Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM 510 > Lecture 1-3 > Flashcards

Lecture 1-3 Flashcards

1
Q

Ecological Model

A
  • framework to illustrate multi-level context of our environment and how factors at various levels can influence one another
  • integration across all levels provides you with how healthcare is delivered in the US
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Societal

A

health, economic, and educational policies and political systems as well as the culture and national norms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Community

A

workplace, neighborhoods, health agencies, where relationships occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Relationships

A

social network of family, peers, religious groups that influence behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Individual

A

biological and personal history factors of the person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does the Ecological Model effect health care?

A
  1. individuals are recipients of health care
  2. Social networks in relationship level can affect how individuals seek health care
  3. Neighborhoods can influence what type of health care is available
  4. Societal can dictate public health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Paradoxes in Health Care in the U.S

A

THE UNITED STATES HAS HIGHEST HEALTH CARE STANDARDS, BEST, MOST ADVANCED TECHNOLOGY AVAILABLE, AND HIGHEST EXPENDITURE PER CAPITA. Ex: Professional and facility licensures and certifications.

2.IN CONTRAST, THE UNITED STATES HAS FRAGMENTED SYSTEM OF CARE, HIGHEST RATE OF MEDICAL ERRORS, AND INEQUITY IN ACCESS TO CARE. Ex:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Fragmented system of care (paradox)

A
  • how health services are financed, organized and delivered

- underperforms on access, safety, coordination, efficacy and equity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Highest rate of medical errors (Paradox)

A
  • 44,000-98,000 deaths per year
  • serious medications errors in 5-10% of hospital patients
  • 1 of 25 patients in acute inpatient care has a health associated infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Inequity in access to care (paradox)

A
  • 46.3 million Americans without health insurance (pre-PPACA, 2007)
  • PPACA helped substantially with increased access overall and partially thru expansion of medicaid eligibility
  • Nearly 25m americans have policies that do not cover important aspects such as prescription costs
  • Worse health outcomes and disparities
  • lack of access to health care in rural areas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Practitioners in the 19th century

A
  • Allopathic physicians and sectarian(no formal training) practitioners usually required payment at the time a service was provided (fee-for-service)
  • many americans in the lower class first treated illness using home remedies or low coast alternative concoctions to avoid fee-for-service
  • services in physicians offices, drugstores and “cure establishments” were mainly sought by middle and upper class
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pure Food and Drug Act of 1906

A
  • addressed accurate labeling
  • Forbade the manufacture or sale of mislabeled or adulterated food or drugs, it gave the government broad powers to ensure the safety and efficacy of drugs in order to abolish the “patent” drug trade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

National Hospital Survey and Construction Act of 1946

A

Hill-Burton Act - funded construction of new hospitals and public health centers

  • ensure that hospitals were an important element in delivering health care
  • medicase and medicaid emerged from governments pursuit for service programs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Medical Education in the United States and Canada (1910)

A

Flexnor Report (1910)

  • changed standards for medical education
  • higher accreditation for medical schools and higher admission standards for medical students
  • admitted fewer students from lower classes, ethnic minorities, and women
  • standardized 4-year curriculum (2 didactic, 2 clinical)
  • abandoned apprenticeship model
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Post WWII “biomedical model”

1945+

A

predominated-emphasis placed on the subcellular and molecular level of life processes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

1970s

A

new emphasis on social inequalities as more women and minorities were admitted into medical schools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

1980s and 1990s

A

response to managed care and new concerns about physician autonomy and quality of patient care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

(21st century) Patient-centered medical home (PCMH) model

A
  • primary care is a way in which policy has supported expansion of primary care
  • patients were seen as whole persons not disease states
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

1860-1870s

A

physical sciences and laboratory instructions basis of curriculum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

1900s

A

Expansion of schools and drugstores

  • apprenticeship no longer adequate
  • More than 50 colleges and departments of pharmacy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

1915

A

Challenges in pharmacy professionalization: Flexner considered pharmacy a part of the medical profession, not individual profession on its own

