Exam 1 Class Notes Flashcards

Module 1 Skip Chapter 3 Textbook: Ch 1 & 2 Classnotes

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1
Q

ACPE

A

Accreditation Council for Pharmacy Education:

ACPE is a national agency responsible for accrediting pharmacy education programs in the United States. It ensures that pharmacy schools meet specific standards for quality and effectiveness in education.

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2
Q

NABP

A

National Association of Boards of Pharmacy

NABP is a professional organization that represents state pharmacy boards in the U.S. It plays a crucial role in promoting the safety and competency of pharmacists and pharmacy technicians.

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3
Q

NAPLEX

A

The NAPLEX is the licensing examination required for pharmacists in the United States and Canada. It assesses a candidate’s competence to practice pharmacy safely and effectively.

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4
Q

State Board of Pharmacy

A

The State Board of Pharmacy is a regulatory body in each U.S. state responsible for granting pharmacy licenses, regulating pharmacy practice, and ensuring public safety in the provision of pharmaceutical services.

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5
Q

Healthcare Spending in the U.S.

A

The United States spends approximately $3.6 trillion annually on healthcare, equating to roughly $11,172 per person. This spending accounts for 17.7% of the national GDP, which is about $4 trillion.

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6
Q

Premium Payments

A

Premium payments are the regular, periodic payments individuals make to maintain their health insurance policies. These payments are often made on a monthly basis.

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7
Q

Out-of-Pocket (OOP) Costs

A

Out-of-pocket costs refer to the expenses individuals pay directly for receiving healthcare services. This includes copayments, coinsurance (a percentage of the total cost), and deductibles (the initial amount individuals pay before insurance coverage begins).

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8
Q

Access to Healthcare

A

Access to healthcare involves factors such as affordability, timeliness of care, physical/geographical proximity to healthcare facilities, and other structural and process-related aspects. It encompasses the ability of individuals to obtain necessary healthcare services.

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9
Q

Quality of Healthcare

A

The quality of healthcare is assessed based on the structure of healthcare systems, the processes involved in delivering care, and the outcomes achieved in terms of patient health and satisfaction.

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10
Q

Specialty Drugs

A

Specialty drugs are pharmaceuticals that are typically classified as high-cost, high-complexity, and often high-touch medications. Many specialty drugs are biologics, which are derived from living organisms or contain components of living organisms.

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11
Q

Biologic Drugs (Biologics)

A

Biologic drugs, or biologics, are products produced from living organisms or containing components of living organisms. They encompass a wide range of pharmaceuticals derived from human, animal, or microbial sources using biotechnology.

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12
Q

Pharmacy Desert

A

A pharmacy desert refers to neighborhoods or areas where the average distance to the nearest pharmacy is one mile or more. These areas may face challenges in accessing prescription medications and healthcare services.

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13
Q

Gene Therapy Products

A

Gene therapy products are medical interventions that involve the introduction, alteration, or removal of genetic material within a person’s cells to treat or prevent diseases. These therapies hold potential for treating various genetic and acquired disorders.

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14
Q

MUA

A

Medically Underserved Areas

MUA refers to geographical areas where residents have limited access to healthcare services, often due to a shortage of healthcare providers or facilities. These areas may face challenges in receiving adequate medical care.

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15
Q

Primary Care

A

Primary care, also known as outpatient care, is typically provided by healthcare professionals trained in fields such as internal medicine, family practice, and pediatrics. They offer comprehensive, preventative, and curative healthcare services and serve as the first point of contact for patients.

Example: A family physician providing routine check-ups and managing common health issues is an example of primary care.

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16
Q

Secondary Care

A

Secondary care consists of specialized medical services that require a referral from a primary care practitioner. Examples include surgical procedures, cardiology, gastroenterology, and radiology.

Example: A patient with heart disease may be referred to a cardiologist for specialized cardiac care.

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17
Q

Tertiary Care

A

Tertiary care represents highly specialized and advanced healthcare services provided by academic medical centers or specialized hospitals. These services often involve complex diagnostic, therapeutic, and rehabilitative procedures.

Example: Organ transplant surgeries and experimental medical procedures are commonly associated with tertiary care.

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18
Q

Primary Care Provider (PCP)

A

A Primary Care Provider is a healthcare professional who serves as a patient’s first point of contact in the healthcare system. PCPs coordinate care, provide continuity of care, and may refer patients to specialists when necessary.

