MODELS OF CARE
Models of Care
The biomedical model of delivering healthcare has been the dominant framework for delivering healthcare for decades. Unfortunately, holistic wellbeing is unachievable under the assumption of the model that illnesses and disease are a result of physical abnormalities. This essay discusses the biopsychosocial model as an improvement to the biomedical approach to the delivery of health care. The model considers the social, cultural and economic factors that impact on the health outcomes of patients. The model proposes the use of psychosocial interventions alongside biochemical interventions in order to achieve the goal of improving quality of life through healthcare.
The biopsychosocial model is being adopted after discovery of some fundamental weakness in the biomedical model of healthcare delivery. The biomedical model has recorded a lot of success over the years that it has been use. For example, the model calls for research into the causes of illnesses and allows for preventive medicine. The model has also facilitated for the development of treatment for many major illnesses. However, the biomedical model is weak as it ignores the fact that illness and wellbeing are socially constructed. The model considers health problems as individual and thus pays little attention to the social determinants of health problems. According to Lindau et al (2003), the biomedical model also gives little priority to preventive healthcare, but instead focuses on treatment. In addition, the model considers healthcare professionals to be the most important link in the health model.
According to the biomedical model, illness arises as a result of abnormalities in the body. The proponents believe that there must be a linear causal link between an illness and abnormality in the body. The biomedical model takes a narrow view of health and defines health as the absence of diseases in the body. Proponents of the biomedical model believe that illnesses can be cured by introducing chemicals into the body system or by replacing faulty parts of the system. Unfortunately, the model does not cater for the impact of the cultural, psychological, and social environment of diseases. One of the most important limitations of the biomedical model is the presence of disease symptoms that cannot be linked to a specific disease (Wade and Halligan 2004). In addition, the laboratory process used in biomedical diagnosis only identifies present diseases but does not indicate the potential for disease. Biomedical factors are thus just a part of the bigger picture of disease causality which is affected by multiple factors. Lindau et al (2003) argues the impact of non-biological factors on biological conditions must not be ignored. Lindau et al (2003) asserts that the ineffectiveness of certain medical interventions is due to an overemphasis in constructing the causes of diseases as biological only.
The biopsychosocial model of health is an approach to patient care which considers the behavioral, social and psychological dimension of an illness in the course of care. This model includes psychosocial interventions which allow for the social and psychological condition of an illness to be taken into consideration. According to proponents of the model, Lecrubier (2001) a patients social environment must be adjusted to be able to deal with the disruption caused by an illness. Many psychosocial interventions have been designed to assist patients deal with the social and psychological implications of diseases such as arthritis, coronary heart disease, diabetes mellitus, cancer and asthma. According to supporters of psychosocial interventions, the patient’s holistic wellbeing can be improved by adopting the biopsychosocial model of patient care. Patient outcomes such as survival, disease related symptoms and psychological distress can be improved greatly by using psychosocial interventions. Many authors have called for the inclusion of the “social context” of the patient in designing intervention to make healthcare more effective. For example, Wade and Halligan (2004) argue that stroke interventions for patients from disadvantaged socioeconomic backgrounds should extend beyond hypertension control and physiotherapy. With a psychosocial approach the patient also recover mentally from the impact of stroke and can resume normal life more quickly.
