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Population Health > Final > Flashcards

Final Flashcards

1
Q

social prospective health seeking

A

result of socioeconomic status, cultural influence, influence in personal relationship

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2
Q

social structure

A

SES has been shown to be a strong predictor of health differences - upper levels of SES experience a longer life expectancy, lower risks for specific disease morbidity and report more satisfaction with their quality of life - race is dominant explanatory factor

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3
Q

domain of those in lower SES than higher ses

A

toxic enviroment

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4
Q

culture

A

values give direction to decisions and behaviors at both the individual and corporate population levels
- fast food- literacy - access and knowledge of tech

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5
Q

social relationship

A

positive, supportive relations help to buffer the effects of stress and promote health outcomes - people who live isolated lives have lower life chances

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6
Q

application of these comceptual frames for heathcare in american society

A

continuing healthcare disparity

relationship and communication with patients are key to facilitate and optimize outcomes

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7
Q

category A

A

risk to national security - easy to transit/disseminate, higher mortality rates, potential cause public panic and social disruption

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8
Q

category A examples

A

anthrax, botulism, plague, small pox, tularemia, viral hemorrhagic fever

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9
Q

category B

A

moderately easy to disseminate, moderate morbidity rates and low mortality rates, require specific enhancements of CDC diagnostic capacity and enhanced disease surveillance

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10
Q

category B examples

A

brucellosis, epsilon toxin, safety threats, glanders, melioidosis, psittacosis, q fever, ricin toxin from castor, staph, typhus, encephalitis, water safety threats

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11
Q

category C

A

emerging pathogens that could be engineered for mass spread because they are easily available, produced and spread and have a potential for hight mortality and morbidity rates and major health impact

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12
Q

category C examples

A

nipah virus, hantavirus

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13
Q

The Volunteer service act

A

immunity for liability to pay volunteers in the state or nonprofit, hospital or gov entity

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14
Q

title 31 emergency management

A

state officer immunity for emergency management workers - except for cases of willful misconduct, gross negligence, or bad faith

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15
Q

healthcare ready website

A

maps open and closed pharmacies in disaster affected areas, monitors international disaster that may affect delivery of critical medicines to the US

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16
Q

MCDP

A

national council for prescription drug programs, guidance for pharmacy industry for resources available during a declared emergency - for healthcare industry providers who need resource info for eligibility and processing individuals

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17
Q

strategic national stockpile

A

12 hour push packs to supplement and re-supply state and local public health agencies in the event of national emergency anywhere and at anytime within the US or territories

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18
Q

role of pharmacists have in a disaster

A

volunteers for mass dispensing, mass vaccination, and mass triage

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19
Q

points of dispensing (POD)

A

used as a method of distribution of meds and med supplies to healthy people in an area of risk during a large-scale public health emergency

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20
Q

waves of opioid overdose

A
  1. 1990 inc prescribing
  2. 2010 rapid inc overdose heroin
  3. 2013 inc in overdose death involving synthetic opioids- fentanyl with combo of heroine and cocaine
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21
Q

patient population from whom data is collected in the monitoring the future survey (MTF)

A

8th, 10th, 12th graders

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22
Q

most striking finding in the most recent MTF survey

A

inc vaping

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23
Q

substance with highest rate of use in MTF survey

A

alcohol, then vaping

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24
Q

what had a decrease of use in the MTF

A

marjuana, illicit drug use, misuse of opioids, cathinone, synthetic cannabinoids

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25
Q

patient population from whom data is collected in the national survey of drug use and health

A

12 yrs or older

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26
Q

recent NSDUH findings

A

inc marjuana since 2007, more than half of drugies start with marijuana, drinking underage has declined, driving and drinking has declined, drinking is used in late teens and twenties, dec coc and methamphetamine, other than alcohol marajuana has the highest rate of dependence, large treatment gap in the us

27
Q

treatment gap in the US

A

8.6% need it but 0.9% go it = 20.2 treated in 2013

28
Q

meaning of NAS/NOWS

A

Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome
o Antenatal exposure to opioids in newborns

29
Q

NAS/NOWS complications

A

1 baby born suffering approximately every 15 minutes (‒32,000 in 2014)
● Newborns with NAS/NOWS are more likely than other babies to also have low birthweight and respiratory
complications.

30
Q

NAS/NOWS payment

A

● 82% of the treatment costs in 2014 were paid by state Medicaid programs

31
Q

health consequences of marijuana

A

Associated with more recent psychological visits and lifetime psychiatric problems at age 50
● Associated with a higher prevalence of lifetime drug use problems
● Associated with more cognitive difficulties, physical illnesses, and lifetime alcohol use problems at age 50

32
Q

drug diversion by healthcare

A

Healthcare employees stealing medications for their own use

33
Q

results of drug diversion by healthcare providers that impact patient care

A

Care delivered by impaired providers
Denial of essential pain therapy
Outbreaks of hepatitis C virus or bacterial pathogens when tampering with injectable opioids

34
Q 
class of drugs most commonly diverted by health care providers and the drug most often
associated with outbreaks of infection due to diversion
A

Opioids are the most commonly diverted drugs.

Fentanyl is most commonly associated with outbreaks of viral and bacterial infection.

35
Q

methods for health care professionals to divert opioids and other substances of abuse.

