The Role Of The Practitioners Personal Health And Community Advocacy

Question 1

What the definition of Well-being?

Answer 1

CDC states while there is no general consensus around a single definition of well-being there is a general agreement at minimum, well-being includes the presence of positive emotions and moods, the absence of negative emotions, satisfaction and other life, fulfillment and positive functioning

Question 2

What is the evidence of physicians personal health behaviours?

Answer 2

2009 survey of Californian physicians following health factors observed:
1) Severe to moderate stress: 53%
2) No or occasional exercise: 35%
3) 6 or fewer hours of sleep: 34%
4) Never or occasionally ate breakfast: 27%
5) Sedative/tranquiliser use: 13%
6) Depression: 7%
8) Marijuana: 4%

2012 survey 53% of primary care physicians were overweight or obese

2013 36% of Canadian 4th year medical students did not meet physical activity guidelines

Question 3

How do physicians’ personal health and attitudes affect patient care?

Answer 3

Meta-analysis 24 studies found a statistically significant association between physical activity and improved attitude toward counselling

Physicians attempting to improve own poor habits have been found to counsel pts significantly more often than those not trying to change

Physicians and medical students who had normal BMI more like to feel confident counselling pts about physical activity

Non smoking physicians more likely to emphasise risks of smoking

Question 4

What is the evidence for physicians’ positive health behaviours?

Answer 4

2000 study of men
Physicians live longer than same-race professionals and non-professionals in the US according to mortality outcomes

2015 study
Physicians and medical students engage in more physical activity than general US adult population

Question 5

What is the evidence for health behaviour differences and similarities among the public and healthcare workers?

Answer 5

Healthcare workers more likely to have reported exercising in the past 30 days

Similar BMI, smoking and smokeless tobacco use and sunburns among the groups

Lower likelihood of overweight/obesity among healthcare workers with at least a college education

Question 6

What was shown about nurses’ health behaviours in the ‘Fit for the Future’ study?

Answer 6

5000 nurses in NSW

Compared to general population:
- nurses slightly less likely to be obese
- more likely to meet dietary guidelines, not smoke and have less central adipose tissue

Nurses had lower levels of physical activity and higher levels of risky drinking across almost all age groups and genders

Question 7

What was shown in the Mayo study about differences among healthcare workers compared to the general public?

Answer 7

Health professionals reported BETTER smoking and physical activity health behaviour and WORSE moderate-heavy ALCOHOL use

Obesity, HTN and diabetes overall slightly lower among healthcare professionals rates increasing similarly over time with that of gen population

Question 8

What are the patient counselling practices of healthy practitioners and their impact on patient care?

Answer 8

Cross-sectional survey 1349 generalists and specialists regarding counselling on personal alcohol, exercise and cigarette smoking found that physical habits were significantly POSITIVELY associated with patient counselling on these habits
- MALE internists health practices for smoking, alcohol, seat belt use and physical activity positively assoc with counselling for each behaviour EXCEPT alcohol
- FEMALE internists health practices for physical activity positively assoc with counselling pts about exercise and alcohol use

Physicians who exercise more > more likely to counsel pts on exercise

Physicians attempting to improve poor habits counsel it’s significantly more often

Training primary care physicians in behavioural counselling and providing them with tools and resources helps in their practice of weight-related care

2014 study physicians and medical students with normal BMIs more likely to feel confident about counselling pts on physical activity

Non smoking physicians more likely to empathise risk of smoking

Female physicians personal health practices had a positive correlation with likelihood they would counsel pts on health behaviours at least once a year

If physicians are less fat they counselled more on cholesterol
If physicians ate five fruits and veg per day they counselled more on nutrition
Physicians who consumed a vege diet more like to counsel on weight loss and nutrition

Systematic review of 13 studies:
Among nurses and physicians those who had higher personal physical activity levels and positive attitudes towards physical activity were more likely to promote physical activity to their patients

Question 9

How do you define Lifestyle Medicine Leadership?

Answer 9

Concept identified in 2010 as part of original competencies for lifestyle medicine physicians
2022 - expanded to all healthcare clinicians

Healthy behaviours foundational to medical care, disease prevention and healthy promotion

Lifestyle medicine leaders seek to practice healthy behaviours and create school, work and home environments that support healthy behaviour d

Question 10

What is the framework to build a culture of health?

Answer 10

1) Making health a shared value
2) Fostering cross-sector collaboration
3) Creating healthier and more equitable communities
4) Strengthening the integration of health services and systems
5) Improving population health, well-being and equity

Question 11

What is Modelling Personal Health?

Answer 11

Important way to develop culture of leadership within health care and impact pt care

Healthcare providers can lead by encouraging professional identity formation of others in the team by intentionally modelling personal health behaviours

Personal health habits of providers can significantly affect patient care

Question 12

What was the 2008 Triple Aim?