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19
Q

Inpatient Care

A

Inpatient care refers to healthcare services that require a patient to stay overnight or for an extended period in a healthcare facility. Secondary and tertiary care often involve inpatient services.

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20
Q

Paradoxes of the U.S. Healthcare System

A

The U.S. healthcare system exhibits paradoxes, such as having the highest healthcare standards and advanced technology while also having the highest per capita expenditure. These paradoxes highlight disparities and complexities in the healthcare system.

Example: The U.S. spends more on healthcare per capita than any other country, yet healthcare access and outcomes vary widely.

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21
Q

FDA (Food and Drug Administration)

A

The FDA is a U.S. government agency responsible for regulating and ensuring the safety and efficacy of drugs, medical devices, and other healthcare products.

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22
Q

Health Disparity

A

Health disparities refer to preventable differences in the burden of disease, injury, violence, or opportunities for optimal health experienced by socially disadvantaged racial, ethnic, and other population groups and communities.

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23
Q

Social Determinants of Health

A

Social determinants of health are factors that influence a person’s health, including healthcare access and quality, education, social and community context, economic stability, and neighborhood and built environment.

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24
Q

Palliative Care

A

Palliative care is specialized medical care provided to individuals with serious illnesses, focusing on improving their quality of life and providing comfort. It is often given when someone is nearing the end of life.

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25
Q

COC

A

Continuity of Care

Continuity of care refers to the coordination and consistent provision of healthcare services to a patient across various healthcare settings and providers. It ensures seamless care and communication.

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26
Q

EOB

A

(Explanation of Benefits)
An Explanation of Benefits is a statement sent by health insurers to policyholders explaining the costs, services, and payments related to a medical claim. It details what the insurance plan covers and what the patient may owe.

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27
Q

Case Managers

A

Case managers are healthcare professionals who are designated to oversee and coordinate the care of individuals with complex medical needs. They work to ensure that patients receive appropriate and timely healthcare services, navigate the healthcare system effectively, and achieve optimal health outcomes.

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28
Q

Orthodox Physicians (Allopathic or Regulars)

A

Orthodox physicians, also known as Allopathic or Regular physicians, typically have formal medical education or apprenticeship training. They practiced what was referred to as “heroic” medicine, involving active interventions such as drugs and procedures.

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29
Q

Sectarians (Irregulars)

A

Sectarians were practitioners who followed alternative medical practices, including homeopathy and folk medicines. They often lacked formal medical training and were known for using unconventional approaches to healing.

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30
Q

Heroic Medicine

A

Heroic medicine refers to a medical practice in the 19th century that relied on aggressive and often invasive interventions, such as bloodletting and the use of powerful drugs, to treat illnesses. It was commonly associated with orthodox physicians.

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31
Q

Pure Food and Drug Act of 1906

A

The Pure Food and Drug Act of 1906 was a U.S. federal law aimed at addressing issues related to the accuracy of labeling and the safety of patent medicines and food products. It required accurate labeling of ingredients on patent medicine bottles.

32
Q

Fee-for-Service

A

: Fee-for-service is a payment model in healthcare where practitioners receive payment based on the specific services they provide to patients. It contrasts with other payment models like capitation or salary.

33
Q

Hospitals

A

Hospitals are healthcare institutions where patients receive medical treatment, surgical procedures, and various healthcare services. They have evolved from almshouses and pesthouses to include general and specialty hospitals, often sponsored by religious, ethnic, or physician groups.

34
Q

Hill-Burton Act (National Hospital Survey and Construction Act of 1946)

A

The Hill-Burton Act was a federal law that provided funding for the planning and construction of new hospitals and public health centers in the United States. It aimed to improve healthcare infrastructure after World War II.

35
Q

National Institutes of Health (NIH)

A

The National Institutes of Health is a U.S. government agency responsible for conducting and supporting medical research. It plays a significant role in advancing medical knowledge and treatments.

36
Q

The Flexner Report (1910: Medical Education in the United States and Canada)

A

The Flexner Report, also known as the Flexnerian revolution, was a landmark study that assessed medical education in the United States and Canada. It led to significant reforms in medical education, including standardization and improved training.

37
Q

Factors for Increased Life Expectancy

A

Several factors have contributed to the significant increase in life expectancy over the years. These factors include improved standards of living, better hygiene practices, access to proper nutrition and diet, improved housing conditions, advancements in public health measures, and progress in medical practices and treatments.

