Even as chronic disease becomes more prevalent, people are living longer. People who address risk factors for chronic conditions can avoid complications later in life. Providers can help patients aspire to longevity and achieve a better quality of life with “P4” medicine—a clinical practice that is predictive, preventive, personalized and participatory.
Getting people to engage in preventive care early in life has always proven difficult. The discussion with patients is critical, but at first may not be persuasive. When patients visit a clinic in my Chicago private practice, the initial consultation emphasizes lifestyle changes and the importance of nutritious food and exercise in building resistance to stress and disease. This is then reemphasized during subsequent office visits to reinforce the connection.
Engaging adults outside the clinical setting is a start. Health fairs and barbershop or salon programs encourage people to get blood pressure screenings or basic blood tests. The Center for Better Aging, (CBA) an Illinois Healthcare Transformation Collaborative based on the St. Bernard Hospital campus, is reaching out to members aged 50 and older in Chicago’s under-resourced South Side communities. Many do not have a relationship with a primary care physician. Once the CBA connects them with a primary care physician, the practitioner can engage in risk assessment and counseling to encourage them to come back.
I ask patients to think about avoiding chronic conditions that will slow them down as they age. Here is an overview of the 4 Ps of medicine and how patient-centered P4 care helps older adults achieve better wellness behaviors:
Predictive Care Starts With Screening
Predictive care tests for early risk indicators while collecting data on heredity and social factors. In my practice, patients fill out a questionnaire before they come to the clinic or in the waiting room. The patient’s family history and barriers to health give us an idea of how to engage with the patient. A health risk assessment asks about patients’ prior medical surgical and social histories, insurance access, as well as transportation and ability to see doctors on a regular basis.
Answers to a baseline questionnaire will drive discussion with patients about their personal habits. There’s always an ongoing conversation about actions they can take now to prevent them from becoming disabled or impaired for the rest of their life. The Center for Better Aging is taking predictive care to the next level and partnering with social service providers, who can look at the quality of its members’ housing, nutrition, and transportation. If they can engage CBA members in their safety, security or mental health concerns and manage the social determinants of health, they are on to a win-win solution.
Preventive Care Slows, Stops Chronic Conditions
Preventive care manages health risks by making vaccination a priority and calling for tests to identify emerging conditions. People who got the Covid-19 vaccine had better success at avoiding the most severe complications, and there is evidence that it improved mental health outcomes as well. Older adults benefit from vaccines for flu, pneumonia, shingles and other conditions.
The primary care physician’s hardest job is to convince their patients to eat right and exercise more. Research links insufficient physical activity to heart disease, stroke, Type 2 diabetes, and breast, colon, and uterine cancers. Physical inactivity is related to other unhealthy conditions and health risks as well. Once people make this connection, they tend to do better at managing their health. Weight control, smoking cessation and exercise programs have also shown direct wellness benefits.
Personalized Care Responds to Patients’ Concerns
Personal circumstances can limit patients’ access to care and ability to follow doctor’s orders. Older adults are a prime example; they may live alone, far from family or with limited means. Often, they fail to take medications—losing track of morning and evening dosing times, fearing side effects or simply finding money too tight to fill prescriptions.
For patients to return on a regular basis and get feedback on their wellness issues, appropriate insurance coverage is essential. Transportation to and from medical appointments is a concern in communities with less public transit access or fewer medical providers. Here again the Center for Better Aging program distinguishes itself, by helping members schedule and arrive at their appointments and making sure they can afford the prescribed treatments.
Patient-centered care for older adults should consider their physical and emotional support systems. Typically, our practice encourages older patients especially to have a relative or caregiver sit in on their appointments and learn about ailments the patients have. The doctor can be clear on goals for patients, such as the numbers to achieve better blood pressure control, and the caregiver can hold them accountable.
Participatory Care Puts Patients in Charge
In under-resourced populations, a P4 approach that brings clinical and social services together, such as the Center for Better Aging, can be valuable to clients. Diet can affect cardiovascular, kidney and lung diseases, so access to fresh produce and health information is essential. Hearing and vision tests, strength and balance training and home assessments all address fall prevention. Access to gyms and other safe spaces for exercise support long, active and fulfilling lifestyles.
The goal is shared decisions that empower active patient participation in their health and wellness journey. It helps that regular physical activity makes life easier. Exercise that raises the heart rate can help people’s stamina and weight control. Exercise has other benefits: strength training makes daily activities easier, and stretching keeps joints working well. Balance exercises are especially helpful as people age because they teach the body how to prevent and recover from a fall.
Technology can assist in this process as well. This has been demonstrated with our diabetic and heart failure patients. Instead of waiting for the next doctor visit, diabetic patients get their average blood sugars monitored on a continuous glucose monitor. Information is then transmitted to the clinic. The medical staff analyzes readings and makes necessary medication changes. Poorly controlled blood sugar readings on a continuous glucose monitor are usually an incentive for diet changes. Ambulatory devices also enable the patient to keep an eye on blood pressure instead of waiting for the next doctor visit.
When they get home from a medical visit, P4 medicine will help the patient and caregiver seek a more active lifestyle, access to proper food and safe housing. Engaging patients in healthy behaviors is essential to managing the chronic conditions that have driven lower lifespans. Patient-centered care for older adults requires a shift in mindset from disease to wellness. The provider and the patient are partners on the journey to healthy longevity.
