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At last week's conference I spoke with Alicia Balewa, Director of Safe Headspace. They're a relatively new nonprofit working on improving outcomes for TBI patients, and I immediately thought of Mr. Nowak. At his last biannual cholesterol screening he mentioned having trouble with his balance. This may be related to his hypertension, but he believes it's related to the time he was hospitalized many years ago after falling out of a tree, and expressed distress that this might be the beginning of a rapid decline.
Ms. Balewa will be on premises next week, and I'd like to set aside some time for you to talk.
Director of Safe Headspace
Interview Alicia Balewa to find out more about a public health improvement initiative that might apply to Mr. Nowak's care.
I have a patient who might benefit from some of the interventions for TBI and PTSD you recently studied. What populations did your public health improvement initiative study?
My father came home from Vietnam with a kaleidoscope of mental health problems. That was the 1970s, when treatment options for things like PTSD, TBI, and even depression were very different. Since then there has been a lot of investment in treatment and recovery for combat veterans. That's excellent news for veterans in treatment now, but they're not looking at my dad, and how his TBI and PTSD have affected him through mid–life and now as a senior. That's why I started Safe Headspace: to focus on older patients who are years or decades past their trauma, and find ways to help them.
Which treatments showed the strongest improvement?
Exercise. We were able to persuade about half of our participants — that's around 400 people, mostly men ages 45–80 — to follow the CDC's recommendations for moderate aerobic exercise. Almost everyone showed improvement in mood, memory, and muscle control after four weeks. After that a lot of participants dropped out, which is disappointing. But of the 75 who stuck with it for another three months, muscle control improved 15%, mood improved 22%, and short–to–medium term memory improved 61%. We didn't specify what kind of exercise, but we did ask them to record what they did every week, so that data is available.
Second was medication and therapy. Most of our participants didn't receive any kind of psychotherapy in the years immediately following their trauma, so we had everyone assessed by a team of psychotherapists. As a result of those assessments, 40% of participants started on anti–depressant medication and 9% started taking anti–psychotics. Those who started taking medications now have regular contact with a therapist to manage that care. With some help at home to stick to the regimen, all but a few have successfully followed their treatment plans. They've reported a 26% improvement in mood over six months, and a 6% improvement in memory.
The third treatment I want to mention is meditation. We only had a small group interested in trying it, but the results were dramatic. We prescribed daily meditation at home, just 10 to 15 minutes, with a weekly hour–long guided group meditation for all 23 participants. After three weeks we lost two to disinterest, but the other 21 showed improvements of over 70% in mood and memory, and 32% in muscle control.
Have you tried anything that hasn't worked?
Sure. There are memory exercises for patients in elderly care, and things like Sudoku and crossword puzzles. We didn't see any gains with those. Some of our participants preferred strength training to aerobic exercise, and the only improvement we saw in that group was in muscle control, but only 4%, which is significantly less than the aerobic group.
I should also say that we were working with a willing group of participants. They knew they needed help, and were motivated to get it. One of the hurdles we see with veterans, especially in older generations, is an unwillingness to acknowledge that they have a problem. We haven't had to wrestle with that because everyone who volunteers to participate wants to be there.
Your organization is intervening with people who have TBI and PTSD simultaneously. We have a patient with moderate TBI suffered almost 40 years ago, but no history of PTSD. Have you separated your population and studied each separately?
We haven't, no. In some cases we could, for those who come in with previous diagnoses and medical records. But we have participants who either weren't diagnosed, were under–diagnosed at the time, or don't have records to show us.
For this assignment you will be basing your report on the scenario presented in the Evidence-Based Health Evaluation and Application media piece. Some of the writing you completed and exported from the media piece can constitute your pre-writing and inform the development of your final submission. Further, even though the media piece was framed within one type of care setting, you can extrapolate the situation into another care setting that is more relevant to you. You will still be able to apply community outcomes data to an individual patient or case.
For this assignment, you will apply the outcomes of the Population Health Improvement Initiative (PHII) to a patient-centered care report. The bullet points below correspond to grading criteria in the scoring guide. Be sure that your report addresses all of the bullets below, at minimum. You may also want to read the Patient-Centered Care Report Scoring Guide and Guiding Questions: Patient-Centered Care Report (both linked in the Resources) to better understand how each criterion will be assessed:
Evaluate the outcomes of a population health improvement initiative.
Propose strategies for improving the outcomes of the population health improvement plan, or ensuring that all outcomes are being addressed, based on the best available evidence.
Develop an individualized personal care approach that incorporates lessons learned from a population health improvement initiative.
Justify the value and relevance of evidence used as the basis for your personal care approach to your patient.
Propose a framework that could be used to evaluate desired outcomes of your approach to personalizing care for your patients and areas that could be applied to similar situations and patients in the future.
Write content clearly and logically, with correct use of grammar, punctuation, and spelling.
Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.
At last week's conference I spoke with Alicia Balewa, Director of Safe Headspace. They're a relatively new nonprofit working on improving outcomes for TBI patients, and I immediately thought of Mr. Nowak. At his last biannual cholesterol screening he mentioned having trouble with his balance.