The Biopsychosocial Model Patient (DONE) -centered care

life can be altered by what a patient:

“HAS” – diseases

such a bipolar disorder, and major depressive disorder

“IS” –dimensions -
intelligence and personality traits: openness, conscientiousness, extrovert/introvert, agreeable, worries.

“DOES” – behaviors --- such as excessive use of alcohol or drugs.

“ENCOUNTERS” - life-story --- such as grief due to the death of a loved one, fear after a rape, or demoralization after loss of a job.

Health and illness can be understood most fully by considering

interactions of biological, psychological, and social factors

The most effective intervention to promote health for the patient will…

address any relevant psychological or social factors in addition to treating the biological illness

What are biological factors?

The pathophysiology of disease, or the disordered physical response to disease.

caused by things such as:
- Viruses
- Bacteria
- Genetic predisposition to illness
- Immunity

What are psychological factors?

Things that are internal to the patient that impact illness and treatment

such as:

Self-Esteem

Emotions, such as stress, fear, or discomfort

Mood disorders (depression, anxiety, bipolar)

Thought disorders (schizophrenia, psychosis)

What are social factors?

Things that are external to the patient.

such as:

Social network and support (or lack thereof)

Insurance status

Employment

Socioeconomic status

Cultural traditions

Religious beliefs

Experiences of discrimination and harassment

Abuse/neglect

Trauma history

substance abuse

Psychosocial Factors

It can be challenging to clearly separate psychological and social factors, so we often think of them together

Psychological (internal to patient) + Social (external to patient) = PSYCHOSOCIAL

Psychosocial considerations for dental care

Impact of medical illness or disability on oral and treatment plan

Need for emotional support related to new diagnosis or treatment plan

Language barriers, including low health literacy

Difficulty with primary medical care access

Transportation barriers

Cultural considerations

Lack of insurance coverage

Concern about affording medications or treatment

Lack of access to basic needs such as food, housing, clothing, etc.

Substance abuse

Mental health, such as dental anxiety or unmanaged depression

Suspicions of abuse or neglect of a child or vulnerable adult

How can Providers address psychosocial Considerations?

Care coordination between providers

Referrals to appropriate community resources and state/federal assistance programs

Self-reflection regarding privilege and assumptions

Preparation to serve a diverse population of patients (cultural competence)

Building communication skills

Awareness of social determinants of health, such as poverty and
discrimination

Commitment to person/patient-centered care

Person/patient-Centered Care

Treating the people accessing health care as “equal partners in planning, developing, and monitoring care.”

“A person who has a tooth attached, as opposed to a tooth that may or may not be attached to a person.

Principles of person-centered care: 1. Respect and cultural
competence

Cultural sensitivity towards patient and family

including, but not limited to, socioeconomic status, race, religion, ethnicity

Considering patient/family needs and preferences to make treatment decisions

Principles of person-centered care: 2. Integration and coordination of care

Care provided by multi-disciplinary teams: families, health care providers, case managers, educators, insurers, community support systems, etc.

Improving collaboration between care teams to improve access to
care: where is care received?

Principles of person-centered care: 3. Communication and information sharing

Open communication between the health care team members and between the team, patient and family to ensure transparency and continuity of care

Enhancing communication skills of providers

Enhancing health literary so patients can understand treatment plans and options

Principles of person-centered care: 4. Quality of care

Providing evidence-based care that is high quality: the best care is not always the most expensive, or the most elaborate!

Receiving feedback from patients and collecting data to improve the delivery of health care

Principles of person-centered care: 5. Whole-Person and comprehensive Care

Attending to the overall health of the person, not just the presenting oral health problem

Emphasizing health promotion to reduce risk and increase quality of life

Common PCC myths
We are practicing PCC if we:

Implement an electronic health record

Have a patient on our committee to redesign the office

Send text reminders to patients

Receive high patient satisfaction scores

What could this look like in dentistry?

Integration of primary and dental care

Mid-level providers to increase access to preventive dental care

Including patients in office decisions such as preferred office hours, design/language of forms, appointment reminder systems

Getting to know patients as individuals, and responding to their particular needs and concerns, aka, the Platinum Rule

Addressing psychosocial considerations for treatment