Preventative Medicine for Paramedic - Essay Example

? Preventive Health Care of the Health Sciences and Medicine of the October 7, Discuss the strategies available to engage patients in taking a more active role in preventive health care. Scenario: A 40 year old man who presents for an insurance assessment. He leads a sedentary lifestyle and smokes Introduction Preventive medicine has its basis in the proverb ‘prevention is better than cure’. Indeed, apart from achieving humanitarian results of lesser suffering, morbidity and mortality amongst people, it has been found to be a cost effective and economical affair and a better investment than the approach and policies of curative medicine (Cohen et al., 2004). Enough data and evidence exist to support strategies for primary prevention and disease avoidance and, therefore, it becomes the obvious responsibility of a health care provider to pursue all opportunities to deliver preventive and integrative health care to the patients. Principles of preventive medicine which are advocated for health promotion and achieving wellness are very simple. They include good and balanced nutrition, adequate physical activity, maintenance of normal weight, enough sleep and avoidance of addictive substances such as alcohol and tobacco. Integrative approach also includes culture-specific measures like yoga, acupuncture etc. If the principles are so simple, then it makes one wonder why they are not a part of everyone’s lifestyle and why is the incidence as well as prevalence of chronic non-communicable diseases increasing? Is there lack of awareness amongst people about the ‘right’ habits? Have unhealthy habits, despite awareness, become so ingrained in the behaviour that they have become part of the lifestyle and are difficult to get rid of (knowledge-action gap). In both of these situations, health care providers can play a role. Increasing incidence of lifestyle-related disorders among middle aged men especially calls for more strategies to deliver preventive health messages to this group and empower its representatives to take a more active role in preventive health care (Shi, Nakamura, & Takano, 2004). Scenario: A 40 year old man who presents for an insurance assessment. He leads a sedentary lifestyle and smokes. A 40 year old man who presents for an insurance assessment is a typical case scenario wherein a health care provider can actively engage in health promotion and education. Also, it is probably the only opportunity to engage in primary prevention as such a patient is very unlikely to visit the doctor unless ‘something is wrong with him’ (Fenner, 2011). A sedentary lifestyle combined with smoking puts him in at an increased risk of obesity, cardiovascular diseases, diabetes, respiratory diseases and cancers. Tobacco-free living and active living would be the two targets that are to be achieved in this individual for better health and wellness (National Prevention Council, 2010). First of all, in order to make the patient listen to any advice, it is important to appear sincere, gain his trust and establish a rapport. It has been seen that health care providers tend to become biased against overweight people and deliver lesser interventions for disease prevention (Quinn et al., 2012). This attitude should be shunned. Instead, the patient should be counselled with conviction and offered advice that will lower his risk of the abovementioned diseases. The risk factors for these diseases and any of the ‘red flags’ that are detected in his medical history should be explained to the patient; physical examination and investigations should be highlighted. These may include the history of chronic lifestyle disease such as hypertension, hyperlipidemia, diabetes, cardiac disease and stroke in the family, presence of increased weight, abdominal girth and blood pressure on physical examination, presence of high blood glucose, serum cholesterol and lipids on blood tests and impaired lung function tests on spirometry. If significant risk factors are present, an ECG and exercise testing should be performed (Fenner, 2011). The message should be delivered in the way that the patient finds easy to follow, and complex medical terms should be avoided. Discussion should be united with questioning and physical examination. Also, figures, numbers and statistics should be used (Fenner, 2011). Age appropriate screening tests should be advised. The whole aim of this exercise is to make the patient aware of the potential health implications of his current lifestyle habits. Once that is done, the next aim is to tell the patient what can be done to lower his risks and achieve a healthier self and how the patient has his health in his own hands. Health care providers can play an important role in prevention and decreasing the prevalence of smoking (Awad, & O’Loughlin, 2007). The recommended approach involves 5 As: ask, assess, advise, assist and arrange (Awad, & O’Loughlin, 2007). As far as smoking is concerned, the patient is asked about his willingness to quit the habit and whether any previous attempts to quit have been made. The patient is assured about the fact that it is indeed possible to give up this addiction and quitting is associated with multiple benefits. Also, the fact of previous quit attempts has been associated with subsequently higher chances of a successful long-term or permanent quit. Both quit techniques of ‘cold turkey’ and gradual reduction are explained. Patient should be informed about ‘quit smoking’ clinics or counselling groups operating in that area and encouraged to join them. Internet is a good resource for young men who seek health advice and want to quit smoking. Some good websites can be suggested to the patient. Similarly, he should be taught how to incorporate physical activity in his daily routine. Gradual increase in the intensity and duration of activity such as beginning from walking and