Report from Institute of Medicine's Global Forum on Innovation in Health Professional Education
May 21, 2015
Elizabeth A. Goldblatt, PhD, MPA/HA, member of the University of Arizona's NCIPH leadership team offered two presentations at the recent Institute of Medicine's Global Forum on Innovation in Health Professional Education, of which Dr. Goldblatt is a member. Her first presentation entitled 'Self-care, Resilience, Health and Well-being in HPE (Health Care education)' focused on why these subjects are critical in today's health professional education. With 1/3 of the population obese, another third overweight and over 90 million with pre-Type II or Type II Diabetes, and with spending between 75-85% of the health care dollars on preventable conditions that relate to lifestyle issues, we must begin to change our fractionalized, disease-based system to one that focuses much more on health and well-being. These conditions and issues also apply to today's health professionals. In addition, health professionals and students are experiencing very high levels of job-related burn-out due to the stressful nature of their work and the current economics of our health care system.
It is well-accepted that we have a health care payment system that focuses on disease and does not reimburse for health professionals to focus on disease prevention, health, lifestyle issues and wellness. Thus, both health professionals as individuals and the economics of health care must change to shift the focus from being a fractionalized, disease-based system and disease-based payment system to one that focuses on collaborative, team-based, patient/person-centered care that emphasizes health, well-being and disease prevention. The IOM Global Forum which includes representation from virtually every health care profession throughout the world, has agreed that it is vitally important to create a health care system that includes interprofessional education and collaborative practice (IPE/CP), meets the Triple Aim and trains our health professional students to meet the needs of the 21st Century. It is also important that health professionals develop self-care and health lifestyle behaviors as students to reduce burn-out which in turn affects the health care they are able to provide. This is both an individual challenge as well as an organizational one and needs to be addressed at both levels.
Dr. Goldblatt went on to describe the University of Arizona project and how it is working with these most important areas. She explained that while this project initially is focused on creating meta-competencies in integrative medicine and health across the primary care professions, the leadership team is aware that both the competencies and areas of content will indeed apply to all health professionals. She introduced the IOM Global Forum members to the InPLT, to the metacompetencies and how they were developed, and the overall goals of the NCIPH. She walked the forum members through each of the meta-competencies as much of the interprofessional education and collaborative practice (IPE/CP) movement works with these areas as well.
A driving force behind the IPE/CP is on collaborative, team-based patient/person centered care. And, the NCIPH meta-competencies includes these areas as well as issues such as self-care, lifestyle issues, etc. Thus the NCIPH HRSA-funded project and the IPE/CP movement are well-aligned. In addition, Dr. Goldblatt went through the content areas that the NCIPH curriculum will likely include and again there is significant alignment with the Global Forum's areas of interest. Dr. Goldblatt also gave a webinar for those who could not attend the IOM Global Forum meeting and that presentation specifically focused on the University of Arizona's NCIPH project and is available on the IOM's web site.
Why is Public Health at the Table with Integrative Medicine and Primary Care? Is it just the good food that the host has to offer?
March 25, 2015
OK, I was officially crowned the outlier today at the initial summit for the National Center for Integrative Primary Healthcare (NCIPH). I know that I am not a clinician and I had only seen one integrative practitioner in my life before this summit. I can accept this title in light of being a positive deviant (doing better than predicted). However, since the summit (February 23, 2015), out of desperation to continue running, I have supplemented seeing an MD and PT with acupuncture and light energy laser to help an ailing hamstring.
So why was I at this summit and was it only because the HRSA guidance stated that public health had to be represented. I think not! I will elaborate on this conclusion based on two issues: (1) the relationship between primary healthcare and public health and (2) what is needed to have integrative medicine become a more integral part of the healthcare system.
First, the 2012 Institute of Medicine report on Primary Care and Public Health: Exploring Integration to Improve Population Health stated, "By working together, primary care and public health can each achieve their own goals and simultaneously have a greater impact on the health of populations than either of them would have working independently. Each has knowledge, resources, and skills that can be used to assist the other in carrying out its roles." So how does primary care and public health work together? One thing that public health does with data and advocacy is set policy at local levels and within institutions (small "p") and at the state and national levels (large "P"). These policies drive how to deliver primary care now and in the future in response to changes in the healthcare system. In return, primary care with a focus on population based health status will lower the costs of health care by having a focus on prevention, early screening and diagnosis of disease, and on the management of chronic diseases. Obviously, there is a lot more to public health than policy but this is a blog and not a book.
Now I will address the second issue about getting integrative medicine to have a greater integral role in the healthcare system. The role that public health can have is based on its role to: (1) identifying interventions that work, (2) measuring the cost-effectiveness of treatments (3) developing interprofessional systems of health, (4) responding to patient-centered care, and (5) making integrative medicine accessible to everyone including underserved and disadvantaged populations. Having public health professionals engaged in these activities is essential to develop the community-based approaches to have integrative medicine be more integral within the whole healthcare system. These competencies and skills as defined by the Public Health Foundation include cultural competency, communication, community dimensions of practice, leadership and systems thinking, analysis and assessment, policy development and program planning, financial planning and management, and public health sciences. It is with these crosscutting skills that integrative medicine will become more accessible and integral to public health.
It is also appropriate that determining how to move forward with integrative medicine and the training of clinicians is being led by the NCIPH within an academic institution. One conclusion from the IOM report was that academic institutions need to be actively engaged as "partners with both health centers and local health departments in sharing data; aligning clinical, research and educational programs; and sustaining integrated operations aimed at improving the health of the entire community." Clearly educating clinicians and non-clinicians on integrative medicine has to include both the clinical aspects of integrative medicine and the public health applications of integrative medicine.
Now that I have sampled the menu of what integrative medicine has to offer, I know that it tastes good, that I have left the table satisfied and that I need to return for seconds. At the same time, I can take these recipes back home and start modifying them for not only my own taste buds but also for the guests, the public, who are invited to join me at this table.
Douglas Taren, PhD
Associate Dean Academic Affairs
Professor of Public Health
Mel and Enid Zuckerman College of Public Health
University of Arizona