About twenty years ago, at the turn of the millennium, the medical community began a transformation that was necessary to meet the various challenges presented by a rapidly changing world. The 21st century, when the general population of the U.S. truly entered The Digital Age, is characterized by instant access to information, total global connectivity, and the ability to accomplish virtually any task – from shopping for groceries to running a business – directly from a laptop computer at home. As these changes became a reality for most citizens, rather than options reserved for those with considerable financial resources, doctors and other healthcare providers across the country realized time and technology had finally reached a moment of synchrony, when achieving the primary – and lofty – goal of providing high quality health care to all was closer than ever before.
What the system needed was a new paradigm for the new world.
What became possible – and what changed dramatically even between 2000 and 2010 – was the ability engage technology to improve communication, efficiency, and quality of care.
At the same time – back around 2000 – physicians and others recognized that alongside these advances in technology and the unprecedented opportunities they offered, the new paradigm needed to shift away from the traditional, physician-as-final-arbiter-of-everything-health-related model – which alienated many patients – to a model that put patients and families closer to the center of all health-related decisions.
The New Model: Revising Relationships
This new model became known as Patient- and Family-Centered Care. The values prioritized in this model – as defined by this report published in 2001 by the National Academies of Science – include three fundamental concepts:
- Care is based on continuous healing relationships between the patient, the provider, and all relevant stakeholders.
- Care is customized according to patient needs and values.
- The patient is the source of control.
Now, as we near the close of the second decade of the 21st century, a new idea is gaining momentum: the idea that patient and family-centered care – which demonstrably improves the lives and well-being of individuals and families – can be expanded to benefit the well-being of the entire community.
In the paper “Transforming Community Well-Being Through Patients’ Lived Experiences,” researchers examine how micro-level interactions – between patients and providers, for instance – can lead to meso-level effects, i.e. those that effect the community as a whole.
A quick side note: if you’re not sure what meso means in this context, don’t worry, it’s not common usage. While you’ve probably seen macro used in contrast to micro, meso, here, means between: one level down from macro, one level up from micro. So, whereas macro- means population level, meso- simply means community level – the level between individual- and population-level interactions.
If you knew that already, great. If not, we’re glad part of your mind won’t be thinking about the time of dinosaurs when we want you thinking about community healthcare.
Back to the topic: a new research paper that examines how structural changes in the way patients and providers interact can resonate outward and have a positive impact on the community as a whole. Study authors focus on the idea of creating a patient ecosystem management (PEM) perspective, which aligns with the definition of health advocated by the World Health Organization (WHO):
“Health is a state of complete physical, social, and mental well-being and not merely the absence of disease or infirmity.”
Before we discuss the PEM perspective, we’ll let you in on a secret: it’s remarkably similar to the integrated, patient-first, family- and community-inclusive model we’ve been using in the treatment of alcohol and substance use disorders for the past decade.
We’ll get to that later.
What is Patient Ecosystem Management (PEM)?
First, let’s make sure we’re on the same page with the word ecosystem: in biology, in means an interconnected system of living organisms and the environment that surrounds them. In this article, it means the sum total of all the relationships connected to the care of an individual patient when they receive treatment or are in recovery from an illness. It includes all the doctors, nurses, pharmacists, physical therapists, family members, insurers, businesses – from health clubs or yoga studios to large pharmaceutical corporations – that a patient interacts with in any way during a course of treatment for any given illness or injury.
Study authors identify two ways in which a patient ecosystem can be improved to benefit community well-being:
- Intra-alignment. The system can be leveraged to intentionally expand and improve access to all aspects of health care of each individual. For instance, providers can learn what barriers exist to treatment for patients and utilize technology to remove those barriers. Tele-medicine can be made available to patients with transportation challenges, thereby increasing their likelihood of adhering to a course of treatment and ultimately improving their overall well-being.