38
Q

Increased Role of Government in Healthcare

A

The 20th century saw a significant increase in the involvement of all levels of government in healthcare. This involvement includes regulation, funding, and the establishment of healthcare programs.

39
Q

Pure Food and Drug Act (1906)

A

The Pure Food and Drug Act of 1906 was a U.S. federal law aimed at addressing the accurate labeling of patent medicines and ensuring the safety of food and drugs. It marked an early step in consumer protection and drug regulation.

40
Q

Hill-Burton Act (1946)

A

The Hill-Burton Act, officially known as the National Hospital Survey and Construction Act of 1946, provided federal funding for the planning and construction of new hospitals and public health centers, improving healthcare infrastructure in the U.S.

41
Q

: Medicare and Medicaid (1965)

A

Medicare and Medicaid were instituted in 1965 as government-funded healthcare programs. Medicare provides healthcare coverage to seniors and certain disabled individuals, while Medicaid offers coverage to low-income individuals and families.

42
Q

Health Maintenance Organization Act (1973)

A

The Health Maintenance Organization Act required employers with more than 25 employees to offer an HMO (Health Maintenance Organization) option in their health care plans. It aimed to promote cost-effective and preventive healthcare.

43
Q

Patient Protection and Affordable Care Act (Obamacare)

A

The Patient Protection and Affordable Care Act, often referred to as Obamacare, was enacted in 2010 with the goal of expanding healthcare coverage and ensuring basic security for all Americans. It introduced various reforms, including the individual mandate and prohibiting insurers from imposing lifetime limits on coverage.

44
Q

Comprehensive (Universal Coverage)

A

Comprehensive healthcare coverage refers to a system where all residents of a country or region have access to essential healthcare services, regardless of their income or employment status. It aims to ensure that everyone has access to necessary medical care.

45
Q

Single-Payer (Government-Run)

A

Single-payer healthcare is a system where the government is the sole payer for healthcare services. It typically covers all residents and is funded through taxes, providing a universal healthcare approach.

46
Q

Health Care Vouchers (Choice and Competition)

A

Health care vouchers involve providing individuals with financial assistance in the form of vouchers or subsidies to purchase healthcare coverage from private insurers or healthcare providers. This model promotes consumer choice and competition in the healthcare market.

47
Q

Patient Protection and Affordable Care Act (Obamacare)

A

The Patient Protection and Affordable Care Act (ACA), commonly known as Obamacare, is a U.S. healthcare reform law enacted in 2010. It aims to increase access to healthcare, improve consumer protections, and control healthcare costs.

48
Q

Individual Mandate

A

The individual mandate was a key provision of the ACA, requiring most individuals to have health insurance coverage or pay a penalty. It aimed to increase the number of insured individuals and spread the risk across a broader population.

49
Q

Lifetime Limits on Coverage

A

The ACA prohibited health insurers from imposing lifetime limits on essential healthcare coverage. This provision ensured that individuals with chronic or serious illnesses would not exhaust their coverage over time.

50
Q

Young Adult Coverage

A

the ACA allowed young adults to remain on their parents’ health insurance plans until the age of 26. This provision aimed to provide coverage for young adults transitioning to the workforce or pursuing higher education.

51
Q

Utilization Management

A

Utilization management is a process used to assess and manage the use of healthcare services, including procedures, medications, and treatments. It helps ensure that these services are appropriate, medically necessary, cost-effective, and of high quality.

52
Q

Prior Authorization (PA)

A

Prior authorization is a utilization management process used by some insurance companies to determine if they will cover a prescribed medical procedure, service, or medication. It involves obtaining approval before the service or prescription is provided.

53
Q

Drug Utilization Review (DUR)

A

Drug Utilization Review is a pharmacy-based utilization management process that helps ensure that outpatient drug prescriptions are appropriate, medically necessary, and unlikely to result in adverse medical conditions. It aims to promote the safe and effective use of medications.

54
Q

5 R’s of Medication

A

The 5 R’s of medication refer to key principles in medication management: ensuring that the right patient receives the right drug at the right time, in the right dose, and through the right route of administration. These principles help prevent medication errors.

55
Q

PPACA (Patient Protection and Affordable Care Act)

A

The Patient Protection and Affordable Care Act, often called PPACA or Obamacare, is a U.S. healthcare reform law that aims to expand access to healthcare, improve consumer protections, and control healthcare costs.