strolling to brisk walking and sporting activities is advised. An active lifestyle in general – for example, not using the lift, walking for small distances rather than using the car etc. – should be advocated. Also, a health care provider cannot simply aim to change the unhealthy behaviour unless attention is paid to the value system of the patient pertaining to his health, his work profile and socio-economical factors determining his lifestyle (Shi, Nakamura, & Takano, 2004). Accordingly, patient’s routine can be tailored to fit in healthier aspects of his activities. An insurance assessment is a good opportunity to inform the patient about all aspects of general wellbeing and drive home the point that compliance and regular follow ups are important (Fenner, 2011). Opportunities for Raising Preventive Health Issues with Patients Very few authors have researched the opportunities that can be used for health promotion (Cohen et al., 2004). Opportunities for raising preventive health issues and health promotion with asymptomatic healthy people are admittedly few. Not many people go to the hospitals or visit health care providers in the absence of any disease symptoms. Regular visits to a health care provider for preventive care are rarely made (Cohen et al., 2004). Pain, fever and other acute symptoms are the most common reasons which bring a person to the hospital. Conversely, most non-communicable lifestyle disorders which are presently being targeted by many health care prophylactic interventions and measures are chronic and apparently non-threatening in nature in the initial period. It is only when a disease has advanced that the patient becomes symptomatic and seeks treatment. However, by that time the disease process is already well established and difficult to reverse. So, it is vital for health promotion strategies to be successful so that the patients at risk are identified early. However, it is difficult to achieve this in reality. Opportunities for patient contact are scarce and, regardless of what they are, they should be utilised in a way that most effectively serves the purpose of health and well being promotion. Such opportunities exist both in traditional and in novel settings. Traditionally, primary health care settings provide patient contact with general physicians or nurse practitioners for minor illnesses or complaints unrelated to chronic lifestyle diseases. These visits may be utilised to identify patients at risk depending upon their history and presence of risk factors, physical examination such as weight and blood pressure and investigations like blood sugar and lipid profile. Accordingly, the patients can be advised about the importance of primary prevention. Health care providers get an excellent opportunity to provide health education to people appearing for an assessment for life insurance or health insurance cover, as is the case in the scenario above. However, this chance is probably missed most of the times, according to the Centers for Disease Control and Prevention’s Report (Centers for Disease Control, 2011). In this report, 90% of the United States adults with uncontrolled hypertension had health insurance coverage, but obviously were not being educated in any aspects of preventive health. How are the Issues Raised? The techniques to provide preventive health care and engage in health promotion can be mechanical as well as conversational and communication based. Mechanical devices that trigger delivery of health messages and allow patients to stick to them are reminder cards, stickers and charts. Cohen et al. (2004) analysed how health care facilities provide preventive care during illness visits. Putting in a reminder about the preventive health message and arranging a follow up visit at the end of meeting was one effective way of providing preventive care. Illness visits can have potentially very useful conversations, during which preventive health care messages can be effectively delivered. Another technique that can be used is a stepwise transition from patient’s presenting a problem to advice about healthy habits (Cohen et al., 2004). This technique can be very useful in this scenario. As the patient has come for an insurance assessment, the health care provider acknowledges and addresses his problems of inactive lifestyle and smoking and tries to connect this to his assessment for insurance. This demonstrates the transition from presenting a problem to preventive health. Next, related questions are asked and the clinician makes the patient aware of a potential health problem and delivers a health related advice. Effectiveness and Obstacles for Health Promotion Activities Although it has been emphasised by policy makers and is also well accepted generally that preventive medicine is a cost effective tool to improve the health of a community and its individuals, less than 10% patients receive counselling for health habits (Cohen et al., 2004). Common barriers that have been identified for health promotion by the health care providers are lack of time, community resources and educational material, inadequate reimbursement and complexity of the guidelines for smoking cessation (Awad & O’Loughlin, 2007). It is also recognised that for it to work effectively, health care providers need training for providing health education and promotion. They should be aware of the factors that influence the application of evidence-based health care programmes in the actual world (Vermunt et al., 2012). At present, the interventions and approaches that are being used for health promotion by the allied health professionals are unsystematic and poorly planned (National Institute for Health Research, 2011). Apart from formal training, this practice requires skills for counselling, empathy, communication and inspiration. Health care providers need to be taught how to recognise opportunities for imparting preventive