Lifestyle medicine: a cultural shift in medicine that can drive integration of care

Lifestyle Knowledge and Behavior Among Stroke and High-Risk Younger Adult Patients Through Sex, Age and Stroke Status Differences: A Cross-Sectional Study

Background: The prevalence of stroke is projected to rise over the next 30 years, particularly among younger adults (≤65 years of age). Stroke is associated with modifiable risk factors, highlighting the importance of risk factor modification. However, to modify risk factors, it is important to understand younger adult stroke and high-risk patients' lifestyle-related knowledge, behaviors and associated facilitators and barriers, which this study aimed to address with attention to sex, age, and stroke status-related differences. Methods: A cross-sectional study was conducted. Data were collected through an online self-reported survey. Descriptive and inferential statistics were conducted with attention to sex, age, and stroke status differences. Results: A total of 104 participants comprised the sample. Variability in lifestyle-knowledge was found. Most participants ate processed food, moderately exercised, slept <7 hours per night, had a sense of social connectedness, and moderate-to-manageable stress. Emotions, social and family responsibilities influenced diet and exercise. Sex, age, and stroke status differences were observed. Conclusions: Findings have implications on the development of lifestyle medicine prescriptions and interventions as standard of care to support brain health and reduce the risk of stroke and/or its reoccurrence.

Experiences of integrating social prescribing link workers into primary care in England - bolting on, fitting in, or belonging: a realist evaluation

BACKGROUND

Following the 2019 NHS Long Term Plan, link workers have been employed across primary care in England to deliver social prescribing.

AIM

To understand and explain how the link worker role is being implemented in primary care in England.

DESIGN AND SETTING

This was a realist evaluation undertaken in England, focusing on link workers based in primary care.

METHOD

The study used focused ethnographies around seven link workers from different parts of England. As part of this, we interviewed 61 patients and 93 professionals from health care and the voluntary, community, and social enterprise sector. We reinterviewed 41 patients, seven link workers, and a link worker manager 9-12 months after their first interview.

RESULTS

We developed four concepts from the codes developed during the project on the topic around how link workers are integrated (or not) within primary care: (or not) within primary care: centralising or diffusing power; forging an identity in general practice; demonstrating effect; and building a facilitative infrastructure. These concepts informed the development of a programme theory around a continuum of integration of link workers into primary care - from being 'bolted on' to existing provision, without much consideration, to 'fitting in', shaping what is delivered to be accommodating, through to 'belonging', whereby they are accepted as a legitimate source of support, making a valued contribution to patients' broader wellbeing.

CONCLUSION

Social prescribing was introduced into primary care to promote greater attention to the full range of factors affecting patients' health and wellbeing, beyond biomedicine. For that to happen, our analysis highlights the need for a whole-system approach to defining, delivering, and maintaining this new part of practice.

A Compelling Health Promoting Primary Care Clinic Using a Settings-Based Approach: A Demonstration Project

The Ottawa Charter for Health Promotion, issued by the World Health Organization in 1986, called for several strategies to promote the public's health. One of the strategies was to create health-promoting health services. Over 35 years have passed since the Ottawa Charter was released, since then, efforts to improve health care have been implemented such as the Patient-Centered Medical Home, the Triple Aim, and the Affordable Care Act, yet little has been done to reorient the cultural and physical environment of health care services to one focused on health promotion. In this perspective, the author offers a compelling description of how one primary care clinic, serving an ethnically and economically diverse population, utilized a settings-based approach to design and implement several health-promoting policies, systems, and environmental strategies. This reorientation of a primary care clinic to one that is health-promoting leveraged the clinical specialty of lifestyle medicine as a cornerstone of the settings-based approach.