organization of health care delivery in the us - ambulatory and primary care Flashcards
1
Q
Characteristics of the U.S. Health Care System
A
- Huge, complex system
- No central governing agency
- Little integration and coordination
- Technology-driven, acute care focus
- High cost, low outcomes
- Private sector more prominent
2
Q
Factors Influencing Health Care Systems
A
- Political climate
- Economic development
- Technological advancement
- Social and cultural values
- Physical environment
- Population characteristics (demographics, health trends)
3
Q
Philosophical Basis
A
- Market justice + social justice
- Access for those who cannot afford
- Multiple players (Medicare, Medicaid, private insurance)
- Unequal access
- High legal risks influencing providers
4
Q
Ambulatory/Outpatient Health Care Services
A
- Ambulatory = outpatient (no overnight stay)
- Includes:
- Diagnostic procedures
- Consultations
- Treatment
- Preventive care
- Interventions/procedures
- Rehabilitative services
5
Q
Growth of Ambulatory Care Services
A
- Managed care’s focus on quality and cost containment
- Medicare’s Prospective Payment System led to shift to ambulatory care
6
Q
Role of Ambulatory Care Services
A
- First point of entry, primary health care functions
- Provides referrals and care coordination
- Mandated by EMTALA to provide emergency care
- Reduces overall health care costs unless inpatient care is needed
7
Q
Ambulatory Health Care Providers
A
- Physicians (general/family, solo/group practices)
- Dentists
- Optometrists
- Physician Assistants
- Nurse Practitioners
- Midwives
- Social Workers
- Pharmacists
8
Q
Facilities Providing Ambulatory Health Care Services
A
- Teaching/community hospital outpatient clinics
- Hospital emergency departments (EMTALA compliance)
- Ambulatory Surgical Centers
- Diagnostic/Imaging Centers
- Specialty Centers
- Health Departments
- Community pharmacies
- Home Intravenous Services
- Home Care Services
- Women’s Health Centers
- Mobile Clinics/Stations
- Free clinics/voluntary agencies
- School and prison health services
9
Q
Outpatient-Related Ambulatory Services
A
- Clinics (general or disease-specific)
- Pharmacotherapy Services (anticoagulation, COPD, asthma, diabetes, hyperlipidemia, hypertension, pain management, MTM)
10
Q
Ambulatory Care Services in Community Pharmacies
A
- Independent, chain, supermarket pharmacies
- Mini-clinics (e.g., Walmart)
- Optometric services
- MTM
- Health promotion and disease prevention
- Prescription services
- Special programs (e.g., Walmart $4 Prescription Program)
11
Q
Emergency Services
A
- Hospital ED (non-urgent, urgent, emergent)
- Emergency Medical Services (EMS)
- Emergi-centers (24/7)
- Urgi-centers (12 hrs/day)
12
Q
Problems in the Emergency Room
A
- Overcrowding
- Long waiting times
- Patient dumping/diversions
- Risk of hospital-acquired diseases
- Unnecessary loss of lives
13
Q
Problems in the Ambulatory Care Setting
A
- Lack of coordination between providers
- Polypharmacy
- Untreated indications
- Lack of integration with public health
14
Q
Ambulatory Care vs. Primary Health Care
A
- Ambulatory care = outpatient care
- Primary health care = first level of care
- Primary care integrates with public health
15
Q
Primary Health Care Providers in the U.S.
A
- Primary care physicians
- Family Medicine/General Practitioners
- Nurse Practitioners (general/specialists)
- Physician Assistants
- Registered Nurses
- Pharmacists
16
Q
Primary Care in the Affordable Care Act
A
- Expansion of primary care services
- Increased payment for primary/preventive care
- Increased funding for training
- Incentives for working in underserved areas
17
Q
The Omnibus Budget Reconciliation Act of 1990 (OBRA ‘90)
A
- Federal law to reduce deficit
- Obligations for ambulatory care pharmacists:
- Prospective DUR
- Generic substitution
- Patient counseling
18
Q
Roles and Responsibilities of the Ambulatory Care Pharmacist
A
- Medication history and assessment
- Pharmacotherapeutic interventions
- Pharmacy care plans
- Screening and early detection
- Health promotion and disease prevention
- Drug information services
19
Q
Drug-related Problems
A
- Untreated indication
- Improper drug selection
- Sub-therapeutic dosage
- Overdosage
- Failure to receive drugs
- Adverse drug reactions
- Drug interactions
- Drug use without indication
20
Q
Prospective DUR under OBRA ‘90
A
- Screen for:
- Over/under utilization
- Therapeutic duplication
- Drug-disease/drug-drug interactions
- Incorrect dosage/duration
- Drug allergies
- Clinical abuse/misuse
21
Q
Information During Patient Consultation/Counseling (OBRA ‘90)
A
- Drug name
- Intended use and outcomes
- Route, dosage form, dosage, schedule
- Special preparation/directions
- Special administration/storage
- Precautions
- Common side effects
- Self-monitoring techniques
- Avoiding drug interactions
- Prescription refills
- Missed doses
- Other patient-specific info
22
Q
Collaborative Drug Therapy Management (CDTM)
A
- Shared responsibility with physicians
- Based on agreed protocols
- May include:
- Ordering lab tests
- Assessing patients
- Initiating/modifying drug therapy
- Monitoring patients
- Administering drugs
23
Q
CDTM in New York State
A
- NY Education Law 6801-A (2011)
- Restricted practice settings
- Requires written protocols
- Requires patient/family consent
- Pharmacists can:
- Adjust/manage drug regimens
- Evaluate/authorize lab tests
- Document interventions
- Inform physicians of changes
