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Pharmacy and Health Care Delivery > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Define Health

A

WHO’s Definition: A state of physical, mental, and social well-being, and not merely the absence of disease or infirmity.

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2
Q

Differentiate between disease and illness.

A

Disease: an objective, biological phenomenon characterized by abnormal functioning of the body. A state of being that a health care worker finds.
Illness: a subjective, psychosocial phenomenon in which people perceive themselves as sick. A state of being that the ill person feels.

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3
Q

Medical Model of Health

A
  • Biomedical model
  • Focuses on individual’s and on the factors most immediately linked to the pathophysiology underlying a person’s disease.
  • Health is defined as the absence of illness or disease.
  • Emphasizes diagnosis and treatment.
  • Health care is generally reactive.
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4
Q

Population Health Model

A
  • Seeks to explain and intervene in the causes of the systematic differences in health between groups.
  • Analyses the patterns or distributions of health between different groups of people in order to identify and understand the factors leading to poorer outcomes.
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5
Q

5 determinants of Health

A
  1. Genetic/Hereditary
  2. Behavior and lifestyle
  3. Physical environment
  4. Social environment
  5. Medical Care
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6
Q

Medical Health Model

A
  1. Checks family history
  2. Lab tests
  3. Intervention
  4. Treatment recommendations
    The medical model does not ask why an epidemic of obesity has occurred or investigate why there are higher rates of obesity in low income and minority populations.
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7
Q

Population Health Model

A

Identifies a wide variety of causes over time to produce the epidemic and the differing patterns for obesity among population groups.
1. More fast food restaurants in low-income neighborhoods.
2. Vending machines in schools
3. Decrease in physical education
4. Fewer children and adults walking or biking
Interventions could include health framework, interventions could include zoning law changes, working with fast food restaurants.

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8
Q

Market Justice Health Care

A

Proposes that market forces in a free economy can best achieve a fair distribution of health care.

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9
Q

Assumptions of Market Justice

A
  1. Health care is like any other good or economic service.
  2. People can make rational choices in their decisions to purchase health care products and services.
  3. People, in consultation with their doctors, know what is best for themselves.
  4. The marketplace works best with minimum interference from the government.
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10
Q

Implications of Market Justice

A
  1. In a pure market system, individuals without sufficient income or who are insured face a financial barrier to obtaining health care
  2. Emphasizes individual rather than collective responsibility for health
  3. Proposes private rather than the government solutions to the social problems of health
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11
Q

Social Justice Health Care

A

Equitable distribution of health care is a societal responsibility. The government takes over the production and distribution functions. Health care is a social good opposed to an economic good. Canadians and Europeans have social justice.

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12
Q

Assumptions of Social Justice

A
  1. Health care is different from most other goods and services.
  2. Responsibility for health is shared.
  3. Society has an obligation for the collective good.
  4. Government, rather than the market, can better decide through rational planning how much health care to produce and how to distribute.
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13
Q

Implications of Social Justice

A
  1. Everyone is entitled to a basic package of benefits.
  2. Public solutions to social problems.
  3. Planned rationing of health care. Government controls medical technology will be dispersed and who will be allowed access to that technology.
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14
Q

What are 3 quantification perspectives on health and health care that may be used for understanding the nature and health status of the population.

A
  1. Demographics and Socio-economic characteristics-census
  2. Health Status Measures-morbidity, mortality, infant mortality, and life expectancy.
  3. Health services and resource utilization- who uses the services and what kind of services are offered.
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15
Q

List 2 purposes of quantifying the demographic and socio-economic characteristics, health status indicators and health utilization patterns of the population.

A
  1. Descriptions- numbers and characteristics of population being served.
  2. Program Planning- descriptive data can reveal existence of problems, data can be used to design solutions, and to enable objective evaluation after new programs are implemented.
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16
Q

Crude Death Rate

A
  • Mortality rate
  • Influenced by distribution of ages in population.
  • Can be misleading
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17
Q

Age-adjusted Rate

A

These control for changing age distribution of population.

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18
Q

Cause-Specific Mortality

A

-Rankings based on absolute numbers of deaths

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19
Q

Infant Mortality

A 
Calculated as: 
# of deaths <1 year age among children born alive divided by the number of live births.
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20
Q

2 Infant Death Categories

A
  1. neonatal deaths: < 28 days old (2/3 of infant deaths are neonatal)
  2. postneonatal deaths: 28 days to 1 year
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21
Q

Trends of Infant Mortality

A

In the United States, infant mortality rates have decreased from 1960 to 2016. Globally, at the United States has the highest infant mortality rate compared to other countries.

