The Case For Whole Person Health Care
Michelle Simon, PhD, ND
Whole person health care is an intriguing new concept to many. Health care models that deliver whole person care are increasingly entering the mainstream. Several new models have emerged and are being evaluated for efficacy and financial feasibility.
One such example is the Whole Health Systems of the Veterans Administration (VA). The VA began this initiative as a part of the Comprehensive Addiction and Recovery Act to address the less than optimal approaches to chronic pain management which is giving rise to opioid abuse. Initially begun as 18 sites, a two-year evaluation1 found that veterans receiving Whole Health services benefited through a health care approach that “empowers and equips people to take charge of their health and well-being and live their lives to the fullest.”2 This type of care encourages self-care through complementary and integrative health approaches.
The evaluation incorporated self-reported outcomes by a standard survey provided through the VA. The veterans who used the Whole Health System (WHS) reported more healthy lifestyle behaviors, being more involved in their health care decisions, and experiencing a greater wellbeing, purpose and quality of life. Their Perceived Stress Scale3 results showed that they had greater ability to manage chronic pain and used less opioid doses than those who received usual care. More use of WHS resulted in more decreases in doses.4
Cost implications of this approach are promising. In the two-year assessment, results showed 12 to 24 percent lower costs in all categories except drugs, and the total cost savings was $4,845 (20 percent) less per person when involved in the WHS.5 Although the drug costs increased, they increased less than those not involved in WHS by 4.1 percent Patient satisfaction, too, is increased with users of integrative medicine. They like primary care providers who are “a good listener and provides time, knowledge and understanding.”6 Veterans reported higher ratings for patient-centered care for being involved in care decisions and experiencing less difficulties in care for providers.
Changes in approach, like that at the VA, are to be commended. I think we are moving in the right direction. It should be acknowledged that these concepts have been pioneered by others, including the naturopathic profession in publications such as that by Secor et al in 2004 that showed decreased pain and improved quality of life with implementation of a naturopathic medicine complementary clinic.7
Health care economist, Dr. Patricia Herman, published an analysis in 20098 that described the cost effectiveness of the naturopathic medical model in the case of chronic low back pain (LBP), which is one of the most costly and poorly resolved conditions in health care. Chronic LBP is also a common cause of opioid prescriptions which do not cure the issue, but address the symptoms.
More recently, in a study by Breed and Bereznay in 2017,9 researchers found that patients with depression and anxiety who were seen by naturopathic physicians in a community health center setting found significantly improved screener scores. This approach builds on the research by Cooley et al in 200910 randomized controlled trial that showed improved anxiety with naturopathic care.
Training in whole person health, which is what naturopathic medicine truly is, well equips NDs to deliver effective treatment for mood disorders, an important aspect of whole person health, chronic pain and chronic diseases, which together comprise the bulk of health care industry spending. A long standing evidence base exists for naturopathic care as an effective model for whole person health as described in our recently published white paper: “Naturopathic Physicians as Whole Health Specialists.”11
Raising awareness about the important contributions to the Whole Person Health Care movement that the naturopathic profession has and continues to make is important work of the INM (Institute for Natural Medicine). We encourage the sharing of this document by those wishing to educate themselves or their colleagues on this progressive profession.
References:
1 www.va.gov/COVER/docs/COVER-Commission-Final-Report-2020-01-24.PDF.
2 Whole Health System of Care Evaluation … Feb 18, 2020 ¢ a Whole Health System of Care (e.g., Infrastructure, – [PDF Document] (vdocument.in).
3 Ibid.
4 Ibid.
5 www.va.gov/COVER/docs/COVER-Commission-Final-Report-2020-01-24.PDF.
6 (26).
7 Secor ER, Markow MJ, Mackenzie J, Thrall RS. Implementation of outcome measures in a complementary and alternative medicine clinic: evidence of decreased pain and improved quality of life. J Altern Complement Med. Jun 2004;10(3):506-513.
8 Herman PM, Szczurko O, Cooley K, Mills EJ. Cost-effectiveness of naturopathic care for chronic low back pain. Altern Ther Health Med. Mar-Apr 2008;14(2):32-39.
9 Breed, C, Bereznay, C Treatment of Depression and Anxiety by Naturopathic Physicians: An Observational Study of Naturopathic Medicine Within an Integrated Multidisciplinary Community Health Center. Journal of Alt and Comp Med, vol X, no X, 2017, pp 1 – 7.
10 Cooley K, Szczurko O, Perri D, et al. Naturopathic care for anxiety: a randomized controlled trial ISRCTN78958974. PLoS One. 2009;4(8):e6628.
11 www.naturemedpro.org/discover-naturopathic-physicians-whole-health-specialists-in-whole-person-care.
Michelle Simon, PhD, ND President & CEO, Institute for Natural Medicine. In 1992, the leadership core of naturopathic doctors established the Institute for Natural Medicine (INM) as a not for profit organization dedicated to advancing natural medicine. The purpose of the INM is to increase awareness of, broaden public access to, and encourage research about natural medicine and therapies. Among its milestones the INM counts the launch of the Association of Accredited Naturopathic Medical Colleges (AANMC) as an independent organization, leading California’s efforts to obtain licensure, developing an interactive childhood education program focused on healthy eating and lifestyles called Naturally Well in 2017, and expanding residency access by establishing and funding a residency program in 2018. INM has joined forces with the American Association of Naturopathic Physicians (AANP), serving as the charitable arm, to deepen access to naturopathic care, public education and research. Dr. Michelle Simon serves as president and CEO of INM, is a licensed naturopathic physician, clinician, educator, and leader in many organizations dedicated to improving the quality and delivery of health care. In addition to holding a naturopathic doctorate from Bastyr University, she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill. Dr. Simon has served on the boards for the Integrative Healthcare Policy Consortium (IHPC), the AANP and the Naturopathic Physicians Research Institute (NPRI). Dr. Simon also served nine years on the Washington State Health Technology Clinical Committee which is part of the Health Technology Assessment program that examines the scientific evidentiary basis for efficacy, safety and cost effectiveness of health care technologies. She was also an invited participant for health care economics at “Summit on Integrative Medicine and the Health of the Public” at the Institute for Medicine (IOM) in 2009. Dr. Simon was recognized as the 2018 Physician of the Year by the AANP.