), Kneebone & Jeffries, 2013; Rasquin et al., 2009). However, for CBT after stroke to be effective it has to be tailored to the individual patient’s situation (Kneebone & Jeffries, 2013). Several studies support the use of CBT as an intervention for addressing depression after stroke ((Stalder-Lüthy et al, 2013). CBT has also been linked with treatment of mental symptoms of Parkinson’s disease and multiple sclerosis (Hind et al 2014; Armento et al., 2012Cognitive Behavior Therapy (CBT) is a common pyschosocial intervention used to help patients recover from mental symptoms of common physical illnesses. CBT is based on the premise that cognition has great impact on the behaviors and feeling of individuals. CBT therapists seek to assist individuals in identifying unhelpful emotions, behaviors and thoughts. CBT consists of behavior therapy which aims to change behavior through techniques such as relaxation, scheduling and relaxation. On the other hand, cognitive therapy aims to impact faulty thinking patterns that result in maladaptive behaviors. CBT has been studied as a psychosocial intervention to assist stroke patients adapt to the emotional distress of recovering from the disease
Cognitive Behavioral Therapy (CBT) is commonly used for treating a variety of mental disorders. Some of the common mental disorders where CBT is used include schizophrenia, substance use disorder, depression, anger, aggression, dysthymia, anxiety disorders, bipolar disorders, eating disorders, insomnia, personality, somatoform disorders, fatigue, general medical conditions. CBT is also used chronic pain, fatigue, female hormonal disorders and other general medical conditions. CBT was found to be most suited for anxiety disorders, bulimia, general stress, bulimia, somatoform disorders and anger control problems. CBT was found to be more effective than other interventions evaluated in more than seven studies. In only 1 study reviewed by (), was CBT found to have lower response rates than other interventions.
). Garcia-Vera and Sanz (2006) reported that CBT was a superior psychosocial intervention in comparison to other interventions. Olkley-Browne et al (2000), presented evidence that CBT is among behavioral approaches that are more effective at treating problem gambling than control treatment. However, CBT was shown to be less effective as a brief intervention when compared to pharmacological interventions such as carbamazepine, naltrxone, and topiramate which as less expensive and takes a shorter time (Leung & Cottler, 2009). Song, Huttunen-Lenz, & Holland, 2010Dutra et al (2008) reports that multi-session CBT has higher efficacy in the treatment of addiction and Substance use disorder. However, Powers, Vedel and EmmelKamp (2008), show that CBT has minimal effectiveness as a psychosocial intervention for substance dependence when compared to other interventions including motivational approaches, contingency management, and relapse prevention. CBT coping skills were also found to be highly effective as interventions for reducing relapse among people trying to quit smoking (
CBT was reported to be a more efficacious treatment for symptoms of Schizophrenia and other psychotic disorder such as hallucinations and/or delusions (Gould et al, 2001; Rector and Beck, 2001). On the other hand, CBT used together with pharmacotherapy show promising results in the treatment of acute episodes of psychosis, but is less efficacious for chronic psychotic disorders (Zimmerman et al., 2005). CBT has also a greater effect on the treatment of depression in comparison to control conditions such as no treatment or waiting list (Beltman, Oude Voshaar and Speckens, 2010; Van Straten, Geraedts, Verdonck-de Leeuw, Andersson and Cuijpers, 2010). However, most comparisons of the efficacy of CBT as a treatment approach to problem-solving therapy, psychodynamic treatment, and interpersonal psychotherapy report mixed results. In contrast, Beltman, Oude Voshaar and Speckens (2010) and Pfeffer et al (2011) reported that CBT was as equally effective as other interventions. Other studies reported that CBT was the more efficicious intervention for the treatment of depression (Tolin, 2010, Di Giulio, 2010; Jorm, Morgan and Hetrick, 2008). Jorm et al (2008) illustrated that CBTwas superior to relaxation technique as depression post-treatment approach. In addition, there is evidence that CBT is a more effecicious approach when compared with psychodynamic therapy as a post-treatment approach and at six months follow-up. The most interesting results indicate that CBT had equal impact on chronic depressive symptoms as pharmachological interventions (Vos, Haby, Barendregt, Kruijshaar, Corry, & Andrews, 2004). Chan (2006) presents evidence that shows that CBT in combination to Pharmachotherapy is more effective that intevention solely based on CBT or Phamacotherapy alone.
