Proactive Care in a Reactive World:
Improving Health and Wellness in the West Valley
Medicine – Historically Speaking
• For much of America's history, home doctor
visits were the norm.
• Home visits died when medical insurance
replaced pay-as-you-go, and administrative
costs and malpractice insurance fees forced
doctors to abandon individual practices and
join together in groups.
• By the early 1970s, fewer than 1 percent of
doctors made house calls.
-Huffpost Healthy Living
Positive Factors of Doctors’ House
Calls
• Convenience
• Doctor could observe patient in their own
environment
• Personal Touch
• Everything was available in
a black bag
…But that’s when medicine
was simpler…
Yesterday’s Physical Exam
Today’s Physical Exam
Often includes:
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laboratory tests
chest x-rays
pulmonary function testing
audiograms
full body CAT scanning
EKGs and/or heart stress tests
vascular age tests
urinalysis
mammograms or prostate exams depending on
gender
Medicine Today
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Shorter physician visits
Greater pharmaceutical dependence
Decreased trust in physicians
Longer waits in ER and doctors’ offices
Shorter acute care stays
More frequent readmissions
From ‘Cure and Fix’ to ‘Health
and Wellness’
• The shift in medicine over the decades has been
one from reactive to proactive.
• A cure and fix approach means to target what is
wrong with a patient’s body. (Reactive)
• A Health and Wellness focus is on the patient’s
total person. (Proactive)
‘Reactive’ Model of Medicine
Reactive medicine has
the diagnosis or disease
at its core
Diagnosis
‘Reactive’ Model of Medicine
Doctor Visit
Problem
D
I
S
E
A
S
E
Temporary
Fix
Change in condition
‘Reactive’ Tendencies
• Following the emergency is when we tend to
make changes that affect a better outcome:
- Heart attack leads to healthier dietary choices and more exercise
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COPD diagnosis contributes to decision to quit smoking
Car Accident leads to a re-evaluation of ability to drive safely
High stress indicates need for better self care
Family medical emergency invokes examination of advance
directives
- A fall and subsequent orthopedic fracture often expedites a change
in living environment
- Medical complications as a result of taking too many medications
leads to a better medication management system
‘Reactive’ Tendencies
• While these choices often lead to an improvement in
quality of life, a notable disparity occurs when applying the
reactive model of care to the prevention and management
of chronic conditions.
• The truth is, many diseases and undesirable health
outcomes can be prevented, yet our current health care
system is only now making better use of its resources to
support this process.
Dr. Natasha Zamalowski ND
- Proactivehealthcare
Proactive Care – The Health
and Wellness Model
Physical
Emotional
Psychological
Spiritual
The wellness model that
people adhere to today moves
beyond that traditional notion
of health and wellness as
being the mere absence of
disease, to the holistic
blending of all levels of
patient functioning.
Proactive Health Care
PROACTIVE HEALTH CARE
• is inherently different from reactive health care for
acute problems because it offers step by step, self
implemented changes (accountability) that
provide the satisfaction of knowing you are doing
everything you can to live the best life possible for
yourself and your family.
The Evolution of Patient
Accountability
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The fallacy of Long Term Care policies
The Hospitalist model
The competitive Senior Resource market
The era of Advance Directives
The pharmaceutical disconnect
The caregiver’s myth
Health and Wellness
The New AARP
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Accountable
Assertive
Resourceful
Preventative
The Question
The Challenge is:
How do you promote a higher degree of patient
accountability without enabling patients
themselves?
The Answer
• EDUCATION and
• PARTICIPATION
Active Engagement in Health and Wellness
programs is the secret to proactive medicine and
patient accountability.
Sun Health is an organization in the NW Valley
whose mission supports providing answers to
people looking for proactive healthcare programs.
Who is Sun Health Today?
Who is Sun Health Today?
3. Champion of Healthy Living - Sun Health
Community Programs
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Care Transitions hospital discharge program
•
File of Life/Vial of Life
•
Medication Management Program
•
Memory Care Navigator Program
1. Sun Health Care Transitions Program
Sun Health Care Transitions Program
Program Description
RNs and LPNs follow patients for 30 days post
discharge
Medicare beneficiaries with CHF, AMI, PN, COPD,
arrhythmias, CABG and other heart surgery,
diabetes, stroke, hip fracture or other high risk
orthopedic conditions
Education and self-management program based on
the Coleman Care Transition Intervention® program
and CTI’s “four pillars”
The Four Pillars
1. Patient is knowledgeable about medications and has a
medication management system.
2. Patient understands and utilizes the Personal Health
Record (PHR) to facilitate communication and ensure
continuity of care plan across providers and settings.
3. Patient schedules and completes follow-up visit with the
primary care physician or specialist physician and is
empowered to be an active participant in these
interactions.
4. Patient is knowledgeable about indications that their
condition is worsening and how to respond.
Sun Health Care Transitions Program
Program Description (continued)
Sun Health Care Transitions Program
Reinforce patient education, including selfmanagement of chronic condition and “red flags”
Medication reconciliation, up to date list created using
SunHealthMeds.org
Physician follow up visit
Personalized plan of care in health record binder
Referrals for other helpful community services
Sun Health Care Transitions Program
Outcomes as of 2/28/13
Sun Health Care Transitions Program
Outcomes as of 2/28/13
Sun Health Care Transitions Program
Outcomes as of 2/28/13
Sun Health Care Transitions Program
Outcomes as of 2/28/13
2. Sun Health Medication Management
Program
Medication Issues: The Statistics
• 48 percent of older adults living at home suffer
from medication-related problems (The Annals
of Pharmacotherapy)
• More than 2 million emergency room visits
annually are related to adverse drug reactions
(Drug Abuse Warning Network)
• Poor adherence to medication plans account for
125,000 deaths each year (Center for Health
Transformation)
Medication Issues: Not Me!
