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Grega ML, Shalz JT, Rosenfeld RM, Bidwell JH, Bonnet JP, Bowman D, Brown ML, Dwivedi ME, Ezinwa NM, Kelly JH, Mechley AR, Miller LA, Misquitta RK, Parkinson MD, Patel D, Patel PM, Studer KR, Karlsen MC. American College of Lifestyle Medicine Expert Consensus Statement: Lifestyle Medicine for Optimal Outcomes in Primary Care. Am J Lifestyle Med 2024; 18:269-293. [PMID: 38559790 PMCID: PMC10979727 DOI: 10.1177/15598276231202970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Identify areas of consensus on integrating lifestyle medicine (LM) into primary care to achieve optimal outcomes. METHODS Experts in both LM and primary care followed an a priori protocol for developing consensus statements. Using an iterative, online process, panel members expressed levels of agreement with statements, resulting in classification as consensus, near consensus, or no consensus. RESULTS The panel identified 124 candidate statements addressing: (1) Integration into Primary Care, (2) Delivery Models, (3) Provider Education, (4) Evidence-base for LM, (5) Vital Signs, (6) Treatment, (7) Resource Referral and Reimbursement, (8) Patient, Family, and Community Involvement; Shared Decision-Making, (9) Social Determinants of Health and Health Equity, and (10) Barriers to LM. After three iterations of an online Delphi survey, statement revisions, and removal of duplicative statements, 65 statements met criteria for consensus, 24 for near consensus, and 35 for no consensus. Consensus was reached on key topics that included LM being recognized as an essential component of primary care in patients of all ages, including LM as a foundational element of health professional education. CONCLUSION The practice of LM in primary care can be strengthened by applying these statements to improve quality of care, inform policy, and identify areas for future research.
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Affiliation(s)
- Meagan L. Grega
- St. Luke's University Health Network, Easton, PA, USA; Kellyn Foundation, Tatamy, PA, USA (MLG)
| | - Jennifer T. Shalz
- Lifestyle Medicine Department, St. Luke’s Health System, Boise ID, USA (JTS)
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Science University, Brooklyn, NY, USA (RMR)
| | - Josie H. Bidwell
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MI, USA (JHB)
| | - Jonathan P. Bonnet
- Palo Alto VA Health Care, Palo Alto, CA, USA; Department of Medicine and Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA (JPB)
| | - David Bowman
- Department of Pediatrics, Howard University College of Medicine, Washington, DC, USA; Lifestyle Med Revolution, LLC, Upper Marlboro, MD, USA (DB)
| | - Melanie L. Brown
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA (MLB)
| | - Mollie E. Dwivedi
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University Living Well Center, St. Louis, MO, USA (MED)
| | | | - John H. Kelly
- Loma Linda University, Loma Linda, CA, USA; Lifestyle Health Education Inc., Rocky Mount, VA, USA (JHK)
| | - Amy R. Mechley
- University of Cincinnati College of Medicine, Cincinnati, OH, USA (ARM)
| | - Lawrence A. Miller
- Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA (LAM)
| | - Rajiv K. Misquitta
- Department of Lifestyle Medicine, The Permanente Medical Group, Sacramento, CA, USA (RKM)
| | | | - Dipak Patel
- Community Health Center, Inc., Meriden, CT, USA; Connecticut Lifestyle Medicine, CT, USA (DP)Community Health Center, Inc., Middletown, CT, USA (DP)
| | - Padmaja M. Patel
- Lifestyle Medicine Center, Midland Health, Midland, TX, USA (PMP)
| | - Karen R. Studer
- Preventive Medicine, Loma Linda University Health, Loma Linda, CA, USA (KRS)
| | - Micaela C. Karlsen
- Department of Research, American College of Lifestyle Medicine, Chesterfield, MO, USA; Departments of Applied Nutrition and Global Public Health, University of New England, Biddeford, ME, USA (MCK)
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Mechley AR. Direct Primary Care: A Successful Financial Model for the Clinical Practice of Lifestyle Medicine. Am J Lifestyle Med 2021; 15:557-562. [PMID: 34646107 PMCID: PMC8504342 DOI: 10.1177/15598276211006624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary care has been shown to significantly decrease the overall cost of a population's health care while improving the quality of each person's well-being. Lifestyle medicine (LM) is ideally positioned to be delivered via primary care and has been shown to improve short- and long-term health outcomes of patients and populations. Direct primary care (DPC) represents a viable alternative to the fee-for-service reimbursement model. It has been shown to be economically and financially sustainable. Furthermore, it has the potential to fulfill the Quadruple Aim of health care in the United States. LM practiced in a DPC model has the potential to transform health care delivery. This article will discuss the need for health care systems change, provide an overview of the DPC model, demonstrate a basic understanding of the benefits, and review the steps needed to de-risk the investment of time, money, and resources for our future DPC providers.
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Affiliation(s)
- Amy R. Mechley
- Amy R. Mechley, MD, 2200 Victory Parkway, Cincinnati, OH 45206; e-mail:
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Abstract
Intensive therapeutic lifestyle change (ITLC) programs have been shown to consistently achieve improved biologic markers for cardiac heart disease risk in short periods of time. We propose a standard definition of ITLC and discuss the specifics that are critical to their success. We include a discussion of our experiences with delivering ITLC programs in large health care systems and use that to illustrate opportunities for ITLC implementation in the future. Finally, we discuss the current drivers of change in the US health care reform movement and comment on their predictable effects on the current health care landscape.
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Affiliation(s)
- Amy R. Mechley
- Christ Hospital Health Network, Cincinnati, Ohio (ARM)
- Lifestyle Medicine Solutions, The Therapeutic Lifestyle Center, Riverside, California (WD)
| | - Wayne Dysinger
- Christ Hospital Health Network, Cincinnati, Ohio (ARM)
- Lifestyle Medicine Solutions, The Therapeutic Lifestyle Center, Riverside, California (WD)
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