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

1922

A

American Pharmacists Association Code of Ethics

  • “the service it can render to the public in safeguarding the handling, sale, compounding and dispensing of medicinal substances”
  • Compatible with Flexner’s view
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

1975: Pharmacist for the Future

A
  • called for 6 year program to educate rather than train pharmacists
  • pharmacists assume responsibility for drug-related needs and held accountable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

1990 Omnibus Budget Reconciliation Act (OBRA)

A
  • mandated evaluation of drug therapy in review of patient profiles
  • established standards for medication counseling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Third party payers and managed care

A

limited pharmacists ability to practice pharmaceutical care in health care settings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Pharmaceutical Code of Ethics (1994)

A
  • covenantal relationship between the patient and pharmacist
  • promotes caring, compassionate and confidential services to the community, individual and societal needs
  • Pursuit of justice in distribution of health resources
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Medicare Modernization Act of 2003 and 2006 Medicare Part D

A

Medication therapy management in institutional and community settings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

2010 Patient Protection and Affordable Care Act

A

Expanded role for pharmacists in medical home models of care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pharmacy leaders in Patient-Centered Primary Care Collaboration

A
  • Task force report Patient-Centered Medical Home (PCMH)

- integrating comprehensive medication management to optimize patient outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Changes in Health and Sickness patterns

A

shift in leading causes of death from acute diseases ( influenza, pneumonia, TB) to chronic diseases (heart, cancer and stroke)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

3 key factors cited explaining rise in life expectancy

A
  1. Improved standard of living including better hygiene, diet and housing
  2. Advances in public health
  3. Progress in medical practice, including therapeutic interventions . Ex: antibiotics have a 56.4 decrease in total number of deaths
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Increased role of government legislation

A
  • Pure Food and Drug Act (1906)

- Food, Drug and Cosmetic Act (1938)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Increased role of government funding

A
  • Hill-Burton Act (1946)

- Institution of Medicare and Medicaid (1965)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Emergence of third-party payment system in 1929

A

Baylor Univ. Hospital enrolled school teachers in plan to cover hospital costs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Emergence of third-party payment system in 1938

A

Kaiser Permanente Medical Care Program to provide healthcare for workers on Grand Coulee Dam. Garfield modernizes the hospital to offer a prepaid health plan, group medicine and integrated services to the workers families

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Emergence of third-party payment system in 1939

A

Blue Cross for hospitals and Blue Shield for physician fees

- health insurance in the US that is provided to more than 106m people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

1973 Health Maintenance Organization Act

A

Mandated all employers with more than 25 employees to offer an HMO option as an offered health plan

  • HMO has its own network of doctors and hospitals and gives you access to those certain doctors and hospitals for a monthly or annual fee
  • growth of managed care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

1996 Health Insurance Portability and Accountability Act (HIPAA)

A
  • Addresses health care fraud and abuse

- set standards for using and disseminating health information

39
Q

1997 State Children’s Health Insurance Program (SCHIP)

A

Re-authorized in 2007 (CHIPRA in 2009)

-SCHIP was created in 1997 to insure children in families with too much income to qualify for Medicaid and too little to afford private insurance

40
Q

2003 Medicare Prescription Drug Involvement and Modernization Act (MMA)

A

Largest revision to Medicare

- Medicare Part D prescription drug benefit program was most important provision which was implemented in 2006

41
Q

Health care reform

A

incremental vs comprehensive

42
Q

Incremental

A
  • employer mandates to provide health insurance (HMO act)
  • expanded eligibility of medicare/medicaid (SCHIP)
  • health savings account (MMA)
43
Q

Comprehensive

A

single-payer

-health care vouchers (choice and competition)

44
Q

2010 PPACA ( Patient Protection and Affordable Care Act)

A
  • ensured more people have health insurance, reduce the cost of health care, and improve how patients get care
  • expanded the role for pharmacists in medical home models of care
  • mandates health insurance for most legal residents
  • reduced the number of uninsured residents
  • eliminated pre-existing conditions clauses
  • removed financial barriers,
  • invested in education and training for an expanded health workforce
  • allowed young adults to be covered by parents insurance until age of 26
45
Q