- Inter-alignment. The system can be leveraged to connect individual patient ecosystems with additional community ecosystems not traditionally associated with patient care. For instance, providers and communities can collaborate to connect patients with diabetes, cancer, or other chronic illnesses with social clubs/activities, health clubs, dieticians, stress-management experts, and other professionals or businesses that can contribute to their care.
The intra-alignment aspect of PEM focuses on individual well-being, while inter-alignment aspect focuses on expanding individual well-being to include the general health and wellness of the community.
The entire PEM concept is centered around the subjective experience of the patient, which occurs on two levels. First, when the self-reported well-being of the patient improves, that circle of wellness expands to include those individuals with whom that patient interacts. For example, when a patient makes progress with a chronic illness, their improvement benefits the physical, emotional, and often financial well-being of their entire family. Second, when a patient interacts with the non-individual elements of the community in a dynamic, proactive way – enabled by improved health and subjective sense of well-being – the elements of the community with which the patient interacts likewise improve. For example, when a patient changes behavioral habits to include healthy eating, the local health food store benefits. The store benefits not only financially, in that they get a new customer, but also in terms of their mission as a business: they get to bring more healthy food to the community.
Treating Addiction: The Community Connection
To medical professionals working in addiction treatment, PEM is not a new concept.
In fact, it’s an approach doctors, therapists, and counselors have advocated for decades.
Top to bottom integration of treatment for alcohol and substance use disorders involves, on the patient level – the intra-alignment component of PEM – delivering treatment that’s sensitive to and works to improve all aspects of the patient’s life. This may be called a holistic approach, it may be called an integrative approach, or it may be called the whole person approach. In all cases, it means offering treatment that helps heal the mind, the body, and the spirit, rather than focusing solely on the disease and its symptoms.
This level of sensitivity would not be possible without a keen awareness, on the part of treatment providers, of the subjective experience of the patient across all levels of experience, e.g. patient ecosystem management. This means that those who provide treatment for alcohol and substance use disorders have already become experts in PEM intra-alignment.
On the community level – the inter-alignment component of PEM – treatment for alcohol and substance use disorders has a longer history. The most obvious example of the community element of alcohol and substance use treatment is Alcoholics Anonymous (AA). Founded in the 1930s, the community support offered by AA has helped countless people on their recovery journeys. AA offers a safe space for people who share common challenges to share their experiences and support one another.
Treatment programs for alcohol and substance use disorders regularly include participation in community support groups such as AA, primarily because treatment providers are aware of and sensitive to the vital role they play in the subjective experience of the patient. Even patients who don’t like AA say they benefit from the meetings – so treatment programs almost always include them.
From a patient ecosystem management perspective, this means that medical professionals in the addiction field are well attuned to the concept of coordinating patient care with external community elements. They’re already experts in PEM inter-alignment.
Connecting the Dots
Let’s circle back.
The paper “Transforming Community Well-Being Through Patients’ Lived Experiences” examines the connection between the micro-level interactions in health care and meso-level effects on the community. It shows that when treatment providers manage the patient ecosystem with sensitivity and care – with an awareness of intra-alignment and inter-alignment – the benefits of this approach redound to the individual who receives treatment and to the community of which that individual is a part.
In plain language, what they’re saying is that a patient-first approach helps everyone, not just the patient.
In the alcohol and substance use disorder treatment community, we’re excited about this research and its big-picture implications. Because, to be honest, we’ve known these things all along – and we’re grateful for the way in which the study authors present and discuss this core approach to addiction treatment.
Every day in our work, we see the way improvements in one person’s well-being resonate outward. With each patient we treat, we understand that when we include more of the community in that person’s treatment – from family members to peer support groups to volunteer opportunities that involve patients and staff – the better that treatment becomes. And we understand that when we – as providers – align treatment with public policy and community interests, we can reach more people and change more lives than when we operate in a vacuum.
We’re ready to be part of this movement in health care, and if anyone outside of the addiction treatment community wants the benefit of our experience, we’re more than willing to share: it might be what we’re best at.
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