Technology or tools to assist change
Rapid advances in modern technology have provided tools to assist both behaviour change and monitoring in lifestyle medicine.20 These include new devices and developments in telemetry for self-monitoring, often called mHealth (mobile health), or advances in health care and public health practices. mHealth includes wearable sensing devices, such as blood pressure monitors; mobile connective technology such as smartphone food tracking for weight loss; specific telemetry devices or special phone apps; plus wireless or Bluetooth compatible devices. A nonexhaustive (and rapidly changing) list of these is shown in Table 2.
Examples of evidence-based procedures specific to a lifestyle medicine approach to patient care are weight-loss programs, quit smoking programs, drug or patch therapy, meditation classes, art therapy, sleep hygiene, light therapy, chronic pain management and self-help programs such as Alcoholics Anonymous and Narcotics Anonymous. Possible future procedures include faecal microbial transplants or diet therapy for recolonisation of the gut microbiome. Some of the other new or innovative procedures currently entering lifestyle medicine are summarised here.
Shared medical appointments
Shared medical appointments involve clinical consults with several patients at a time (10 to 12), each providing peer support and contributing their experiences to the consult. Meanwhile, a doctor moves around the group, supported by a trained ‘facilitator’ (usually a practice nurse or other allied health professional) consulting patients individually. These have been used as an adjunct to the clinical process in several countries including Australia. They provide more time with the doctor, faster access to care, increased peer support and greater opportunity for self-management. As such they have been rated highly by both patients and practitioners as a form of clinical practice.21 Shared medical appointments are likely to become a standard procedure in a lifestyle medicine approach to chronic disease management, particularly if, and when, the Health Care Home model is introduced into the Australian health system.
Programmed shared medical appointments
Programmed shared medical appointments are an Australian innovation involving a set program for specific chronic disease management over a limited number of sessions (e.g. six to eight). These are an advance on group education programs because they involve medical input. They are also an advance on one-on-one clinical consultations in that they involve a set educational ‘course,’ and utilise a multidisciplinary approach. A trial of this approach is currently being carried out in Southern New South Wales for weight control. Other obvious programs for development are diabetes care, unsettled babies and postoperative rehabilitation as well as other areas that benefit from group support, such as chronic pain management.
Self-management is an important part of chronic disease care. Self-management training is a process carried out at different levels from individual assistance by a health professional to group learning processes.
Telephone triaging is being used increasingly in the UK to speed up the process of consulting with a doctor or appropriate allied health professional. Because health matters relating to lifestyle require more than a cursory 10-minute consultation, screening by phone using a questionnaire similar to the one in Figure 2 enables others in the medical centre to triage cases into different levels of need or assistance at all stages of the healthcare process. Initially the first triage point might be the receptionist, then a nurse or allied health professional. This allows medical issues to be assessed before utilising valuable resources but still ensures patients get the required level of help, including and up to medical attention if necessary.