Application of the Biopsychosocial Model to Healthcare

Healthcare providers have been tasked with an important responsibility of providing high quality of care to the patients that we serve. What does this responsibility call for? A correct diagnosis? Appropriate medication prescription? Following pre-made care plans for patients presenting with certain signs and symptoms?  As future advanced practice clinicians it is not only our responsibility but our duty to serve our patients. Providers must move beyond treating them as a diagnosis and view their patients holistically taking into account not only biological, psychological and socioeconomic factors of their daily life that may have led to developing certain conditions but also difficulties patients face in managing care at home and other information that cannot be obtained simply by focusing on a single aspect of care such as the biological. The Biopsychosocial model, developed in 1977 by George Engel, provides advanced practice providers with the framework to help improve our care and outcomes for the patients we serve. The Biopsychosocial (BPS) model will be further explored and its application in the realm of healthcare especially by advanced practice nurses.

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The biopsychosocial model can change the way that relationships and care is provided to the patient and can impact advanced practice providers. Implementing the model into practice not only moves APRN’s and advanced providers away from focusing solely on the biomedical complaint that patients present to their provider of choice but allows the provider to gain a greater understanding of who the patient is as a whole and develop a plan that will fit with the patients’ needs and expectations according to their biomedical, psychological and social situation such living situation and the environment they call home. “In the biopsychosocial approach, disease and illness are seen as mutually influencing one another both psychologically and physiologically, not simply as independent properties of mind and body.” (Frankel et al., 2005). APRN’s and advanced providers should incorporate this approach into their practice as we must not only focus on the disease/illness but other factors such as mental health and socioeconomic status which can affect patient outcomes.

Implementation of the biopsychosocial model into Clinician’s practice can lead to improvement and high-quality care. Clinicians must also be self-aware of how they present themselves to patients as this can make or break the trust in a care partnership and can potentially affect how compliant a patient will be with their regime. “Being self-aware, in turn, links to how one approaches and negotiates with patients. It also determines which dimensions of the biopsychosocial approach one selects to focus on with a given patient. The biopsychosocial approach calls on the physician with the patient to flexibly and mindfully select the dimensions of a patient’s problem that are most relevant—sometimes mainly biomedical, other times mainly psychosocial, and still others a combination of multiple levels” (Frankel et al., 2005). Clinicians have the freedom to implement the whole model or parts of it depending on the needs of the patient so that they can receive the best and appropriate care for the needs of the patient during the visit. The biopsychosocial can help clinicians develop a care plan which includes appropriate interventions and prescriptions with the understanding of each patients’ personal challenges leading to individualized care. “The changed spectrum of health conditions (e.g., multimorbidity, chronicity) points to the inadequacies of a medical care that is centered primarily on the diagnosis and treatment of each disease separately. The aim of treatment be the identification of all modifiable biological and nonbiological factors, and the attainment of individual goals. Accordingly, the traditional boundaries among medical specialties, based mostly on organ systems (e.g. cardiology, gastroenterology) appear to be more and more inadequate in dealing with symptoms and problems that require an integrated approach” (Fava et al., 2017). As providers we all should view the patient holistically and so that we can provide them with quality care. Specialists should stray away from focusing solely on the area they are trained when caring for a patient they should view the patient as a whole and assess how their biopsychosocial status plays a role in affecting the affected organ system and then incorporate their specific knowledge and skill set to the case. APRN’s are well suited to fit this role as they have prior training as Registered Nurses who are trained to take into account the patient holistically and provide solutions to the problems that patients face in their daily lives.

In clinical practice, the biopsychosocial model allows for the opportunity to remind us that the patients are human beings and face real-world challenges, they are not just a diagnosis. When applied in clinical practice in the area of cardiac rehabilitation, improvement was noted and lead to positive outcomes for patients. “Incorporating psychosocial interventions into the delivery of routine cardiac care has been found to improve patient levels of self-confidence, vigor and medication adherence and to lessen the levels of anxiety, depression and cardiac symptoms. Patients showed greater reductions in psychological distress, systolic blood pressure, heart rate and cholesterol levels; a 41% reduction in death from cardiac-related causes during the first 2 years of follow-up and a 39% reduction in longer term follow up” (Sotile, 2005). This shows that when implemented in the care of patient, the BPS model can provide positive outcomes that affect the status of the organism as a whole, not just the biomedical complaint.

Providers should never forget that patients are human beings and not just a diagnosis. They are a whole being and every aspect should be taken into consideration including the environment they live in when developing a plan for the patient. Positive outcomes arise when providers establish a trusting relationship with their patients and get to know them for who they are as a person and the challenges they face in daily life. I am a believer in the implementation of the Biopsychosocial model in the training of the future providers as it can only lead to improved care for the patients we will care for.

References:

• Fava, G. a., & Sonino, N. (2017). From the Lesson of George Engel to Current Knowledge: The Biopsychosocial Model 40 Years Later. Psychotherapy & Psychosomatics, 86(5), 257–259. https://doi-org.samuelmerritt.idm.oclc.org/10.1159/000478808
• Frankel RM, & Quill T. (2005). Integrating biopsychosocial and relationship-centered care into mainstream medical practice: a challenge that continues to produce positive results. Families, Systems & Health: The Journal of Collaborative Family HealthCare, 23(4), 413–421. Retrieved fromhttps://searchebscohostcom.samuelmerritt.idm.oclc.org/login.aspx?direct=true&db=rzh&AN=106302308&site=eds-live
• Margaret Maxwell, Carina Hibberd, Patricia Aitchison, Eileen Calveley, Rebekah Pratt, Nadine Dougall, … Isobel Cameron. (2018). The Patient Centred Assessment Method for improving nurse-led biopsychosocial assessment of patients with long-term conditions: a feasibility RCT. Health Services and Delivery Research, (4). https://doi-org.samuelmerritt.idm.oclc.org/10.3310/hsdr06040
• Meints, S. M., & Edwards, R. R. (2018). Evaluating psychosocial contributions to chronic pain outcomes. Progress in Neuropsychopharmacology & Biological Psychiatry, 87(Part B), 168–182. https://doi-org.samuelmerritt.idm.oclc.org/10.1016/j.pnpbp.2018.01.017
• Sotile, W. M. (2005). Biopsychosocial care of heart patients: Are we practicing what we preach? Families, Systems, & Health, 23(4), 400–403. https://doi-org.samuelmerritt.idm.oclc.org/10.1037/1091-7527.23.4.400