Hi, this is James Fricton again. And this is the last module of our course on prevention of chronic pain, a human systems approach. And again I'm presenting from the University of Minnesota. And the title of this last presentation is Transformative Care. I want to take a few minutes to talk a little bit about the International Myopain Society, prior to the presentation. It's an organization of people around the world who are very interested in not only prevention of chronic pain, but helping reduce pain in those patients who already have chronic pain. And it's a group of people that are focused primarily on trying to understand soft tissue pain, muscle pain, as well as joint problems. So, I encourage you to look at the Society to see if you're interested in participating, joining and engaging in the conversation on a personal level. Now this module, is entitled, Transformative Care, and has we'll discuss seven different aspects. One is, of course, is how can transformative care, deal with some of the issues with our, the current U.S. healthcare system. And perhaps even enhance healthcare systems in other parts of the world. In addition, I'll give a case example of, how we can implement transformative care into clinical setting with a particular patient. I wanted to talk about what is the efficacy of interventions with chronic pain? About opioids for chronic pain, surgery for chronic pain? As well as developing a transformative treatment plan for the individual case. Finally, there are the few take home messages that I'd like to share with you, and if you are interested we have a listen and learn sessions from other pain clinicians, people who focus with not only on prevention of chronic pain but in management of patients with chronic pain. So by the end of this module, these are the specific goals that you'll have and it's again, it's been a pleasure working with you on this course and I really appreciate your participation. Within the course. So let's get into the first part, addressing the issues with our current health care system. And when I mentioned the current health care system, I'm talking about the United States, but it does have implications in health care systems in other parts of the world. There are a number of issues that we have discussed that are critical that, that we need to address, particularly with chronic pain and prevention of chronic illness. And includes a variety of things like doctor shopping with chronic pain patients. Failure of medications and surgery in some situations. The complex psychosocial problems that some patients have with this. Frequent overlooked pain diagnosis, the addiction and dependency with opioids and other medications, the poly pharmacies that people are using. And often the trial and error over treatment that occurs with patients with chronic pain because the we don't know what the diagnosis is. And then of course health plans do favor treatments over training. We'd like to change that. Risk factors are often not addressed, so the pain continues over time. And there's a lot of Iatrogenic side-effects from the different medications as well as treatments we have. And each of those are, have been addressed in this course. And I wanted to kind of summarize it here. We need a fix. There are a lot of problems out there. And you know, as most people in the United States feels we can fix anything right? Now we want to fix it a little bit better than this example here but there's a lot of organizations are working to improve that right now. One of them is the U.S. Center for Disease Control and their belief from a public policy perspective is consistent with the concepts behind transformed care. And that is to identify the problems, identify the risk and protective factors. And then not only implement and disseminate the knowledge to patients. Implementation and training and do a program and policy evaluation at the same time. So you develop a new strategy for health care. And we wanted to know what the economic impact in evaluation is. So that we have safer, healthier people. So, transformative care, requires a transformation of the healthcare system. And, it's not easy to do that. There's a number of changes that need to be made within that regard. First, of course, we need to employ more broad based model of care, and we discussed that in the earlier modules. Within this course. Of course we want to ring out the old and bring in the new. And biomedical model needs to be replaced with a broader human systems approach that includes the whole patient, not just the physical problem. We need to be more than just disease oriented. We really need to treat the disease and the contributing factors. Those risk factors and protective factors that play a role in the condition. And we need to avoid being fragmented as we currently have it. And instead, be inclusive of dealing with all the risk factors and protective factors with a team of individuals. We need to not only be reductionist and understand the details in the path of physiology of a condition. But we need to be holistic, and look at the broader view of the whole patient and how they interact with their environment and their relationships. We need to establish more, from, shift from short term relationships to establish more long term relationships with our patients. Because change takes time and that relationship with health care providers is really the key for accomplishing that. We need to be as procedure oriented in some ways, but we also need to focus on the process of healthcare, how do we ensure high patient satisfaction, understanding, compliance, and change? And finally we need to really focus on the outcomes. What are the outcomes and we need to look at the broad base outcomes, not just reduction in symptoms. But really, the whole improvement in the patients life. We want to help the patient, transform themselves, into one of health and wellness. And we need to measure that. And after we change the model of care, and look at different models, a broader model, then we shift to consider the