A

Theft of unopened vials
Tampering with vials or syringes resulting in substituted or diluted dosages being administered to the patient
Theft of residual drug left in a syringe or vial after being administered to a patient, including those that had
been properly disposed of in a “sharps” safety container

36
Q

appropriate response in health care facilities when diversion is suspected

A

assess pt of harm, consult with public health officials, prompt reporting to law and other enforcement agencies

37
Q

cost-effectiveness of drug addiction treatment

A
  • Every dollar invested in addiction treatment yields a return of $4-$7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1.
  • Cost of 1 full year of methadone maintenance treatment: ~$4,700 per patient; cost of 1 full year of
    incarceration: ~$24,000 per person
38
Q

role of the U.S. Preventative Services Task Force (USPSTF).

A

Reviews all evidence on specific preventative services and provides evidence-based recommendations.
o Focuses on screening, behavioral counseling, and preventative medications
o Posts draft recs for public comment and further scientific scrutiny
● Calls for more research in areas where there is not enough evidence to make a recommendation and reports to Congress on priority research gaps

39
Q

ACA incorporates USPSTF recs

A

ACA requires health insurance plans to offer free-of-charge preventative services recommended by the USPSTF that have an evidence rating of “A” or “B,” and the patient does not have to meet a deductible to
access these services

40
Q

Grade A:

A

service recommended; high certainty of substantial benefit

41
Q

Grade B:

A

service recommended; high certainty of moderate benefit or moderate certainty of moderate to
substantial benefit

42
Q

Grade C:

A

selective offering/providing of service recommended; clinicians should use professional
judgement on an individual patient basis; at least moderate certainty of a net small benefit

43
Q

Grade D:

A

service NOT recommended; moderate or high certainty of no net benefit or that the harms outweigh the benefits

44
Q

I statement

A

current evidence is insufficient to make a recommendation

45
Q

orgs who make preventative health recs

A

CDC, WHO, disease specific associations, USPSTF

46
Q

approach when USPSTF and clinical standards differ

A

best for pt

47
Q

find recs for specific pt using USPSTF

A

go to USPSTF.org and click search topics

48
Q

how med counseling fits into the pharmacists patient care process

A

Part of implementation of a patient care plan is provision of education and self-management training to the
patient and/or caregiver. Communication with the patient is at the center of the PPCP.

49
Q

why you should counsel pt on meds

A
  1. liability- failure to warn pt of risks is common and successful theme of lawsuits against pharms
  2. Omnibus Budget Reconciliation Act of 1990 (OBRA ’90): requires you to discuss reg of each medicaid pt when filling
  3. al state law requires all pts offered counseling
50
Q

effective questioning methods

A

open ended - motivational interviewing is a technique used with resistant/unsure pts that need to change their behavior

51
Q

general steps of pt counseling

A
  1. caring relationship- language needs met
  2. assess pt knowledge and needs
  3. provide info orally with the use of visual aids or demonstration
  4. verify understanding of the pt or caregiver
52
Q

three prime questions of pt counseling

A
  1. What did your prescriber tell you this medication was for?
  2. How did your prescriber tell you take this medication?
  3. What did your prescriber tell you to expect?
53
Q

16 pts to consider when counseling a pt on a new rx

A

drug names, benefits, use, actions, onset of action, RoA, DF and admin schedule, what to do if a dose is missed, refill available, proper storage, how to contact pharm, precautions, interactions, disposal, pt specific info, directions for preparing, using or admin

54
Q

pharmacists barriers

A

body language, voice, volume and pitch, ineffective listening “righting reflex”

55
Q

pt barriers

A

language, literacy, diabilities, neg past experience

56
Q

enviromental barriers

A

intimidating counseling room/area

57
Q

adherence over compliance

A

Compliance indicates “obedience” to healthcare professional instructions. Adherence is patient-centered, looking at the extent to which the patient’s behaviors correspond with the agreed-upon recommendations of
a healthcare professional.
Adherence indicates a partnership between the patient and healthcare professional when approaching the
patient’s care. Compliance is more like a boss-subordinate relationship.

58
Q

consequence of non-adherence

A

There is a linear relationship between medication adherence and clinical outcomes. In fact, improved
medication adherence would provide better clinical outcomes in most cases than the emergence of a new
drug.
Medication non-adherence causes 1/3 of medicine-related hospitalizations and nearly 125,000 deaths each year.
Medication non-adherence costs $300 billion.

59
Q

factors contributing to nonadherence

A

Socioeconomic, Health Care System, medical conditions, therapy-related, patient related

60
Q

Intentional non-adherence:

A

deliberate; associated with patient-related factors, rx beliefs, unwilling to accept sick, lack of trust, fear stigma

61
Q

unintentional non adherence

A

misunderstanding, inability to use, cognitive, poor social support, financial limits, low health literacy

62
Q

Direct therapy

A

Directly observed therapy (DOT): Patient comes into a facility and a healthcare provider administers medications such as infusion
therapy
▪ Correctional facilities
▪ Inpatient facilities
o Therapeutic drug monitoring: plasma concentration tests, other indicators

63
Q

indirect

A

Patient self-reporting (interviews, structured instruments)
o Pill counts
▪ Have patients bring “latest” prescription bottle
o Electronic device monitoring
▪ Bottle cap monitors, inhaler counters; typically used in clinical trials or with affluent populations due
to cost
o Prescription claims data
▪ Medication possession ratio (MPR) based on fills
o Clinical assessment
▪ Drug screens
▪ Physical indicators (the body tells on the patient)
● Ex: patient on β-blocker still has a heart rate of 90 bpm
● Ex: rifampin turns secretions reddish-orange, but patient has yellow urine

64
Q

approaches to improve therapy

A

Optimize therapy, Help patients remember their medications, Address financial barriers, Address physical barriers, Adopt strategies to address patient limitations

Population Health (3 decks)

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