Presentation that demonstrates the importance of the bio psycho social model of care is a cornerstone of the Patient Centered Medical Home.

1. The Patient’s Journey
And its Relevance to the Patient-Centered
Medical Home

2. 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

3.  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
Overview

4. • 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
Sick Role Concept

5. 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.
Rights

6. 1. The sick person is expected to get well; sickness is
temporary and undesirable.
2. The patient is obliged to be compliant.
Responsibilities

7. • The BPM model posits – an individual and his/her
response to illness is impacted by and impacts biological,
psychological, and social factors.
The Bio-Psychosocial
Model

8. • 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.
The Bio-Psychosocial
Model

9. • Patterns of response are individualized
• Patterns are unique to the individual
For some patients, identification of
primary symptoms appropriate treatment return to
adaptive functioning.
The Bio-Psychosocial
Model

10. • Other patients require simultaneous treatment of different
factors contributing to the illness in order to return to
illness resolutions.
The Bio-Psychosocial
Model

11. Psychosocial
(intra psychic)
Individual
Social
(inter personal)
Environmental
(extra personal)
(disease/organic)
Spiritual/
Cultural
Somatic
Behavioral Determinants of Illness

12. • The biology of the disease process
• The patient’s individualized response
• The social factors which may interfere with or enhance
the response to treatment.
The BPM model allows the care giver to
individualize treatment with these
facors taken into consideration.

13. THEORY
DB PCMH
BPM
Bio-Psychosocial Model (BPM) drives the alignment of the of the Patient
Centered Medical Home (PCMH) and the Determinants of Behavior (DB)

14. 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.
What Makes a Patient
Centered Medical Home?

15. 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.
What Makes a Patient
Centered Medical Home?

16. 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
What Makes a Patient
Centered Medical Home?

17. BIO
PSYCHO
SOCIAL
The Patient’s
Journey

18. Psychosocial
• ? Chronic
Schizophrenia
• Hx of
unsuccessful MH
tx
Sam
Social
• No family
• No close friends
• No social support
• Alienation of
services
Environmental
• Lives alone
• Unsanitary
conditions
• Poor Meal
Planning
• Poor hygiene
Somatic
• Abd Aneurysm
• Hypertension
• Venus Insuf/ulcer
• Cellulitis
• Renal Cyst
• Onychonmycosis
Spiritual/Cultural
• Unknown except
pt has kept local
pawnshop/thrift
store operating in
the black.

19. Psychosocial
• PTSD; psychotic
disorder
• Hx of abuse
• Trust issues
• Chronic anger
• Intellectual
functioning
Joe
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
Somatic
• CAD
• SOA/COPD
• Hypertension
• Diabetes
• Multiple surgeries
• Fatty liver
• Constant dental pain
Spiritual/Cultural
• Lost his faith
• People don’t care
• No involvement in
community
• No interest

20. PCMH
BPM
DB

21. We cannot fill the check
boxes on the PCMH until
until we are in check with
our own humanity.

22. • 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
RESOURCES/REFERENCES

23. PRESENTATION DESIGN:
NANCY VANDERVEER
ADMINISTRATIVE DIRECTOR
TJ SAMSON FAMILY MED CENTER