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22
Q

Life Expectancy

A
  • Age to which the average individual can be expected to live, given that the person has reached a specific age.
  • Often used as a measure of health for a population
  • Improvements in life expectancy are due to advances in science and public health in conquering diseases and reduction in infant mortality.
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23
Q

Incidence

A

Number of new cases of the disease in question occurring during a specified time period, usually a year.

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24
Q

Prevalence

A

Total number of cases existing in a population during a specified time period, or at one point in time.

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25
Q

Explain why utilization of health care services data may be incomplete.

A

Reliable utilization data is regularly reported only for services provided by licensed MD’s, DO’s and dentists. Not for alternative therapy providers. Can be difficult to aggregate all data sources across the country.

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26
Q

What was the role of pharmacist’s in the 1600s.

A

Physicians had the dual role of diagnosing and treating a patient’s illness. Pharmacist’s are not really a thing.

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27
Q

What was the role of pharmacist’s role in the 1700s.

A

Emergence of apothecary shops. The role of the shops was to manufacture and distribute medications. Provided “medicine chests” to physicians.

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28
Q

When did the professions of medicine and pharmacy separate, and the independent pharmacy practitioner emerged.

A

After the War of 1812

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29
Q

Drugstore Era

A

(1850-1910)
Pharmacists became known as the proprietor of a drugstore.
Pharmacists role- Computing prescriptions, recommending and selling over-the-counter medications and first aid items.

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30
Q

Food, Drug and Cosmetic Act (1938)

A

This act was responsible for the creation of the Food and Drug Administration (FDA). They are a federal agency that are responsible for approving new drugs for market. Enforced safety and efficacy.
Pharmacists role- dispense medications and counsel patients
4 year degree

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31
Q

Era of Expansion

A

(1940s to early 1970s)
Hospitals grew in number and medicare and medicaid programs were enacted.
Pharmacists’s role- role as a compounder decreased due to manufacturers and wholesalers arise.
4 year degree. Pharmacists were overeducated and underutilized.

32
Q

Durham-Humphrey Amendment to the Food, Drug, and Cosmetic Act (1951)

A

Created two classes of medications: OTC and prescription

33
Q

Aha Code of Ethics (1952)

A

The pharmacist does not discuss the therapeutic effects or composition of a prescription with a patient. When such questions are asked, he suggests that the qualified practitioner is the proper person with whom such matters should be discussed.

34
Q

Era of Cost Containment

A

(Early 1970s to the Mid-1980s)
By the 1950s, many new effective drugs available I the healthcare system
Increase in the number of prescriptions being dispensed.
DRGs are created.
Dichter Institute Study (1973)
Millis Commission’s Report in 1975
APhA code of ethics revised in 1969

35
Q

What is a DRG?

A

Diagnostic Related Groups
Made in the early 1980s.
Are categories of disease states or conditions that would be used to reimburse hospitals on a perspective bias
Sicker and quicker

36
Q

Dichter Institute Study(1973)

A

Reports that consumers view most pharmacists as profit oriented businessman, rather than as healthcare providers.

37
Q

Millis Commission’s Report (1975)

A

Report suggested that pharmacists believed they lacked proper management skills and the skills to effectively communicate with patients, physicians, and other healthcare professionals.

38
Q

APhA Code of Ethics revised in 1969

A

A pharmacist should hold the health and safety of patients to be of first consideration; he should render to each patient the full measure of his ability as an essential health practitioner.

39
Q

Era of Assessment and Accountability

A

(Late 1980s to 2000)
-Hospitals expanded to health systems including ambulatory and home care services.
Pharmacy in the 21st century Conferences (1984-1989)
-AACP urge of curricular revision to doctor of pharmacy degree (1992)

40
Q

Pharmacy in the 21st Century

A

Conferences held 1984-1989

-Purpose of the conference was the need for the pharmacy profession to move toward providing comprehensive patient care.

41
Q

In 1992, AACP urged all pharmacy institutes revision of curricular.

A

Entry-level doctor of pharmacy degree.
-In 1995, the Argus Commission of AACP recommended that the 6-year Pharma degree should be the entry-level degree into the profession of pharmacy.
-Shift in pharmacy education from what is being taught to how it is being taught.
Doctor of Pharmacy degree actually started in 1999.

42
Q

Implications of Pharmaceutical Care

A
  1. For pharmacists to practice pharmaceutical care, they must reexamine both their role as a healthcare provider, as well as the patient’s role in the pharmacist-patient relationship.
    A. Pharmacist must take responsibility for drug-related outcomes to meet the patient’s drug therapy needs.
    B. Patient works with the pharmacist in a therapeutic relationship to manage their medications.
    C. APhA Code of Ethics has been further revised to include a focus on a shared responsibility for health outcomes in the pharmacist-patient relationship.
43
Q

The Comprehensive Pharmaceutical Care Process

A

1995

44
Q

Issues Related to Implementing Pharmaceutical Care

A
  1. Views of other healthcare professionals-turf wars
  2. Marketing of pharmaceutical care services to patients-educated pharmacists role
  3. Lack of pharmacist reimbursement for services.
  4. Structural barriers- lack counseling rooms
  5. Education required by pharmacy professionals to provide care
  6. Access to accurate and up-to-date drug therapy information
  7. Lack of pharmacy personnel
  8. Pharmacy ignorance and inertia.
45
Q

Medication Therapy Management

A

MTM represents a comprehensive and proactive approach to help patients maximize the benefits from drug therapy and includes services aimed at facilitating or improving patient adherence to drug therapy, educating entire populations of persons, conducting wellness programs and becoming intimately involved in disease management and monitoring.

