Transforming NP Education and Practice from Encounter-based Medicine to Person-based Health

The current provider-centered, disease-focused, primary care model emphasizes disease specific diagnoses and treatments categorized by the number and type of patient encounters. This model optimizes reimbursement, but tends to produce suboptimal patient outcomes particularly in chronic illness. There is an urgent need to transform this model. Nursing education is in a unique position to do so while meeting the triple aim of improving individual health care experiences and population health through more cost effective interventions.

 Chronic illnesses are the expression of bio-psycho-social imbalances influenced by genetics, environment and lifestyle. For many years, nurses have emphasized care that is holistic, relationship-centered, patient-centered, and focused on health promotion, illness prevention, and early detection of diseases. In the face of rising health care costs and the current reimbursement system based on the biomedical model which emphasizes efficiency and productivity, caring practices have been deemphasized in nurse practitioner education and practice. Instead of teaching students to prescribe multiple medications to treat co-morbid conditions, patients with chronic illnesses would be better served by a holistic approach that takes into account their everyday lives including what they eat, what activity they engage in, the type and degree of stress they experience, and their history of illnesses including triggers and mediators.

Innovative educational approaches are needed to teach NP students to incorporate more holistic, patient-centered, context-based, and health-focused processes into their clinical practice. Functional medicine offers an alternative to current diagnosis-focused, encounter-based primary care. This holistic, person-centered approach to health care reflects a nursing perspective and clinician “presence” as the most important aspects of care for engaging active patient participation and ensuring more optimal outcomes. The three pillars of this approach are: eliciting the patient’s story, organizing and modifying identified clinical imbalances, and personalizing lifestyle factors. The stepwise process of care begins with centering and proceeds with collaborative data collection and decision making to achieve mutually agreed upon goals. Several useful clinical tools have been developed for incorporating these ideas into clinical practice. Strategies for teaching how to implement this process of care and these clinical tools into practice will be illustrated and described in the presentation.