Answer 12

Approach to optimising health system performance, proposing that healthcare institutions simultaneously pursue three dimensions of performance:

1) Improving the health of populations
2) Enhancing the patient experience of care
3) Reducing the per capita cost of healthcare

HMO Group Health Cooperative in early 2000s > focusing exclusively on triple aim lead to physical burnout, quality reductions and cost increases

Question 13

What was the 2014 Quadruple Aim?

Answer 13

2014 study - Bodenhemier et al
- wellbeing of provider and care team essential pre-requisite to meeting the original Triple Aim

1) Improving the health of popns
2) Enhancing the patient experience of care
3) Reducing the per capita cost of health care
4) Well-being of the healthcare team

Question 14

What was the 2022 Quintuple Aim?

Answer 14

COVID highlighted need for heath equity in healthcare
Fifth aim - identifying disparities, creating interventions to reduce them, investing in equality measurement + incentivising equity achievement

1) Improving health of popns
2) Enhancing pt experience of care
3) Reducing per capita cost of health care
4) Well-being of healthcare team
5) Health equity

Question 15

What is the role of self-care in practicing clinicians?

Answer 15

American Medical Association Code of Ethics
- ethical responsibility for provider to attend to own self-care and wellbeing

Declaration of Geneva published by WHO 2017
- ‘I will attend to my own health, well-being and abilities in order to provide care of the highest standard’

Principles of Medical Professionalism
- Merlo proposes self-care is our professional obligation and duty in order to serve our pts and society > foundational to tenets of medical professionalism

Question 16

What are the types of Wellness programmes?

Answer 16

1) Lifestyle: smoking cessation, weight, management, stress/coping type

2) Disease-focused: diabetes, asthma and heart disease

3) Generalised: those that offer healthy foods or fitness opportunities

Question 17

What are the reasons for implementing wellness programmes?

Answer 17

• Saving on healthcare costs
• Improve health
• Decrease injuries
• Increase productivity
• Decrease absenteeism

Question 18

What is the Therapeutic Alliance?

Answer 18

Measure of the clinician’s and patient’s mutual engagement in the work of treatment this representing an important component for achieving treatment success regardless of the specific treatment modality employed

Positive patient-provider relationship leads to better adherence to the treatment plan

Question 19

What does the acronym RAIN stand for?

Answer 19

Described by Tara Brach to help identify key steps in maintaining compassionate attitude throughout clinical encounter:

R - recognise what’s happening
A - allow room for the experience
I - investigate and be curious in the moment with interest and care
N - nurture by witnessing the experience and applying self-compassion

Question 20

What is the definition of Well-being?

Answer 20

A state of positive feelings and meeting full potential in the world
Can be measured subjectively and objectively
Not synonymous with mental health

Question 21

What is the definition of Burnout?

Answer 21

Syndrome consisting of the following:

1) high emotional exhaustion
2) high depersonalisation
3) low sense of personal accomplishment from work

Question 22

What is the definition of Mental Health?

Answer 22

Defined by American Psychological Association:
State of mind characterised by emotional well-being, good behavioural adjustment, relative freedom from anxiety and disabling symptoms, capacity to establish constructive relationships and cope with the ordinary demands and stresses of life

Practitioners suffering from burnout often do not meet the criteria for a diagnosable mental disorder in North America

Question 23

What is the definition of Compassion Fatigue?

Answer 23

Emotional, spiritual, or physical exhaustion from repeated or prolonged exposure to the suffering of others leading to an inability to cope and impaired ability to provide care for others

Improves with increased provider self-care and self-focus

Question 24

What is the definition of Empathy fatigue?

Answer 24

Emotional drain experienced when empathising with pts who are in severe psychological and psychic pain

Neuroimaging > empathising with pain of others activates same part of brain as when processing own pain

Question 25

What is the definition of Moral Injury?

Answer 25

The strong cognitive and emotional response that can occur following events that violate a person’s moral or ethical code

Actions that are witnessed conflict with the provider’s values and beliefs and may cause psychological harm over time

Question 26

What are the findings from the National Academy of Medicine in regards to Burnout?

Answer 26

2019
- approx 35-45% US nurses and physicians have substantial sx of burnout
- 45-60% of medical students

2022
- may be closer to 60-70% of primary care providers

Question 27

What are the outcomes of burnout?

Answer 27

• worse patient outcomes
• increase in major medical errors
• fewer hours worked
• greater turnover

Question 28

What are the causes of Burnout?

Answer 28

• too many work related tasks
• hours worked
• bureaucratic responsibilities

Mutiple studies
- work demands, lack of time, lack of managerial support, patient aggression and violence, exposure to traumatic events

Those dealing with more psychological issues noted to be more susceptible to burnout

Role conflict and role stress can also be factors in burnout which may affect genders differently

Question 29

What is the definition of Resiliency and factors which mediate well-being?

Answer 29

Ability of person to withstand, adapt, recover, rebound or even grow from adversity, stress or trauma

Individual factors
- self-efficacy, hope, an easy-going personality, strong personal relationships

Organisational factors
- decreasing paperwork, creating a positive work environment and culture and addressing burden of paperwork

Question 30

What are some of the studies on Resiliency?

