The Whole-Person Integrated-Care (WPIC) Wellness Solution: Part 2

Last week, in part 1 of the WPIC solution, I began defining a new type of wellness program based on a whole-person integrated-care (WPIC) model, which takes a whole-person (mind, body, spirit, and environment) view of health, and which coordinates sick-care with well-care across the entire healthcare continuum. I included an introductory discussion of the value proposition of such a wellness program and its goals and methods. I also mentioned that (at least) four types of people with different character traits require different approaches to wellness due to their other thoughts, emotions, behaviors, knowledge & understanding, and coping strategies. In this post and future ones, I examine these differences.

Definitions

Since I'm presenting additional terms, let me take a moment to define them:

• Thoughts refer to a person's attitudes, beliefs, perceptions, assumptions, reasoning, expectations, memories, "self-talk," and other mental processes (i.e., one's cognitions).
• Emotions refer to a person's feelings and moods (i.e., one's affect).
• Behaviors are what a person does (i.e., one's actions).
• Knowledge & understanding are related terms, which I discuss in some detail at this link. Briefly, knowledge refers to information someone knows about essential things, such as relevant people, things, places, times, reasons, rules, and methods. Understanding, on the other hand, is being able to apply that knowledge when doing such things as:
  
  • Explaining, interpreting, discovering, and gaining insights into the nature of things
  • Noticing contradictions/inconsistencies
  • Using logic and evidence to support decisions, make accurate predictions, and judge/evaluate things rationally and sensibly
  • Creating and imagining
  • Focusing attention on what's important (i.e., having good situational awareness), being prepared to act, and justifying one's beliefs/hypotheses.
• Coping strategies are adaptive or maladaptive ways of thinking, feeling, and acting when dealing with problematic situations. Following are ten common coping strategies people tend to use. The first five are positive strategies because they help a person solve a problem or learn to accept it with minimal distress. The latter five are negative strategies because they fail to resolve one's issues or enable healthy acceptance.
1. Logical Analysis is a positive approach strategy in which a person tries to understand what caused the problem and think of different ways to handle it.
2. Social Support is another positive approach strategy in which a person explains the problem to someone or asks others for advice or help. This can help determine what, if anything, can be done to solve it.
3. Problem-Solving is another positive approach strategy in which, after logical analysis, a person determines that a problem can be solved and what has to be done to solve it. Then, a specific action plan is created and implemented, and the person learns from the results and modifies the plan accordingly.
4. Positive Reappraisal is another positive approach strategy in which a person views a problem as helping him/her change or grow in a good way, find new faith, or learn valuable lessons. This strategy can be used whether or not a problem can be solved.
5. Rational Acceptance is a positive non-action strategy in which a person accepts—without undue emotional distress and self-defeating behaviors—that nothing can be done to solve a problem, so s/he does nothing except adopt a rational way of thinking about it, which fosters psychologically healthy acceptance.
6. Behavioral Distraction is a negative avoidance strategy in which a person tries to feel better emotionally by doing enjoyable or interesting things rather than trying to solve the problem or cope with it through positive reappraisal and rational acceptance. While it may help reduce one's upset temporarily, this strategy is maladaptive because it will never solve the problem and does nothing to help one cope with it long-term. This strategy wastes precise time that could be better spent trying to understand and deal constructively with the problem rather than letting things get worse.
7. Cognitive Avoidance is another negative avoidance strategy in which a person simply acts as if there is no problem or tries not to think about the issue. As with behavioral distraction, the strategy may help reduce one's upset temporarily. Still, it will never solve the problem and does nothing to help one cope with it long-term, as well as wasting precise time.
8. Emotional Discharge is another negative avoidance strategy in which a person expresses negative emotions by yelling or crying, taking it out on others, or avoiding certain people or situations. As with the previous two strategies, this one may help reduce one's upset temporarily, but it will never solve the problem and does nothing to help one cope with it long-term. In addition, this strategy may annoy other people, push them away, and waste precise time.
9. Wishful Thinking is another negative avoidance strategy in which a person simply hopes a miracle will make things better or that his/her wishes or prayers will be answered. As with the other avoidance strategies, this one may help reduce one's upset temporarily, but it will never solve the problem and does nothing to help one cope with it long-term, as well as wasting precise time.
10. Resignation is a negative non-action strategy in which a person determines that nothing can be done, so s/he does nothing while remaining in an emotionally distressed state of anxiety, depression (hopelessness and helplessness), and/or anger.

Describing the Characteristics of Four Types of Individuals

As I discussed in my previous post, wellness programs should address the particular needs of (at least) four types of people: Activists, Wannabes, Inactives, and Ignorers/Deniers. In this post, I present the Activists. They are most motivated to deal actively and eagerly with health & wellbeing issues and are most likely to take advantage of wellness programs.

Activists

Activists' attitudes about managing their physical and mental health can be summed up in thoughts such as: "I believe I can do whatever must be done, and I'm willing to do it!" Such views reflect a joy of living and a willingness to take constructive action to reduce fear, uncertainty, and doubt through problem-solving (if their health problems can be resolved) or rational acceptance (if the problems can't be fixed). Activists tend to be confident, motivated, aware, rational, and assertive regarding their character traits. From a whole-person integrated-care perspective, they seek knowledge about their physical and mental health status and risks to help them make wise decisions. And they try to understand how to avoid health problems, self-manage chronic conditions, treat existing problems most safely and cost-effectively, and use their knowledge to live healthy lifestyles. Activists, in other words, are rational people who deal with their physical and mental health problems (existing conditions and risks) by using positive, proactive coping strategies, such as:

• Trying to understand what caused the problems by thinking of different ways to handle it
• Talking to someone about what they are going through and asking certain people for advice or help.
• Determining what must be done to solve a problem and then using a specific action plan.
• Viewing a problem as something that helps them change or grow in a good way, find new faith, or learn valuable lessons
• Rationally accepting when a problem cannot be solved to minimize their emotional distress.