Medicine (1700s-1800s)

A
  • pharmacists back then learned by being an apprentice (having no formal education)
  • little to no concepts of diseases causes or processe
46
Q

Primitive procedures

A
  • blood letting, emetics: isolation and quarantine
  • hospitals were “almhouses” ( house built for poor people to live in) or for quarantine. People would go there to die
  • hospitals were just a place to separate the sick from the healthy
47
Q

Medicine (1800s-1900s)

A
  • medicine began to be established as a prestigious profession
  • science and technology further developed as anesthesia, microbiology and antibiotics became a thing people knew about
48
Q

Hospitals

A

early 19th century- hospitals had origins in the almshouse(poor) and quarantine (isolation)

  • early 20th century physicians accepted the germ theory of disease -> hospitals: improving aseptic and surgical techniques
  • hospitals grew in number from 100 to more than 5000
49
Q

APhA Code of Ethics (1922)

A

primary objective is the service it can render to the public in “safeguarding the handling, sale, compounding and dispensing of medicinal substances

50
Q

Pharmacist for the Future (1975)

A
  • called for a 6-year program to educate rather than train pharmacists
51
Q

1990

A

adoption of 6 yr PharmD curriculum for all new students

52
Q

Medicare modernization act of 2003 and 2006 Medicare Part D

A
  • Medication therapy management in institutional and community settings
  • Pharmacist “paid” for medication review and counseling
53
Q

major causes of death in 1900 compared to 2015

A

1900: Flu, Pneumonia, TB, digestive disease and heart disease
2015: Heart disease, cancer, lung disease and stroke

54
Q

comparison in medicine and technology in 1900 to 2015

A

1900: No antibiotics or vaccines, TB was little understood. There were no screening tests, or medical treatments for infections or diseases. They didnt understand how lifestyle changes like diet and exercise can improve your life
2015: Most diseases are preventable though lifestyle changes. For ex: Stopping smoking can prevent lung cancer. Theres now screening for certain diseases and cancers. Diseases can also be prevented by exercise and diet

55
Q

1954 Tax decision

A

Employer contributes for health insurance and gets a tax exempt from taxable income for employees

56
Q

Purchasers

A

Individuals, employers and government

57
Q

Insurers

A

Insurance companies

58
Q

Providers

A

Hospitals, nursing homes, home care, pharmacies

59
Q

Suppliers

A

Pharm, Medical Supply Co, computers and software vendors

60
Q

US has

A
  • the largest annual healthcare expenditure across all the countries
  • mortality rate and life expectancy is also below the average in most industrialized countries
61
Q

US Relative performance compared to OECD avg

A

US has many factors lower than OECD avg like life expectancy in both males and females, low mortality rate, high obesity, high asthma

62
Q

Socialized Medicine (Beveridge Model)

A
  • Provides health care to all citizens and is financed by the gov. through tax payments
  • employs practitioners, owns facilities and administers the healthcare system
63
Q

Examples of Socialized Medicine

A

UK, Cuba, Spain and New Zealand

64
Q

Decentralized National Health Program (Bismarck Model)

A
  • employers and employees are required to obtain private health insurance usually provided by nongovernment insurance companies
  • these health insurance plans do not make a profit and must include all citizens
  • facilities like hospitals and clinics are privately owned
65
Q

Examples of Bismarck Model

A

Germany, France, Belgium, Netherlands, Japan and Switzerland

66
Q

National health Insurance

A

Socialized health insurance model

  • a single government-run insurance program that finances health care services that are provided by private payers with negotiated reimbursement
  • health care delivery facilities are mostly privately owned
67
Q

National health Insurance example

A

Canada and Taiwan

68
Q

Out of pocket model

A
  • found in the majority of the world and is common in developing countries
  • no private health insurance or gov. sponsored health care system
  • accompanied by shortages of healthcare facilities, low expenditures and poor health outcomes
  • people that can afford health care get it and those who cant afford it stay sick and die
69
Q

Out-of-Pocket example

A

Africa, India, China, and South America

70
Q

How does funding effect health care delivery?

