Acute Benign Intervention


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	Acute Benign Intervention Patterns of Self Medication – data from the Boston University School of Public Health – Slone Epidemiology Unit (JAMA, Jan. 16, 2002 – Recent Patterns of Medication Use in the Ambulatory Adult Population of the United States) indicate that in their recent survey of 2,590 participants across all 48 continental states and the District of Columbia, showed the following data: - 81% used at least one medication in the past week - 50% took at least one prescription drug - 7% took 5 or more drugs - 14% of the population took an herbal supplement - 16% of prescription drug users also took an herbal supplement - Herbal supplements were most commonly used for “health” Self medication and the use of herbal supplements are not uncommon or unacceptable to most of the ambulatory adult population. Reasons for Self Medication – in the same Slone study the top 40 most used medications were ranked. Although almost two thirds (27) were available only by prescription, 6 of the 10 most frequently used drugs, including the top 4 were available over the counter (OTC). The most frequently used entities were acetaminophen (paracetamol), ibuprofen, aspirin and pseudoephedrine hydrochloride. This use translates into headache, fever, allergy, sinus congestion, arthritis, colds and flues being the most common conditions self-treated by ambulatory patients. Acute Benign Intervention - in order to prevent inappropriate or excessive physician utilization for common benign self limiting conditions, it is incumbent upon the physician to offer an acceptable and therapeutically satisfying alternative route of response, other than seeking physician diagnosis and treatment. This interventional mode of self modulation was developed during a capitation contract (payment of a fixed amount per head, per month, irrespective of whether the patient is seen or not). A list of acceptable common self limiting disturbances in a bodily function was developed which included: - Reactions to the environment - Over or under action of the gastrointestinal system - Lack of energy - Laying awake at night - Inability to deal with your living environment - Miscellaneous bodily aches - Catching everything that is going around A “Wellness Kit” was developed that utilizes selected formulas of Traditional Chinese Herbs, Homeopathic remedies and nutritional supplements to treat the above self limiting disturbances. Patients were instructed over the phone or to self assess to take the appropriate Wellness Kit formula (each patient had an instruction sheet) and to follow their bodily changes under self modulation for 48 hours. If they did not see an improvement in their bodily disturbances, they would be seen that day by the doctor. Doctor visits decreased 25% by ‘self modulators’ (who later called in for appointments) and 40% by phone consultations. Although the capitation arrangement no longer exists (now fee for service), many patients still elect to have their Wellness Kit and to use it at their own discretion because it empowers them and saves them money. Why Chinese Herbs, Homeopaths and Supplements? - In order to carry out this self modulating alternate, it is necessary to have a well proven effective system of modulation that has the maximum effect in the majority of patients, while being non-toxic and having minimal interactions with regular medications. The only systems that fill the bill are Traditional Chinese Herbology, Homeopathy and Nutritional Supplements. Traditional Chinese Medicine has more than 2,000 years of clinical practice to draw upon. The Chinese patent formulas have been somewhat modified over the years to address modern life styles and stresses, and are very successful at mitigating these acute benign common presentations. Chinese patent formulas are sophisticated herbal combinations that are formulated to specifically counteract the patterns of disease seen in these acute manifestations. Western herbology has no such system of herbal combination or philosophy and is not used as extensively. Chinese herbs are safe and inexpensive and have few interactions with regular medications. The problem herbs such as Ephedra and Aristolochea are purposely excluded from any of the formulations used in the Wellness Kit. The most common side effect of taking herbs is gastric discomfort or loose stools in those patients with a sensitive stomach. These patients just have to reduce their dose and take the herbs with a meal. Homeopathy has 200 years of medical history mainly in Europe and India. The great advantage of Homeopathy is its immediate efficacy, lack of interactions with regular drugs and complete lack of toxicity. It is easily administered to and accepted by children. All patients should be on a core multivitamin and mineral supplement. The benefits that accrue to having all necessary enzyme cofactors and nutritional building blocks have been documented in a recent New England Journal of Medicine article and editorial (N.E.J.M., What Vitamins Should I be Taking Doctor?, Dec. 20, 2001). Supplementation is especially cost effective in those populations who are malnourished, incorrectly nourished and/or heavy drinkers. Models and Programs in Existence - There are many integrated Alternative Medicine programs in the United States. The two formalized ones are the Washington State Program of Integrative Medicine and the University of Arizona Program in Integrative Medicine. Integrative Medicine research is in full swing at the 8 centers for excellence of the National Center for Complementary and Alternative Medicine at the National Institutes of Health; and many other academic centers. Wellness Programs existing in the private sector include the Akron General Health and Wellness Center, with associated life style and fitness centers; Riverside Health System in Virginia with six fitness centers and outreach programs. The MEDSTAT GROUP of Washington, D.C. compared total and lifestyle–related medical care costs for employees of a major corporation participating in a work site health promotion program over a three year period with non-participants. Savings of $392 per person and $1.56 million was seen by the third year (Goetzel et al, Health Care Costs of Worksite Health Promotion Participants and Non-Participants, J. of Occupational and Environmental Medicine, Vol. 40, No 4 1998). Conclusion The use of the Wellness Kit will result in the following changes in a HMO population: Large cost savings, through decreased utilization, and Increased patient satisfaction and empowerment through proactive self management of self limiting acute benign presentations. As healthcare becomes more expensive and unaffordable for the consumer, the average person is going to start taking their care into their own hands and self medicate. It would behoove an HMO to become the source of those medications in a proactive manner to retain brand loyalty in the event of discontinuation of HMO coverage.