Biopsychosocial Model Primary Care Block - PowerPoint Presentation

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Biopsychosocial Model

Primary Care Block

Rachel Wong

Case Scenario

CC: 39F here to follow up of abnormal labs and rash

Medical

Hx

: DMI,

gastroparesis

, HTN, hyperlipidemia, depression, anxiety, PTSD, seizure disorder

Last visit: established care, treated with steroid cream for diffuse, itchy rash and had lab work done

Current symptoms: rash has improved slightly with steroids, but seem to have new lesions spreading to the neck and scalp

Case Scenario

Psych

Hx

: multiple hospitalizations, last 1 month ago for 6 weeks in Brunswick Hospital

currently being treated by an NP at FEGs

History of suicide attempts trying to overdose on medication

Social

Hx

:

Former smoker

Prior history of ETOH, LSD, marijuana, cocaine, last use 5 months ago

Transgender, had former partner that died from AIDS, last HIV test 1 month ago was negative, not sexually active for 1 year

Family

Hx

:

Father with HTN, sister with

hx

of substance abuse and depression

Labs: anything concerning?

Case Scenario

Medications

Lantus 50U SC BID

Aspart

16U pre-meal

Buspar

15mg daily

Celexa

40mg dailyClonazepam 1mg TIDGabapentin 900mg TID

HCTZ 12.5mg daily

Prazosin

8mg QHS

Losartan 50mg daily

Lovastatin 40mg daily

Tegretol

200mg BID

Triamcinolone 1% cream BID

Biopsychosocial Model

Systematic consideration of biological, psychological and social factors and their complex interactions in the understanding of health, illness and health care delivery

Gliedt

, J. An illustration of the biopsychosocial model

Retrieved from https://

www.researchgate.net

/figure/2-An-illustration-of-the-biopsychosocial-model-comprised-of-biological-psychological_fig1_317415046

Biopsychosocial Model

5 domains, 3 of them

sociobehavioral

domains:

Social support

Community and environmental resources

Behavioral and substance abuse disorders

Chick D. (2014) Psychosocial Model of Clinical Care

Retrieved from https://

caringwithcompassion.org

Screening for psychosocial issues

Fear of what we will find

Uncertainty with how to address psychosocial concerns

Time considerations

Lack of resources

Personal discomfort

A patient’s personal support network and resources are integrated with social determinants and are essential to achievement/maintenance of health.

Family/social support have stronger influence on care plan adherence than biomedical factors.

Social Support

Personal connections, relatives, friendships

Screen for positive (friends) and negative (domestic violence)

Screening questions

Who lives with you?

Do you have friends or family who help out when you have difficulties?

Who are they?

Do you feel safe where you live?

Community and Environmental Resources

Housing, community environment, health insurance, food security, income, and transportation

Difficult to address clinical needs when subsistence needs unstable

Screening questions:

Where are you staying? Is it a stable living situation?

How long have you stayed there/will you stay there?

How much money do you receive regularly each month?

How do you pay for medical care?

Where/when/what was your last meal?

How do you get to medical visits?

Behavioral and Substance Abuse Disorders

Personality disorders, substance abuse, and somatization

Personality disorders

Extremes in idealization and devaluation

Passive aggression

Anger/blaming

Dependence

Substance Abuse

Have you had challenges with drugs or alcohol?

Somatization

Patterns of non-anatomical/non-physiologic physical complaints that shift over time

Substance abuse screening

CAGE-AID 79% sensitive, 77% specific

C: Have you ever felt you ought to cut down on your drinking or drug use?

A: Have people annoyed you by criticizing your drinking or drug use?

G: Have you ever felt bad or guilty about your drinking or drug use?

E: Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover?

AUDIT, MAST, MAST-G

DSM-5 Substance Use Disorder

Tolerance

Withdrawal symptoms

Craving

Substance taken in larger amount and for longer period than intended

Persistent desire/attempts to quit

Much time/activity to obtain, use, recover

Important activities given up or reduced

Use continues despite adverse consequences

Recurrent use resulting in failure to fulfil major role obligation at work, home, school

Recurrent use in physically hazardous situations

Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated

Psychiatric Disorders

Major psychiatric conditions (DSMV Axis I conditions): major depression, bipolar disorder, and schizophrenia

Screening questions

Have you ever been diagnosed with a mental health condition?

Have you ever been hospitalized for a mental health condition?

Do you have a mental health provider?

Do you have a mental health case worker?

Biomedical Disorders

Acute medical problems

Chronic diseases and complications

Medications and treatments

Functional Status

Provides information on the net effect of the 5 domains on the patient’s life and self-management capabilities

Role functioning in significant personal relationships, occupation/employment, social/community roles: educational level, occupation, literacy and numeracy, social and community engagement can affect role function

Activities of Daily Living (ADLS): eating, bathing, toileting, transferring, dressing, and grooming)

Instrumental Activities of Daily Living (IADLS): medication management, driving, food access and preparation, walking / gait stability

Case Scenario

20 minute urgent care visit

What kinds of questions to address

biopsychosocial

domains?

Case Scenario

20 minute urgent care visit

What to address this visit? Triage? Follow up?

Initial Plan

Rash-likely scabies

Hypertriglyceridemia-start

fenofibrate

DM-uncontrolled, does not currently seem to be in

DKA and able

to store and self-administer insulin, has supplies and insulin syringes/vials

Gastroparesis

-no current issue but not eating much because of access to foodPotentially unstable/unsafe housing situation and homelessness-FUV in 1 week to further assess

Populations in Need

Chick D. (2014) Psychosocial Model of Clinical Care

Retrieved from https://

caringwithcompassion.org

Biomedical Conditions

Disease Specific: Tb, HIV

Behavioral: Smoking, ETOH, Substance Abuse

Nutritional: malnutrition, diabetes, obesity, electrolyte abnormalities, vitamin deficiency

Dermatologic: scabies, lice, trench foot, dermatitis

Chronic Disease