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.


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.


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.


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.



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.



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

Health & Medicine

The bio psychosocial model of care