When dealing with an existing health problem, Activists actively seek knowledge and guidance to understand the pros & cons of different treatment options. And when dealing with their health risks, they seek to understand the pros & cons of varying prevention options. If Activists have money problems—which prevent them from carrying out their wellness plan of care (e.g., buying more healthy foods, a gym membership, prescribed medications, diagnostic tests, etc.)—they strive to find a way to afford what they need, including political action. If they have family and other demands that consume their time and thus make lifestyle change difficult, they find ways to make time available. And if they have physical handicaps or cognitive impairments that interfere, they will explore alternative approaches to health improvement that accommodates these limitations. Finally, the more a person's character traits resemble an Activist, the more likely s/he is to gain from a wellness program and improve his/her health and wellbeing. In my next post, I examine the Wannabes and Inactives.

Patient-Centered Life-Cycle Value Chain: the Sick Care link

In my previous post, I discussed the first link in the Patient-Centered Life-Cycle (PCLC) Value Chain, which is emergency care through emergency management. In this post, I discuss the second link, which involves sick-care, also known as the “clinical encounter” between a patient and one or more healthcare providers.

Sick-care consists of the following six categories of physical and psychological problems (including diseases, illnesses, dysfunctions, and traumas):

1. Acute health problems characterized by sudden onset and short duration, which progresses rapidly and require urgent care. An acute myocardial infarction (heart attack) and serious accident victim are examples.
2. Subacute health problem distinguished by abrupt onset, but it has longer duration or changes less rapidly than acute problems. Examples include post-operative care, complex wound management, and rehabilitation for stroke.
3. Chronic health problem of indefinite duration, which may persists with virtually no change over time, or which may lead to complications. Diabetes, depression, congestive heart failure, hepatitis and asthma are examples. Note that once stabilized, enabling patients to adhere to plans of care for avoid complications and premature death is part of well-care.
4. Physiological health problems consist of illnesses and dysfunctions in any part of the body.
5. Psychological health problems consist of emotional, mental, or behavioral disturbances and disorders.
6. Mind-Body (Biopsychosocial) health problems are related to the interaction between physiological and psychological factors.

Sick-care has five sick-care delivery models for delivering tests and procedures (treatments):

1. Inpatient Care model focuses on treating patients in hospitals, nursing homes, and other inpatient facilities.
2. Outpatient Care model focuses on treating patients in the offices of primary care physicians and specialists, clinics, and other outpatient facilities.
3. Medical/Bodily Care model focuses on delivery of (a) emergency medical care (e.g., accident victims, infections, poisoning, etc.) and (b) non-emergency medical and non-medical bodily care (e.g., elective surgery, chiropractic, dental, vision, etc.).
4. Psychological Care model focuses on delivery of medical/psychiatric and non-medical/psychological care for mental, emotional, cognitive, and behavioral problems.
5. Biopsychosocial/Integrative Care model focuses on delivery of integrative (mind-body) care for problems having physiological and psychological causes or consequences.

Sick-care delivery processes focus on diagnosing and treating health problems in inpatient and outpatient sick-care settings:

1. Inpatient care processes for physical and psychological health problems including (a) emergency room/trauma center care; (b) obstetrics; (c) tests and examinations; (d) elective surgery; and (e) psychiatric care for severely disturbed patients.
2. Outpatient care processes physical and psychological health problems including (a) tests and treatments for physical and psychological problems during primary care during office visits to primary care physicians and specialists, as well as to ambulatory clinics and other such facilities, and (b) coordinating care for patients requiring multidisciplinary teams can work together effectively.

A core problem with sick-care today is that we rarely know what constitutes cost-effective (high-value) sick-care that is tailored to a patient's particular needs and characteristics. That is, we lack patient-specific evidence-based guidelines about how to treat each patient so they get well rapidly and with least risk and complications. This is because our country hasn't focused on supporting the kinds of research and information systems necessary for generating and using the knowledge (best practices) providers and patients need for improving treatment outcomes/results and controlling costs.

On top of that, high-value sick-care is less profitable than wasteful, inefficient, redundant, excessively costly and error-prone care. This is because our crazy payment system rewards high volume and costly procedures through higher profits, while it discourages the efficient delivery of cost-effective care through lower profits.

In the PCLC Value Chain, therefore, sick-care focuses on:

• Using and evolving evidence-based practice guidelines defining how to deliver cost-effective care
• Assessing and improving clinical outcomes continuously
• Empowering healthcare consumers to make knowledgeable decisions about their own care by being active participants in shared decision-making
• Treating the “whole person,” both physically and psychologically
• Tailoring care to each person’s specific needs and preferences
• Coordinating care and facilitating cooperative communications across all providers treating a patient for better continuity of care
• Fostering collaboration between practitioners and researchers
• Maximizing safety and efficiency
• Utilizing advanced information systems for supporting diagnostic and treatment decisions
• Assuring greater financial gains to providers dedicated to delivering high-value care.

In my next post, I examine the third link in the PCLC Value Chain: Well-Care.