and integrative health messages and how to exploit these situations efficiently. Without sounding superior or convoluted, the message should be put across in a straightforward manner. In addition, it is difficult and probably impossible to accomplish behavioural change in a single meeting or patient-health care provider contact. Behavioural change and lifestyle modification demands persistent motivation and follow up. Thus, it is possible to inculcate preventive health approach in an individual; however, the follow up needs to be done, either by repeated visits to the health care practitioner by individual’s initiative or use of communication means such as telephone or internet to keep a track of patient’s habits and provide continual support, encouragement and motivation. Role of Paramedics in Health Promotion All health care and allied personnel such as physicians, nurses, pharmacists, paramedics, physiotherapists and occupational therapists can engage in health promotion activities on interaction with the patient (National Institute for Health Research, 2011). The role of allied health professionals such as paramedics has expanded and it now entails health promotion, illness prevention and education for the patients and their careers at every opportunity of meeting them. Critical care paramedics are usually involved in the management of patients with acute or life-threatening illnesses. As patients rarely make health care visits when they are healthy, the opportunity to provide preventive messages during acute illnesses can be seized by paramedics. At such times, a patient may be more receptive of the preventive health messages delivered by the paramedic due to the health scare he or she has received. In fact, even emergency departments (ED) are now considered suitable settings for delivering health promotion by giving health information to the patients, as well as screening and injury prevention (Bensberg & Kennedy, 2002). Also, they are skilled in prehospital care and this could prove useful in their function in non critical, non emergency settings such as screening and education programmes. It has been recognised that paramedics are an underused resource, especially in rural and remote areas, where there is shortage of workforce, and they could become a part of the multidisciplinary health care team which provides preventive medicine and care for patients with chronic illnesses. To serve this purpose, a newer curriculum and certificate course is being conducted (Reeve et al., 2008). This course has led to a transition in the role of these paramedics from emergency acute responders to primary and preventive health care personnel. In the scenario of the patient in question, a paramedic can be a part of the team that is likely to assess the patient and can provide valuable support. Similarly, O’meara et al. (2011) determined that Expanded Scope Practice for paramedics leads to more engagement of paramedics in community health promotion. On the contrary, in the study of Unger et al. (2011) in which the authors studied the utilisation of primary care in the prevention of chronic diseases like type 2 diabetes and cardiovascular diseases, there was no mentioning of paramedics in the allied health practitioner group, which serve a sizeable proportion of the rural community as far as preventive medicine is concerned. Conclusion It can be concluded that practice of health promotion by healthcare providers is currently unstructured and unsystematic. It is also true for paramedics, who work in a relatively newer field currently the subject of research and study. Even at a distance, being a part of the multidisciplinary health care team, paramedics can play a role in health promotion. The scenario discussed above deals with two commonest unhealthy habits that make people prone to health afflictions which can be mitigated to a large extent by virtue of preventive medicine. References Awad, M. A., & O’Loughlin, J. (2007). Physician delivery of smoking prevention counselling to young patients in the United Arab Emirates. Patient Education and Counselling, 67, 151 -156. Bensberg, M., & Kennedy, M. (2002). A framework for health promoting emergency departments. Health Promotion International, 17(2), 179-188. Centres for Disease Control. (2012, September, 7). Vital Signs: Awareness and treatment of uncontrolled hypertension among adults — United States, 2003–2010. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6135a3.htm?s_cid=mm6135a3_w Cohen, D., DiCicco-Bloom, B., Strickland, P. O., Headley, A., Orzano, J., Levine, J.... Crabtree, B. (2004). Opportunistic approaches for delivering preventive care in illness visits. Preventive Medicine, 38, 565–573. Fenner, P. (2011).The pre-employment medical: Nuisance or great opportunity? Australian Family Physician, 40(7), 541-544. National Institute for Health Research. (2011, August).The allied health professions and health promotion: a systematic literature review and narrative synthesis. Retrieved from http://www.netscc.ac.uk/hsdr/files/project/SDO_ES_08-1716-205_V01.pdf National Prevention Council. (2011, June). National prevention strategy: America’s plan for better health and wellness. Retrieved from http://www.healthcare.gov/prevention/nphpphc/strategy/report.pdf  O'Meara, P. F., Tourle, V., Stirling, C., Walker, J., &, Pedler, D. (2012).  Extending the paramedic role in rural Australia: a story of flexibility and innovation. Rural and Remote Health, 12, 1978. Retrieved from http://www.rrh.org.au/articles/subviewaust.asp?ArticleID=1978 Quinn, V. P., Jacobsen, S. 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A., Schelfhout, J. D. M., Westert, & G. P. (2012). Implementation of a lifestyle intervention for type 2 diabetes prevention in Dutch primary care: opportunities for intervention delivery. BMC Family Practice, 13, 79. Retrieved from http://www.biomedcentral.com/1471-2296/13/79 Read More