Aug 24, 2016 - Skin care, nutrition/weight loss, hormone therapy and pain ... Educational effort to support the clinical
8/24/2016
Dustin Cupp, D.O. St John Clinic/Family Medical Care In His Image Family Medicine Residency
#MANIPULATEWELLNESS
Disclosure I have no financial or other contractual
agreements to disclose regarding this presentation
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GOALS 1. Define wellness and its relation to evidenced‐based medicine 2.Explore the relationship between traditional medicine/medical
clinics and the wellness approach to healthcare 3. Discuss how Osteopathic Medicine may be able to bridge the gap between traditional medicine and the wellness approach 4.Show how OMT can be used to promote wellness, specifically in resource limited environments
What is WELLNESS? Quality or state of being healthy in body and mind, especially as the result of deliberate effort Wellness is a conscious, self‐directed and evolving process of achieving full potential Wellness is multidimensional and holistic, encompassing lifestyle, mental and
spiritual well‐being, and the environment Wellness is positive and affirming
The definition of wellness, long used by the National Wellness Institute is consistent with
these tenets. Wellness is an active process through which people become aware of, and make choices
toward, a more successful existence.
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Osteopathic Wellness Tenets of Osteopathic Medicine
The body is a unit, and the person represents a combination of body, mind and spirit. The body is capable of self‐regulation, self‐healing and health maintenance. Structure and function are reciprocally interrelated. Rational treatment is based on an understanding of these principles: body unity, self‐regulation, and the interrelationship of structure and function.
Traditional Medicine Disease centric Focuses on treating disease, rather than the prevention of disease What about chronic disease? Life expectancy has grown in many parts of the developed world
79.3 years (combined male/female, 31st in the world‐WHO 2015)‐ U.S. Live longer with chronic disease Do we live “well” longer or simply longer with chronic disease? How much of chronic disease is considered preventable? Increased patient volume‐ monopolizes physician time spent treating chronic disease Less time available for wellness and disease prevention
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A New Dichotomy? A new generation of Wellness Clinic Focus on alternative treatments Skin care, nutrition/weight loss, hormone therapy and pain Majority are staffed by physicians trained in primary
care vs other allied health professionals (chiropractors) Minimal chronic disease management
Intentional Division? A purposeful “break” from traditional medicine? Traditional medicine vs Functional medicine Controversial in many medical circles Is this “break” patient centered or financial centered? A division between evidenced based approach to
population based care by traditional medicine vs an individual approach by wellness/functional medicine Who created the division and why?
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Institute of Functional Medicine Founded by Susan and Dr Jeffery Bland in
1991 Founded to support the implementation of
functional medicine across the disciplines within the health care sector Educational effort to support the clinical nutrition behind their supplement company, HealthComm www.functionalmedicine.org/AboutFM/History/
Institute of Functional Medicine Provides certification in functional medicine to
licensed health care professionals
Online classes in 7 courses Applying Functional Medicine Advanced Practice Six Functional Medicine Advanced Practice Moduules GI Detox Immune Hormone Cardiometabolic Energy
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Traditional vs Functional Traditional
Functional
Disease‐Centered Shorter appointments‐
dictated by insurance reimbursement Primary focused on management of disease Population based Uses ‘normal’ and ‘abnormal’ ranges for lab values
Patient‐Centered Longer appointments Seeks the root cause for
disease Individual based Uses ‘optimal’ ranges for lab values
Criticisms Lack of evidence to support therapies and
treatment Scientific vs unscientific
Financially motivated Use of a multitude of expensive and unnecessary
testing www.sciencebasedmedicine.org/quackademia-update-2014/
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Traditional Wellness Encourages health lifestyle habits while discouraging risky
habits Recommending periodic screening tests USPSTF
Created in 1984 Independent, volunteer panel of national experts in preventive and evidenced based medicine Establishes recommendations on preventative services Recommendations are given a letter grade based on strength of evidence; benefits vs risk of harms
ARE WE DOING ENOUGH?
Can Osteopathy Bridge the Gap? Interweave the focus on wellness/prevention
and evidenced based medicine Use of OMT as “Somatic Hygiene” Term coined by Rebecca J. Bowers, D.O. in an article published in the Journal of the American Osteopathic Association in 2013
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The Difference a D.O. Makes! “Preventive Osteopathic Manipulative
Treatment and the Elderly Nursing Home Resident: A Pilot Study.” Karen T. Snider, MS, DO; Eric J. Snider, DO; Jane C.
Johnson, MA; Celia Hagan, RN, BSN, CCRC; and Conrad Schoenwald, DO The Journal of the American Osteopathic Association, August 2012, Vol. 112, 489‐501.
Preventive OMT? Objective
Conclusion
To investigate the benefits
Twice monthly OMT
elderly nursing home residents may receive from preventive OMT
protocols reduced the number of hospitalizations and decreased medication usage in elderly nursing home residents
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Additional Research Practical applications Fall risk prevention Athletic injury prevention and performance
enhancement Labor dystocia in pregnant patients Recurrent back pain Decrease missed days of work? Decrease prescriptions for pain medications?
Why Does it Matter? The typical wellness patient is less likely to be
concerned with evidence
many seek alternative treatments when traditional
medicine fails to provide an answer
Evidence provides:
Validity to the treatment Increased visibility Increased referrals Justify coverage
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Where Else? MISSIONS! Domestic and international
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