• Do you have more than one physician who
prescribes medications? (54% of seniors)
• Do you have your prescriptions filled at more
than one pharmacy? (35% of seniors)
• Have you been recently hospitalized?
Multiple physicians, multiple pharmacies and
recent hospitalizations put you at risk for medication
issues such as duplications and interactions!
Medication Issues: Not Me!
• Do you sometimes forget to take your meds?
• 75% of Americans report not always taking their
prescriptions as directed, which can lead to:
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Unnecessary disease progression
A lower quality of life
Reduced functional ability
Increased disease complications
Medication Issues: What can Sun
Health Offer?
• Community Education
– Medication Safety Awareness
– Medication Adherence Awareness
– Medication Therapy Information
• Tools to Improve Medication Adherence
Medication Adherence
• Patients want information on prescriptions including
why it was prescribed, the duration of the
prescribed therapy, and what happens if they don’t
take prescribed medication.
• Healthcare professionals communicate
inconsistently about prescriptions, spending an
average of 49 seconds to discuss a new
prescription.
Source: Merck, 2009.
Medication Adherence
83% of patients
reported they
would never tell
their provider if
they did not plan
on buying a
prescribed drug
Source: Merck, 2009.
74% of
physicians think
their patients are
taking their
medicine correctly
Medication Adherence
2-Way
Communication
PATIENTS
Source: Merck, 2009.
PHYSICIANS
Sun Health Medication Management
Program Components
My Medication
Profile
• Free online secure
medication profile
My Personal
Pharmacist
• Pharmacist
consultations and
review of personal
medication profile
www.SunHealthMeds.org
My Medication Profile
My Medication Profile
Maintain a list of your
medications, including
pictures, instructions, and
purpose for each medication.
Set up text and email
reminders so you never
forget to take your
medications.
Add your healthcare
provider and health
insurance information
for quick access.
My Personal Pharmacist Review Includes:
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Potential safety issues such as drugdrug or drug-disease interactions
Duplicate therapies
Drug doses that fall outside the normal
therapeutic range
Cost-savings opportunities
Adherence to national treatment
guidelines
Opportunities to improve medication
adherence
Patient education opportunities
My Personal Pharmacist
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Comprehensive medication review by a
pharmacist
Phone consultation/discussion between
participant and pharmacist to discuss
recommendations
Communication with physician(s)
outlining medication recommendations
and/or alerts
Continued access to pharmacist for
questions and concerns, 24 hours a day,
7 days a week.
Sun Health Medication Management
Program Costs
My Medication
Profile
• FREE
My Personal
Pharmacist
• $120 per year
3. VIAL OF LIFE / FILE OF LIFE
PROGRAM
VIAL OF LIFE / FILE OF LIFE
• In your home
• Recognizable
standard in our
community for
years
• Away from home
• Use while traveling
• Can hold additional
useful forms such as
advance directives
Vial of Life
• Contains a preprinted Emergency
Medical Information form and an
orange notification cling
• Fill out the form, insert in Vial and
place Vial in refrigerator in visible
location
• Remove orange “V” cling from
backing paper and attach to front of
refrigerator or an outside window to
notify emergency personnel that Vial
of Life is inside
Emergency Medical
Information Form
Form does not
include SSN, address
or insurance ID #
File of Life
• 2 GB capacity with 3 preloaded forms:
1. Instructions
2. Emergency Medical Information Form
3. Life Care Planning Packet (from the Arizona
Attorney General)
• Self-closing to protect USB port
• Includes a lanyard
Emergency Medical
Information Form
• On the File of Life, this form is in a “fillable PDF”
format that you can type on and save.
• Requires free download of Adobe Reader® if you
don’t already have this program.
• Collects key information that is helpful in the
event of an emergency:
• Physicians
• Medications
• Emergency contacts
• Medical conditions
What Else Can I Put on My
File of Life (optional)?
• Emergency medical info for family members
• Photo
• Key medical results such as recent labs or
medical imaging reports, especially if you are
being treated for a chronic condition. These
may be scanned/saved on the flash drive.
• If your physician uses an electronic medical
record, they may have the ability to provide you
an electronic Continuity of Care Document
(CCD) that summarizes your most recent visit,
medications and tests. Ask your physician.
Where Should I Take My
File of Life?
• EVERYWHERE!
• Have it with you when you exercise, including if
you are walking the dog or walking around the
block
• Make sure your family and friends are aware
that you have prepared the flash drive to be
available during an emergency and where they
can find it
• Take it with you when you travel
4. Sun Health Memory Care Navigator Program
Memory Care Navigator
Memory Care Navigator Program
• Program that helps to support patients and families as
they navigate the difficult stages of dementia, and
particularly Alzheimer’s disease.
• Through this service, the Memory Care Navigator will
offer personal and professional intervention for a patient
and family dealing with the emotional, psychological and
physical effects of dementia.
Memory Care Navigator
The Sun Health Memory Care Navigator will:
• Serve as a community liaison to help patients and family
members recognize and address the complex
challenges that arise from an Alzheimer’s or dementia
diagnosis.
• Facilitate patient follow-up through personal consultation
• Develop a plan of care that supports patients and family
through the phases of the disease process
• Link patients and families to other available Alzheimer
and dementia services in the Valley