56
Q

Medication Synchronization

A

Medication synchronization is the proactive assembly of a patient’s medications for a single, typically monthly pickup. It simplifies medication management and improves adherence by aligning prescription refill dates.

57
Q

PE (Patient Engagement)

A

Patient engagement involves active participation by patients in their healthcare, which includes continuity of care (COC), coordination of care (COC), and self-management (SM). Engaged patients are actively involved in managing their health and healthcare decisions.

58
Q

UM (Utilization Management)

A

Utilization management is a healthcare process that focuses on optimizing the use of healthcare services, considering factors such as quality, cost, and prevention. It helps ensure that healthcare resources are used efficiently and effectively.

59
Q

DUR (Drug Utilization Review)

A

Drug Utilization Review is a process that assesses and manages the use of prescription drugs. It can be conducted from different perspectives, including prospective (before dispensing), retrospective (after dispensing), and concurrent (during dispensing). It aims to ensure the safe and appropriate use of medications.

60
Q

Nonadherence

A

Nonadherence refers to a patient’s failure to follow prescribed treatment plans or take medications as directed. It can lead to suboptimal health outcomes and increased healthcare costs.

61
Q

Uncompensated Care

A

Uncompensated care refers to healthcare services provided by hospitals or healthcare providers for which they do not receive payment. This may occur when patients cannot afford to pay for medical services or do not have insurance coverage.

62
Q

EUU (Explanation of Benefits and Utilization)

A

EUU typically refers to information provided by health insurers to policyholders regarding the costs, cost-sharing arrangements, utilization management, and administrative details related to their healthcare coverage. It helps patients understand their benefits and healthcare utilization.

63
Q

Value-Based Healthcare

A

Value-based healthcare ties the compensation of healthcare providers to the outcomes they achieve for their patients, including quality, equity, and cost-effectiveness of care. It incentivizes delivering better patient results.

64
Q

Fee-for-Service (FFS)

A

Fee-for-Service is a traditional insurance model in which healthcare providers are either paid directly for each service they provide or reimbursed for each specific service rendered to patients

65
Q

Pay-for-Performance (P4P)

A

Pay-for-Performance, also known as value-based payment, is a reimbursement model in which healthcare providers are financially rewarded for achieving positive patient outcomes or meeting specific performance targets.

66
Q

Anti-Steering Laws

A

Anti-steering laws prohibit healthcare professionals from directing patients to specific medical practices, drugs, or pharmacies for personal financial gain. They aim to ensure unbiased healthcare decisions.

67
Q

Gatekeepers (Primary Care)

A

In healthcare, gatekeepers refer to primary care providers who coordinate and control access to specialist care. Patients typically need referrals from gatekeepers to see specialists in some managed care plans like HMOs.

68
Q

Capitation

A

n: Capitation is a payment model in which healthcare providers receive a fixed amount of money per patient per unit of time (e.g., per month) in advance, regardless of the actual services provided. It encourages cost-effective care delivery.

69
Q

HEOR (Health Economics and Outcomes Research)

A

ealth Economics and Outcomes Research involves the study of the economic and clinical outcomes of healthcare interventions and treatments. It assesses the cost-effectiveness and impact of healthcare services.

70
Q

Drug-Related Morbidity

A

Drug-related morbidity refers to harm or injury caused by the use of drugs, such as adverse reactions or complications related to medication. It encompasses health issues resulting from drug-related problems.

71
Q

Drug-Related Mortality

A

Drug-related mortality refers to deaths directly attributed to the use of drugs. It involves fatalities resulting from the administration or misuse of medications or other substances.

72
Q

Self-Selected Pools of Insurance

A

Self-selected pools of insurance occur when individuals consider purchasing insurance only when they perceive a need for it. This can lead to imbalanced risk pools and higher costs for insurers.

73
Q

Outcome-Based Contracting (OBC)

A

Outcome-based contracting is a reimbursement model in which the payment for a healthcare product or service is based on its effectiveness in achieving desired outcomes. It is issued by companies that manufacture healthcare products.

74
Q

Nosocomial Infections

A

Nosocomial infections, also known as hospital-acquired infections, are infections that develop in patients after they have been admitted to a medical facility, such as a hospital. These infections typically occur more than 48 hours after admission and can result from various factors, including exposure to pathogens within the healthcare setting.

75
Q

Moral Hazard

A

This concept refers to the excessive use of healthcare resources when the high cost of care is shielded from the patient, often resulting in increased healthcare spending.