A

Public funding focuses on efficient allocation of resources

  • higher proportion of public funding -> better and more equitable health outcomes
  • better outcomes partially due to more equitable distribution of scarce resources
71
Q

Developed Countries

A

High Income Economies

  • Mostly industrialized capitalist democracies
  • Strong health infrastructures
  • Positive healthcare outcomes
72
Q

Developing countries

A

Low-income & middle income economies

  • 85% of the worlds population
  • 12% of global world expenditures
73
Q

Portability of benefits

A

Coverage even when one is not in the province

74
Q

Comprehensiveness

A

coverage for all necessary services- physician and hospital services

75
Q

Universality

A

Same services for all citizens of a province

76
Q

Accessibility

A

Reasonable access to services is assured

77
Q

Reasonable access to services is assured

A

plan is run by a nonprofit, public organization accountable to the provincial government

78
Q

Structure of Canadian Health Care System

A
  • Private insurance is allowed as supplemental coverage
  • public facilities often have long wait times
  • Private facilities provide better access to services and higher paid MDs
  • must rely on private supplemental Rx coverage or out-of-pocket
79
Q

Medicare

A
  • covers outpatient prescription drugs for the following groups: seniors, low-income individuals, and patients with specific diseases states
80
Q

German health care system

A

Krankenkasse “sickness funds”

  • initiated to cover certain occupations and regions, but now covers all citizens
  • worlds oldest national health care system
  • 85% of germans covered
  • 11% have private insurance
  • 4% recieve free medical services
  • has a copay for some health services
81
Q

Self-govenance

A

administered by self managing organizations

82
Q

Social partnership

A

employer and employee have a share in the system

83
Q

Social solidarity

A

ensuring equality in health care through some members subsidizing the health care costs of others

84
Q

Retail pharmacies in germany

A
  • must be owned by a pharmacist
  • each pharmacist can own up to 4 pharmacies
  • three as branches of original in same or neighbor country
85
Q

Three innovations of National Health Service(NHS) Act (1946)

A
  1. Universal and comprehensive service
  2. Financing through general taxation with little or no change at point of service
  3. Nationalization of the country’s hospitals
86
Q

Principles of UK health care system

A
  • True socialized medicine
  • most services are provided by practitioners that work for the government
  • gov. controls establishment of primary-care practices
  • secondary and tertiary care is provided by hospitals
  • patients must be referred by their GP and wait times can be long
87
Q

National Institute for Clinical Excellence (NICE)

A
  • evaluates efficacy and cost-effectiveness of all NHS- approved drugs
88
Q

Negative Formulary

A

a list of drugs that the health care program wont cover. Then it determines which drugs it will provide on a subsidized basis

89
Q

Principles of Cuban Health Care System

A

1: Healthcare is right
2. Health care is the responsibility of the state
3. Preventative and curative services are integrated
4. Everyone participates in the function of the health care system
5. Health care activities are integrated with economic and social development

90
Q

The US has

A

elements of all 4 models of health care

  • Employer based benefits-Bismarck model
  • VA, military, and Native American health systems- Beveridge Model
  • Elderly, disabled, indigent in Medicare/Medicaid- National Socialized health insurance model
  • Uninsured- out-of-pocket
91
Q

Implications for US

A
  • The U.S relies on private systems and funding for health care
  • people with the ability to pay can get best possible health care
  • spends more per person on health care than any other country yet doesn’t achieve better health outcomes on average
92
Q

Public health

A

is strongly linked to government regulations, policies, and political activity

93
Q

Improving economic performance

A
  • make patients more sensitive to health care costs and quality
  • report costs, quality, and quantity (performance) of services of providers to promote competition
  • design physician and hospital reimbursement with incentives to reduce costs

PHRM 510 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions