part in.
So, let me propose what I believe are the benefits to both practitioner and patient.
1. Better quality of life, i.e. improved functional movement and participation in activities of daily living.
2. Less visits over time, i.e. an opportunity to enter into a trial withdrawal, rehabilitation treatment schedule as treatment urgency declines.
3. Less pain over time, i.e. the patient moves further and further away from an acute pain episode.
4. Less healthcare spend over time, i.e. spaced out visits affords the patient the opportunity to budget.
5. Easier treatment delivery, i.e. practitioners find it easier, patients are more comfortable with treatment as they move away from their acute episode.
6. Better educated patients, i.e. each visit is an opportunity to educate patients regarding diet, exercise, rehabilitation aids or other referral options so they can better self-care.
7. More empowered and health conscious patients, i.e. patients start to embrace a patient-centred health model.
8. Higher quality of like-minded referrals, i.e. patients who continue care beyond pain are more likely to refer others with similar expectations and attitudes.
9. Deeper engagement with patients over time, i.e. practitioner and patients can expect to more deeply engage over time which may enhance clinical outcomes over time.
CONCLUSION:
Transformative, wellness, periodic care, maintenance care…just makes sense. We expect our accountant to pro-actively manage our finances over time. We do not want a crisis to ensue causing us to then call our Accountant in a panic! The same applies with our Dentist, our mechanic and, in my view and many others, many professions and services.
This is underpinned of course on integrity and ethics. Transformative care should be about fewer visits over time, not more! It should be about giving information not holding it back! It should be about adjusting the frequency to suit each individual to achieve that fine balance between over and under-servicing.
References:
[1] Chhabra S, Challenges in health professionals’ training and health care for wellness, International Journal of Healthcare Management , Received 23 Apr 2019, Accepted 27 Jun 2019, Published online: 06 Sep 2019.
[2] Vogel et al., Cost-Effectiveness of the Wellness Incentives and Navigation (WIN) Program, Value in Health, Available online 29 October 2020.
[3] Anderson G et al., The CREATION Model: A whole-person wellness model to facilitate patient-provider partnerships for health promotion, Journal of Health and Social Sciences 2020; 5,4:485-500, The Italian Journal for Interdisciplinary Health and Social Development.
[4] Blount et al., Wellness in the helping professions: Historical overview, wellness models and current trends, Journal of Wellness, Vol.2, 2020, Issue 2.
[5] Parson et al., Mainstreaming health and wellness: The RHWP Innovation model to complement primary care, Nursing Forum: An independent voice for nursing, First published: 29 January 2019.
About the Author:
Dr. Andrew Arnold is a Chiropractor and director of Back In Motion – Cranbourne (formally Cranbourne Family Chiropractic and Wellness Centre). He is founder and CEO of Million Dollar Wellness, an Allied health practitioner