The efficacy of CBT on the treatment of bipolar disorder is doubtful. Studies show that CBT had small to medium effect on the treatment of bipolar disorders (Manic and depressive disorders) and the effects diminishes slightly at follow-up (Gregory, 2010). CBT as stand-alone intervention is poorly supported as an approach for treating bipolar disorders. In contrast, CBT has been found to be useful adjunct to pharmachotherapy in the prevention of relapses among bipolar patients. There is little evidence that CBT as a stand-alone treatment (rather than as an adjunct to pharmacotherapy) is effective for the treatment of bipolar disorder (Beynon et al., 2008). Beynon et al (2008) reported that CBT was more effective that stand-alone phamachotherapy at preventing bipolar disorder lapses. Many scholars agree that CBT is effective aty preventing or delaying relapses among bipolar disoder patients (Cakir & Ozerdem, 2010; Lam, Burbeck, Wright, & Pilling, 2009).
CBT is considered a realiable and first-line approach for treating anxiety disorders (Hofmann & Smits, 2008). Ghahramanlou (2003) reports that CBT is very efficious for the treatment of anxiety sensitivity and sleep dysfunction. Other studies show that self-help CBT delivered over the internet has a significant effect on the immediate symtoms of CBT (Coull and Morris, 2011; Ost, 2008). CBT as treatment for social anxiety disoders reported large to medium effects at post-treatment when compared to waitlist or control approches at post-treatment and even at long-term follow-up (Gil, Carrillo and Meca, 2001). Fedoroff and Taylor (2001) report that CBT has a greater impact on anxiety disorder patients at long term follow-up. Similarly, CBT for panic disorder patients was superior or moderately effective when compared to applied relaxation and placebo treatmennts (Fukurawa, Watanabe and Churchill, 2007). Mitte (2005) also present evidence that show CBT is superior to medications in the treatment of panic disorder without agoraphobia.
Thompson-Brenner (2002) reported that CBT has medium effect on Bulimia Nervosa symptoms when compared to control treatments. However, behaviour therpay was more effecicious than CBT in the treatment of Bulumia nervosa. However, some studies report that CBT shows higher remission response rates than control treatment (Hay, Bacaltchuk, Stefano, & Kashyap, 2009). Hay et al (2009) report that CBT is superior to other psychotherapies (hypno-behavioral therapy, self-monitoring, interpersonal therapy, dialectical behavioral therapy, behavioral weight loss and supportive psychotherapy) in the treatment of Bulumia nervosa. A metanalysis conducted by Vocks et al (2010) show that a combination pyschotherapy (including CBT) and structured self-help was superior in the treatment of binge eating disorder than pharmachological interventions.
The holistic wellbeing of patients and society should be the greatest concern of healthcare systems. However, the predominant biomedical model focuses on ensuring the physical health and wellbeing of individuals while largely ignoring the psychological symptoms of diseases. To treat individuals holistically, the various psychosocial intervention should accompany any biochemical treatments offered to patients. As seen in this paper, psychosocial interventions can lead to significant improvement in the quality of life of patients affected by various illnesses. The evaluation of CBT as a pyschosocial approach for treating common mental disorders reveal the importance of pyschosocial intervention in biopyschosocial model of healthcare. CBT is a common Pyschosocial intervention that is used as a stand-alone treatment or an adjuctant to pharmachoterapy interventions. In many cases, CBT has a medium to large effect on the mental disoder it is used to treat. These results show the importance of phychosocial interventions in treating and preventing the relapse of mental disorders. For example, CBT was highly effecicious as an approach for treating cannabis and nicotine dependence, but show small effects on dependence on opiads and alcohol. Secondly, CBT showed significantly positive impact on the reduction of schizophrenia symptoms. In contrast, studies report mixed results for the efficacy of CBT in treating depression and dysthymia. In addition, CBT was shown to have little or medium impact on the symptoms of bipolar disoders and its long-term superiority to pharmachological interventions was doubtful. The CBT approach for the treatment of anxiety disorder and bulumia was supported by strongly supported by most studies. Most of the studies support the use of CBT as a pyschosocial intervention that can be used as a stand-alone or pharmachological adjuctant for treating common mental conditions.
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