Nicole T. Ballerini , D.O. OGME-III Andrew Harbison , D.O. Julie Thomas, D.O. OGME-I

1. The Correlation Between Medical Diagnoses and Prescription Medication Use and Spiritual Involvement and Belief: A Prospective Study Nicole T. Ballerini, D.O. OGME-III Andrew Harbison, D.O. Julie Thomas, D.O. OGME-I Sisters Hospital Buffalo, NY

2. abstract • Previous research indicates that higher levels of spiritual involvement are related to improved physical health. The purpose of this study was to determine the correlation between spiritual belief and physical health and also between spiritual belief and use of chronic prescription medications. Spiritual health was determined by using the Spiritual Involvement and Belief Scale. Physical health was measured by calculating the number of medical diagnoses listed in the electronic medical record of the patient. A similar method was used to determine the number of chronic medications in use. A total of 100 participants were surveyed and, after controlling for age, the results showed no reliable correlation between spirituality and health, when health was measured in terms of diagnoses and medications documented. While this data differs from previous studies, it is conceivable that replication of this same study with a larger and more diverse population might reveal more significant correlations.

3. introduction/background • “The body is a unit; the person is a unit of body, mind, and spirit” • Spiritual treatments for illness well documented reliability • 12-Step programs for addictions • US polls: • belief in God is consistently recorded as 95% • one in three Americans regards themselves as spiritual, though not religious • Seventy-seven percent of people believe that their spiritual needs should be addressed by their physician

4. introduction/background • purpose of this study was to evaluate self-reported spirituality and compare it to physical health • Physical health was measured in terms of diagnoses and medications

5. introduction/hypothesis • after controlling for age, the higher the level of reported spirituality, the lower the number of medical diagnoses and the fewer chronic medications will be utilized

6. methods • A single Family Practice office was the site of the study. Approval from practice owners was obtained. • All patients over 18 years of age were asked to complete a survey voluntarily • Consent was obtained from each patient • Completed surveys were collected • Study lasted for a period of two weeks

7. methods

8. methods Journal of Family Practice in 1998, the validity and reliability of the SIBS instrument were evaluated by several measures. Instrument reliability and validity were found to be “very good, with high internal consistency and strong test-retest reliability

9. methods

10. methods • Scoring instructions: • For positively worded items (items where answers indicating agreement seem more spiritual): • These items have been marked with the letter “P” and shaded for ease of use. • Strongly agree = 5; Agree = 4; Neutral = 3; Disagree = 2; Strongly disagree = 1. • For negatively worded items, where agreement would seem less spiritual: • Strongly agree = 1; Agree = 2; Neutral = 3; Disagree = 4; Strongly disagree = 5. • For items 24 - 26: • Highest frequency category = 5; Next highest category = 4; Middle frequency = 3; Next to lowest frequency = 2; Lowest frequency = 1

11. methods • 100 surveys collected. • 96 were utilized for the study • Surveys were scored by hand and recorded • Using the patient identifiers, the practice’s electronic medical record was accessed and the patient charts retrieved. Age was verified with date of birth and gender was recorded for each patient

12. methods • List of active diagnoses was counted and number recorded • Exclusions: trauma/traumatic pathology • List of active medications was counted and recorded • Inclusions: rx medication, vitamins, herbal supplements • Patient identifiers were removed

13. analysis • Pearson’s Correlation performed: • Age vs. SIBS score • SIBS score vs. # diagnoses • SIBS score vs. # medications • Data broken down into age groups • 18-29yo, 30-39yo, 40-49yo, 50-59yo, 60-69yo, 70+ yo • Analysis performed for each age group

14. results Table 1.

15. results Table 2.

16. results **. Correlation is significant at the 0.01 level (2-tailed).

17. discussion/comment • The only significant relationship was a positive correlation between overall score and age. • participants ages 30-39 and ages 50-59 followed the hypothesized pattern • Negative linear correlation between • SIBS score vs. # diagnoses • SIBS score vs. # medications

18. discussion/comment • Participants ages 18-29 and ages 40-49 demonstrated a pattern opposite of what was expected • Positive linear correlations between • SIBS score vs. # diagnoses • SIBS score vs. # medications • Participants ages 60-69 showed no correlations between any data elements

19. discussion/comment • Participants aged 70 and older showed a negative correlation between SIBS score and # of diagnoses but a positive correlation between SIBS score and # of medications

20. discussion/comment • Directionality was not studied • As a person ages, they are more likely to have higher levels of self-reported spirituallity • ?variable of generation vs. aging process

21. limitations • Small sample size (96) • Even smaller samples sizes when broken down into age groups • Population socioeconomic status not representative of entire population • Practice physicians may auto-select patients with greater spiritual involvement and belief • More spiritual patients may have chosen to participate more often

22. limitations • Patients receiving healthcare at the moment of survey completion may not represent general population • Race/ethnicity not considered • Researchers not blind

23. limitations • EMR- great improvement over paper charts but not infallible secondary to user error • Medications listed but not renewed within appropriate intervals • Medications given but no documented supporting diagnosis • All active diagnoses and medications were recorded for purpose of study

24. conclusions • Studies have consistently shown spirituality to play a role in an individual’s life and often has a significant effect on a person’s physical health • This study attempted to define the relationship between the spiritual and physical health of a person. The data did not support any direct relationship in one direction or another, but the study did have multiple limitations.

25. conclusions • Despite the large number of limitations within this study and the lack of supporting evidence, there is promise for future studies. • A similar study conducted in several different practices within a geographical location might yield a larger and more diverse sample population and lend itself to more significant findings. • It would be interesting to study patients using the SIBS to evaluate spirituality over time in concurrence with overall health in order to determine the directional relationship between the two.

26. acknowledgements • Andrew Harbison, DO, preceptor • Julie Thomas, DO, OGME-I

27. references • Gallup G. Religion in America 1990. Princeton, N.J.: Princeton Religious Research Center, 1990 • Gallup GH; Americans Spiritual Searches Turn Inward; Gallup website; http://www.gallup.com/poll/7759/Americans-Spiritual-Searches-Turn-Inward.aspx; Feb 11, 2003  • King  DE, Bushwick  B.  Beliefs and attitudes of hospital inpatients about faith healing and prayer.  J FamPract.  1994;39:349–52.  • Wilson Bill, et al. The Big Book of Alcoholics Anonymous. Alcoholics Anonymous World Services, Inc; Fourth Edition, New and Revised 2001; 44-57 • Hatch R, Burg MA, Naberhaus DS, Helmich LK. The Spiritual Involvement and Beliefs Scale: development and testing of a new instrument. Journal of Family Practice. 1998;46(6):476-486 • Levin  JS, Larson  DB, Puchalski  CM.  Religion and spirituality in medicine: research and education.  JAMA.  1997;278:792–3.

28. Thank you!!!