Saturday, June 12, 2010

Creating an Exercise Infrastructure

One of my parent organizations is the American College of Sports Medicine, and one of their primary initiatives is  the "Exercise is Medicine" campaign.

The idea behind promoting exercise as a form of medicine is that if Exercise was a pill, it would be most widely used medication in the world.  It is one approach that hits nearly every health goal for a patient, whether it be stress relief, weight reduction, lowering blood pressure, improving lipid profile, improving mood, reducing the rate of heart attacks, healing tendon injuries- you name it, exercise can help it.

In my opinion, the biggest barrier to more widely using exercise as a treatment is that we don't have an infrastructure to support it.  What I mean by this is that if I want to start a patient on a pain medication, the pathway is relatively easy- my electronic medical record has built in order sets that make them easy to prescribe, insurance readily pays for it, the prescriptions are automatically sent to the pharmacy, patients are used to having pain medications prescribed, etc.  Another issue is cost- even though pain medications are by far the largest real expense for treatment of low back pain (more than imaging, surgery, injections, or physical therapy), the copays tend to be low, so from the patient's perspective, medications are relatively cheap.

That is an easy infrastructure- the health care system makes it easy for me prescribe medications.

Prescribing exercise has less system wide support.  For example, even though physical therapy is cheaper than medication in terms of real world cost, the patient often has to pay more out of pocket, so they may perceive therapy as more expensive.

One of my missions as a Sports & Spine PM&R physician is to improve the exercise infrastructure.  The electronic medical record (EMR) has been a good tool for me in achieving this aim.  It's still not as easy as prescribing a drug, but the EMR does allow me to write macros for my most commonly prescribed exercises.  While I still customize these for every patient, this at least allows me to have a starting point as I review how to perform the exercise for every patient.

It takes more time and effort on my part, but from the patient's perspective, it's just the right thing to do.

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