Article review: “The ideal of biopsychosocial chronic care: How to make it real? A qualitative study among Dutch stakeholders” by van Dijk-de-Vries et al (2012)

Article review: “The ideal of biopsychosocial chronic care: How to make it real? A qualitative study among Dutch stakeholders” by van Dijk-de-Vries et al (2012)

Chronic conditions (such as COPD or diabetes) are increasing in Western countries like England and Holland. These long-term conditions need the patient to be active in managing their condition in order to achieve reduced financial healthcare burden and better quality of life for the patient.

In this way, evidence shows that a biopsychosocial model would benefit patient well-being and produce these financial improvements. However provision of care that starts from the medical, emotional or social needs of individual patients does not fit in easily with the current Dutch health care system.

So the biopsychosocial model is a great idea – how to implement it?

Ideas on how achieving implementation of the biopsychosocial perspective could be improved related to active patient participation, the training of professionals, high-quality guidelines, protocols and tools, integrated primary care, research and financial issues.

In Holland, they recommend a move away from government funded to a quasi free-market model where health insurers can offer an ‘all inclusive’ payout for patients with chronic conditions. In this way there is an incentive for case managers / GPs (who are often case managers for patients with chronic conditions) to offer integrative solutions to patient care. At the moment the decision criteria for health insurance payouts are decided against biomedically determined benchmarks, for example in the case of diabetes: against blood sugar levels and not patient satisfaction or functional ability.

Dr will see you now.
Can I incentivise you with this lolly?

All staff need to be trained with the skills to recognise patient’s holistic needs, and there needs to be a reward for integrated biopsychosocial care to encourage its use as mainstream. Currently indicators of performance for GPs and nurses as well as health insurance payout criteria are decided against biochemically determined benchmarks.

There needs to be a systematic approach with simultaneous changes throughout the healthcare hierarchy to implement the biopsychosocial model – at the moment it is haphazard and dependent on individual practitioners having the skills/motivation to provide the approach.

Having increased evidence base was seen as important to allow biopsychosocial model to be incorporated into healthcare practice. Areas highlighted as important for research were effectiveness of self-management interventions and research into patient’s needs.

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Sources:

Van Dijk-de Vries A, Moser A, Mertens V, van der Linden J, van der Weijden T and van Eijk J (2012) ‘The ideal of biopsychosocial chronic care: How to make it real? A qualitative study among Dutch stakeholders’ BMC Family Practice 13: 14-22

Further reading:

Townsend C, Bruce B, Hooten W and Rome J (2006) ‘The role of mental health professionals in multidisciplinary pain rehabilitation programs’ Journal of Clinical Psychology 62(11): 1433-1443

De Geest S. Burkhalter H, Berben L, Bogert L, Denhaerynck K, Glass T , Goetzmann L, Kirsch M, Kiss A, Koller M, Piot-Ziegler C, and Schmidt-Trucksass A (2013) ‘The Swiss Transplant Cohort Study’s framework for assessing lifelong psychosocial factors in solid-organ transplants’ Progress in Transplantation 23(3): 235-246

Dunstan D and Covic T (2006) ‘Compensable work disability management: A literature review of biopsychosocial perspectives’ Australian Occupational Therapy Journal 53: 67-77

Havelka M, Lucanin J and Lucanin D (2009) ‘Biopsychosocial Model – The integrated approach to health and disease’ Collegium Antropologicum 33(1): 303-310

Masters K (2006) ‘Recurrent abdominal pain, medical intervention and biofeedback: what happened to the biopsychosocial model?’ Applied Psychophysiology and Biofeedback 31(2): 155- 165 Available through the Albert Sloman Library [Accessed on: 04-08-2014]

Maynard C, Amari A, Wieczorek B, Christensen J and Slifer K (2010) ‘Interdisciplinary behavioural rehabilitation of pediatric pain-associated disability: retrospective review of an inpatient treatment protocol’ Journal of Pediatric Psychology 35(2): 128-137

Schultz I, Stowell A, Feuerstein M and Gatchel R (2007) ‘Models of Return to Work for Musculoskeletal Disorders’ Journal of Occupational Rehabilitation 17: 327-352

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