paradigms of care. And again, we discussed this in a previous modules but let me just review them again for you. We need to assume that people are multi dimensional, they're complex, they're not simplistic. We need to understand the whole patient in the seven realms of their lives. We need to focus on the patient's self responsibility. And with that, we need to engage them in a self care and self management programs. We also need to provide that education and training for the patients in order for them to know what to do and how to do it. And then as I mentioned earlier, create long term, sustainable change within the individual. Not just some temporary band-aid fix but really help them improve and transform their lives into something more, more healthy and, and well with minimal pain. And in part of the process then we need to enhance the care process also. And this requires relying on strong partnerships between the healthcare providers, and the patient. We need to empower and motivate them to really want to change. What are the benefits that they have in, in making changes and achieving a more healthy, well life? And then, it's going to take social support, so how do we engage the people around the patient in order to support the change that's needed? Finally, we need to always expect that there's going to be ups and downs. We need to predict those to some extent. We need to help people understand what to do when they have a downturn, an increase in the pain. We need to measure the outcomes, as I mentioned earlier. And we need to basically help a person transform their lives into one of health, happiness, wellness and all the other wonderful things that can be achieved. But in that process we need to upgrade the delivery system to accomplish that. We need to look at a variety of different models of delivering health care. One which I've used for many, many years is an interdisciplinary model. This is using a team within one setting so that I can walk down the hall and talk to a particular patient. Or another clinician about their, their condition. And that includes working with the physicians or dentists, health care psychologist, physical therapist, health educators, and a variety of other health care providers. We need to make sure that the care is integrative. In other words, we need to not only rely on traditional, successfully documented biomedical, biomedical treatments. But also focus on self care and complimentary care. And the care needs to be individualized. So it needs to max the treatment strategy with the individual characteristic of the patient. And we need to understand what those characteristics are. And once we upgrade the care delivery system we'll find that it will evolve into a more financially sustainable model. Right now, and we have more spending and worse health. As you can see by this diagram, the people who are in the lowest 50% have the highest degree of care and cost of care. Those people in the excellent have a very minimal, excellent health have a minimal amount of cost. So these are the people we need to really work on is the lowest 50%. They are the most expensive. And so the economics will change and we'll have less spending. And better health. And we'll do that through a number of changes. We need the transparency. And this has been talked about by a lot by many people. We need to open the book on the fees. What does it cost to go to the doctor, to have a surgery, to have a diagnostic test? We need to reward consumers. We need to, to reduce health plan fees and deductibles for those, those consumers that really focus on reducing their risk factors and improving their protective factors. We need to reward health care providers. We need to reimburse providers for offering risk assessment and training programs. Right now, this is not done because there's no reimbursement. Or at least minimal reimbursement for that. And then we need to measure outcomes, as I have mentioned before. And this, then will improve health care costs. It's a triple win, actually, when you look at this type of transformation. Who will benefit by? Well, health plans and accountable care organization will benefit by, by supporting prevention, early intervention, which minimizes hospitalization, surgeries and medications. Reduce of the cost. The providers, the clinics, and the hospitals will gain because they will be reimbursed for patient training on risk and protective factors. And finally, the patient will gain significantly, because improving their condition long term will help them as well as reduce their costs. So, it's a triple win for, really, everybody to really make the change that's needed to help encourage more transformative care. So, we need to bring these all together, not only the medical interventions that have been documented to be so successful. But we need to do early detection and identification of risk factors and protective factors. We need prevention programs. For not only public health, but people indi, individually. And that is done by practicing daily personal wellness practices. And this all can be accomplished with the four T's of transformative care. With the patient, we need to test them, to identify diagnosis risk factors and, and protective factors. With personal assessments. It's a questionnaire to fill out. Self-report. What are they doing? How is their life going? What are their risk factors and protective factors? And then we need to work on training the patient in reducing these risks, enhancing protective factors. Third, we need to treat them. With our standard biomedical treatments. Medications, rehabilitation, and if in some situations surgery, and we'll review each of those in this module. And then finally, a team approach is most effective in working with the whole patient, all contributing factors. We can't expect one clinician to know everything and to be able to spend the time with the patient needed. So by working with a team we can help the patient really transform their lives. So thank you for listening to this first module. [BLANK_AUDIO]
