P is for prevention...

 

Prevention is better than cure, so the saying goes. As the population in the developed world ages and there are many more people who have chronic conditions and illnesses many of which are lifestyle related, government policy is changing. Services like the National Health Service were set up to treat illness. Now the emphasis is changing and there is more focus on prevention of illness and on helping people who have chronic conditions to manage their illness. There is a greater emphasis on health and wellbeing.

Occupational Therapists (OTs) have traditionally worked in rehabilitation or recovery settings, but have the skills and in depth knowledge to deliver preventative programmes based on occupation, or peoples’ daily routines that are effective and sustainable.

Last year I heard Dr Sheena Blair speak at the Student Occupational Therapy Links Scotland(SOTLS) conference in Glasgow. Dr Blair concluded that as occupational therapists, our next big challenge and emerging area of practice is in public health and in the prevention of illness. Follow this link to read my post about the conference.http://www.blogger.com/blogger.g?blogID=7020627754640309197#editor/target=post;postID=7331785227788042008

During my recent study visit to the University of Southern California to investigate the Lifestyle Redesign® occupational therapy approach developed there, I learned about it’s use in many different areas f practice, including prevention.

Preventative occupational therapy can be categorised into three areas, primary, secondry and tertiary. The examples given below to illustrate this are from the Lifestyle Redesign® Diabetes Programme developed by Dr Chantelle Rice, but could easily be applied to other situations or conditions.

Primary prevention is defined as education or heath promotion strategies designed to help people avoid the onset of unhealthy conditions, diseases, or injuries.

• Example: Both of an individual’s parents have diabetes and he/she is overweight with high blood pressure and elevated blood sugar levels.

Secondary prevention includes early detection and treatment designed to prevent or disrupt the disease process.

• Example: An individual was just diagnosed with diabetes and according to lab results, their physician believes that he/she has had diabetes for approximately 6 months. He/she does not have any of the chronic conditions associated with diabetes and should focus on healthy eating routines, physical activity and other healthy habits to control blood sugar, lipids and pressure.

Tertiary prevention refers to treatment and services designed to arrest the progression of a condition, prevent further disability, and promote social opportunity.

• Example:An individual has had diabetes for 10 years, has suffered from a stroke, and currently lives with diabetic retinopathy, tingling in their fingers and numbness in their feet. Facilitating the implementation of healthy lifestyle habits to prevent the further development of chronic conditions, or additional conditions, and increase ability and function in activities of daily living.

Reference

Brownson, C. (2001). Occupational Therapy in the promotion of healthy and the prevention of disease and disability statement. The American Journ Occupational Therapy, 55 (6), 656-660.

Lifestyle Redesign Diabetes Program

For the past 2 weeks we have had OTs who work in the USC Faculty Practice come to speak to the Lifestyle Redesign class about some of the programmes they are involved with.

Last week Dr Chantelle Rice (the OT who runs the weight management group I have been attending) spoke about the Lifestyle Redesign Diabetes Program. Chantelle developed the programme for her one year doctoral residency after completing her Masters in OT. Her presentation covered 4 areas:

1. What is diabetes? How does it impact on function?
2. What are the self care behaviours of diabetes self care and management?
3. OT's role in diabetes prevention and management.
4. Lifestyle Redesign Diabetes Program

 Chantelle Rice, OTD, OTR/L

Diabetes is a chronic and progressive disorder of glucose metabolism related to insulin deficiency and/or resistance. I am not going to go into further detail here as there are many places to look up this information, however it is useful to reflect on a few 'fast facts' that show why prevention and management are so important (these are US based, but other developed countries have similar issues).

• over 25 million people in the US have diabetes
• among US adults, diabetes is the most common cause of kidney failure, non-traumatic lower limb amputations & new cases of blindness.
• excluding stroke & heart disease, diabetes is the 7th commonest cause of death.
• compared to non-Hispanic whites, diabetes risk is 77% higher for non-Hispanic blacks, 66% higher for Hispanics and 18% higher for Asian-Americans.

In the US, OT is one of 13 disciplines that are eligible to become Certified Diabetes Educators (CDE), a formal qualification requiring a period of study and assessment, follow this link for more information.
Treatment at the different stages may progress through lifestyle modifications, oral medication and lastly insulin therapy. Diabetes has numerous harmful long term complications so the longer the disease can be prevented or managed the better for the individual and for society.

People who attend the Lifestyle Redesign Diabetes Program may have diabetes, be in the 'pre-diabetes' stage or may be aware that they have a high risk of developing diabetes- it is more common in people with certain metabolic disorders such as polycystic ovaries. 

OT can intervene at any of these stages by working with individuals to assess their daily occupations and to create sustainable health promoting routines based on the 7 areas of lifestyle change that have been shown to be effective in managing diabetes:

1. Healthy Eating- e.g. how food choices affect blood sugars, sustainable routines around food and snacks, safe food preparation in view of reduced sensation or vision, finding 'healthy pleasures' to replace eating 'comfort food'.

2. Being Active- e.g. understanding the benefits of physical activity specific to diabetes such as improved insulin resistance, reduced blood pressure; setting 'SMART' goals for activity; educating about contraindications and precautions.
 

3. Healthy coping- e.g. addressing the high risk in people with diabetes for stress, depression, eating disorders and anxiety. This could include working on social and emotional support, providing information or reviewing time management strategies.


 4. Risk Reduction- e.g. making sure appointments to screen for complications are kept, managing 'hypos' and sick days, developing strategies to keep track of medical appointments, test results etc.
 

5. Monitoring- e.g. incorporating essential checks like foot inspections, weight and blood glucose into everyday routine.


 6. Taking Medications- e.g. ensuring the client understands the regime and helping the person embed it into their daily routine.


7. Problem Solving- the OT and client work as a collaborative with the client as problem solver. The OT will assess the client's readiness for change and any other factors such as literacy or cognitive function and use the most appropriate strategies to help to identify barriers and supports and to enable the individual to achieve success. Factors relevant to individuals will be included as required such as difficulties due to reduced sensation or pain, visual problems, need for adaptive equipment, home evaluations etc.


The OT needs to draw on knowledge of change theory, a thorough knowledge of diabetes, motivational interviewing skills as well as a knowledge of the program's theoretical underpinning. The intervention lasts 16 weeks. There are similarities to the Weight Management program as healthy eating is obviously very important, but this program addresses issues specific to diabetes.