Answer 30

Rushton et al
- greater resiliency in nurses practicing in a high-intensity setting was assoc with a greater sense of personal accomplishment and lower rates of emotional exhaustion
- positive teamwork climates appear to improve capacity for resilience

Mospan and Olenik identified several ways for pharmacists to build resiliency:
- reducing workload, socialising, journaling, deep breathing, mindfulness and yoga, involvement with arts, utilisation of problem-focused coping strategies

Question 31

What is the role of lifestyle medicine in building resiliency and reducing burnout?

Answer 31

Systematic review of burnout in surgeons
- those who engaged in regular exercise were less likely to experience burnout

Managing stress by spending time with friends and family and talking about feelings appears to be another important way to reduce burnout

Regular sleep patterns shown to be impact

Fagundes et al
- supportive, close relationships > lower rates of morbidity and mortality from psychiatric illness compared to those who do not

Question 32

What are the Individual-Focused Burnout Risk Reduction Strategies?

Answer 32

Prevention model described by Merlo and Rippe

1) Primordial prevention
- decrease risk factors before burnout onset
E.g. social support networks in workplace, working to increase/maintain job control, maintaining pillars of LM, self-care (meditation, mindfulness, social connection , healthy diet), advocating to reduce stigma of burnout

2) Primary prevention
- systems-based or individual-focused and seeks to identify and reduce source of burnout
- systems-based: positive work and learning environments, reduce admin, enable tech solutions, provide support to clinicians and learners, invest in research
- individual-focused: decreasing isolation, normalising struggles, addressing organisational issues, adjusting workload and pace, addressing mortal distress, managing institutional infrastructure, supporting provider personal issues

3) Secondary prevention
- reduce severity of burnout before negatively affecting individual
E.g. stress management programmes, mindfulness techniques, ongoing screening programs, developing resources for physicians to promote a healthier workplace culture

4) Tertiary prevention
- minimise adverse consequences of burnout
E.g. referral to MHT, using employee assistance programme
-

Question 33

What is the definition of Advocacy?

Answer 33

Coordinated efforts to defend, promote or protect something or someone by influencing public policy debate and interacting with influencers

Occurs at local, state and federal levels as well as when advocating for individual needs

Question 34

What is the role of healthcare providers and clinicians in advocacy?

Answer 34

Offering a powerful and credible voice that can help influence policymakers and politicians
Identify preventive measures and positive solutions
Personalise an issue with patient stories and frontline experience
Employ healthcare change within clinical care teams
Extend impact of work in the clinic by connecting and engaging with community

Question 35

What are steps for Advocacy?

Answer 35

1. Defined the problem and desired solution
   - health trends in community, both past and present, potential impact
   - consider short and long term solutions and why community should support this
2. Understand one’s audience
   - identify key stakeholders, build connections
   - consider ideal time to approach audience
3. Determine strategy, tactics and timeline
   - decide who best to submit a request to decision makers
   - research relevant legal or regulatory guidelines that may help in developing strategy
   - strategise if, how and when an opportunity for public comment might be best used
   - strategise how to overcome resistance or opposition
4. Decide how outcomes will be measured if change is implemented

Question 36

What is the Blue Zones project?

Answer 36

Five geographical locations where people live the longest:
Okinawa, Japan
Ikaria, Greece
Loma Linda, California, USA
Sardinia, Italy
Nicoya, Costa Rica

9 common characteristics:

1. Move naturally in day-to-day lives
2. Feel a sense of purpose
3. Eat a mainly plant-based diet
4. Stop eating after becoming 80% full
5. Relax
6. Downshift
7. Put family first
8. Find the right group of people to engage with
9. Belong to something greater than oneself

BZP is a community-led collaboration among community leaders, educators, health providers, public service officials, community itself implemented across North America along with an international programme to see current cities transform into places of longevity

Question 37

What are some other lifestyle medicine/ public health programming spawned from advocacy?

Answer 37

Dean Ornish - plant-based cardiac rehab programme
Creative placemaking - incorporating arts to transform communities
Healthy Nurse, Healthy Nation - social movement designed to improve health of nurses and beyond
Healthy People 2030 - 355 health measures to improve upon over the next decade
WHO’s Knowledge Action Portal on Noncommunicable Chronic Diseases - platform for multiple stakeholders to connect and share

Question 38

How do you prepare a readiness assessment and personal action plan for providers?

Answer 38

1) Pick a focus area
2) Assess self-readiness to change using TTM
3) Assess self-confidence in your ability to change and perceived importance of making the change using 0-10 scale
4) Develop specific action plan using SMART goals
5) Personalise the plan - create a monitoring system ie daily log, checklist and elicit help from support team
6) Follow up at established time intervals

Reassess progress, confidence and importance of making a change
Celebrate success and brainstorm ways to overcome barriers to help with specific actions