PUBLIC HEALTH
Engaging Families in Health Care Everybody Wins BY TAI MENDENHALL, PH.D., LMFT AND AALAA ALSHAREEF, MS, LAMFT
attended to and included; they can ignored or excluded (purposefully or passively). We argue that they be included and purposefully attended to.
t is well-established that up to 40% of patients who present in primary care have a diagnosable mental illness, and that more than 70% of all clinical presentations carry some kind of exacerbating psychosocial foci (e.g., workplace stress, housing instability, unemployment, institutional racism, legal troubles, academic struggles). These statistics are arguably more diverse – and often higher – across secondary and tertiary care environments.
Data Talk: Families are Important
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What appears less universally agreed-upon – or even recognized – is the role(s) that patients’ families play in health, wellness, illness, disease, injury, and/or recovery. Modern Western medicine conventionally focuses on onepatient at-a-time. Patients’ physical illnesses, mental health struggles, and psychosocial stressors are usually addressed absent consideration of family dynamics. Our third-party payers and HIPAA rules reinforce this practice. But families play important roles in the lives of our patients. They can be a source of support or a source of stress; they can be part of a solution or part of a problem. They are almost always “there” somehow, and are consequently influential to the courses and outcomes of medical advice. They can be
Specialists in Musculoskeletal Pain Treatment
Effective Non-Opioid Treatment Evidence-based Biopsychosocial Approach Active Therapy Multidisciplinary Care Team Quality Outcome Reporting
PDR Outcomes
• 67% of patients rate their pain reduction between 50-100%
• 74% of patients rate their headache reduction between 50-100% • 64% of patients rate their use of medications decreased 50-100% • 109% increase in Lumbar Extension ROM & strength • 165% increase in Cervical Rotation ROM & strength
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Proponents of the “medical home” – from pediatric to geriatric care contexts – agree. The Joint Principles of the Patient-Centered Medical Home (PCMH), advanced by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and the American Osteopathic Association, call for physicians to engage with patients and their families in active partnership(s) across all care processes so as to improve health. Compelling data – across both individual studies and systematic reviews – are emerging to support such efforts. In primary care, family medicine studies have long-paired the inclusion of family members in preventive and therapeutic interventions to positive outcomes (e.g., physical activity, blood pressure, metabolic control, dyslipidemia, smoking, overall cardiovascular risk). In pediatrics, stalwart support for the involvement of multiple family members in treatment is extant for care targeting child/youth diabetes, asthma, and obesity. In internal medicine, similar trends are recognized in the treatment of patients with multiple and complex morbidities, including diabetes (and other weight-related foci) and substance use/abuse. Examples supporting the inclusion of families in secondary care include: intensive care practices involving families have been paired with greater trust for care teams, satisfaction with care-related decision-making, and patient/ provider consensus in decision-making. In OBGYN contexts, familyinclusion in care is well-established in the reduction of perinatal distress, allayment of chronic genital pain, and improved coping with unexpected pregnancy termination for fetal abnormality. In emergency medicine, family involvement is strongly predictive of reduced psychological distress and improved follow-up with discharge planning. In oncology, it outperforms individual approaches in the promotion of coping, improved problemsolving skills, decreased psychological distress, and reduced depression. In psychiatry, including families in care has shown superior outcomes in the treatment of ADHD, anxiety, PTSD, depression, and suicidal ideation. Examples of compelling data in tertiary care are also myriad. In palliative and hospice contexts, including families in treatment is strongly predictive of improved patient/caregiver coping, increased self-efficacy, better qualityof-life, and reduced caregiver burden. In endocrinology, diabetes-related outcomes (e.g., A1c, BMI, BP, dietary practices, physical activity) are consistently better when care includes patients’ family members as opposed when patients are treated in isolation from them. In alcohol and drug treatment, family-interventions almost universally outperform individual care for use/abuse of substances (ETOH, opioids, etc.) and other addictions (gambling, pornography, etc.) across both adolescent and adult samples.
Everybody Wins The inclusion of family members in treatment processes within other care environments and target populations that do not fit neatly into conventional