46
Q

How was MTM strengthened?

A

MTM was strengthened in the Medicare Prescription Improvement and Modernization Act (MMA) of 2003.
-Mandates payment for MTM services and includes pharmacists as providers who may offer such services.

47
Q

Core Elements of MTM

A
  1. Medication therapy Review
  2. A personal Medication Record
  3. A medication related action plan
  4. Intervention and/or referral and documentation and follow up
48
Q

Pharmacist Patient Care Process

A

To promote consistency in patient care service delivery across the profession

49
Q

What are the 5 components of the Pharmacist Patient Care Process?

A
  1. Collect
  2. Assess
  3. Plan
  4. Implement
  5. Follow-up
50
Q

What are the 4 major periods in the evolution of the American health care system.

A
  1. Era prior to the Federal buildup of health care resources-up to WWII
  2. Federal buildup of health care resources era-post WWII (1945-1970)
  3. Federalization and Cost-Containment Era (1970s and early 1980s)
  4. Competitive Health market, defederalization and refederalization of health care system era (Early 1980s to present)
51
Q

Colonial America (1600-1800)

A

-up to WWII

  • Widespread infectious diseases due to European, Native American and African slave contact
  • Public health programs were minimal and led to widespread disease
  • Colonists used common European health practices/ medicines
  • European physicians did not look to colonies as locations of great professional or economic opportunities.
52
Q

Nineteenth Century

A

a. Well being related to an individuals level of wealth.
1. Urban-health based on social class wealthy enjoyed access to better health.
2. Rural-self-reliance, family members primary health care providers
b. Theories of Disease Causation
1. contagion theory-people who were well avoided contact with those who weren’t.
2. Supernatural/ Religious-sickness was a punishment from god.
3. Individual responsibility-proper personal behavior
4. Miasma theory-important relationship was between disease and the atmosphere.
c. Rise of the hospital

53
Q

Federal buildup of health care resources era

A

Post WWII (1945-1970)

  1. Government assumes the leadership role in shaping the health care system
  2. Large investment in basic and clinical research, health facilities, health providers
54
Q

Hill Burton Act (1946)

A

National Survey and Construction Program-purpose was to provide federal aid to individual states for the construction of hospitals and health centers.

55
Q

Health Amendments Act

A

(1965)

-Was directly responsible for the dramatic increase in supply of physicians and other health professionals.

56
Q

Kerr-MIlls Act

A

(1960)
-sought to eliminate some of the economic barriers to medical care for elderly medically indigent by creating the Medical Assistance for the Aged (MAA) program.

57
Q

Medicare

A

Title XVIII
Social Security Amendment of 1965
-Federal program that provides financing of medical services for elderly, regardless of ability to pay

58
Q

Medicaid

A

Title XIX
Social Security Amendment of 1965
-Federal state financing program of the indigent

59
Q

Federalization and Cost containment Era

A

1970s and early 1980s

  • rapid rise in health care expenditures.
  • Focus shifted from development of medical care resources to more direct control of the rising costs in medical care.
60
Q

1972 Social Security Amendments

A
  • Created PSROs (professional standards review organizations
  • PSROs were unsuccessful and replaced later on with PROs (peer review organization)
  • Section 1122 provided mechanisms to control capital expenditures of health care organization.
61
Q

Health Maintenance Organization Act (HMO)

A

1973
-Nixon’s initiative, established a program of financial assistance for the development of HMO’s by employers with 25 employees or more.

62
Q

Medicaid Act Amended

A

1981

-Allowed states to take bids and negotiate contracts with selected providers- took away free choice of provider

63
Q

Medicare Prospective Payment System Diagnostic Related Groups

A

1983
-Pays hospitals a present diagnosis-specific amount that is is independent of length of stay and services provided to the individual patient

64
Q

1994

A

Renewed efforts for National Health Insurance (Clinton Administration)

65
Q

Health Insurance Portability and Accountability Act

A

1996
HIPAA
Title I-protects health insurance for workers and their families when they change or lose their jobs.
Title II- requires the establishment of national standards for electronic healthcare transactions and national identifiers for providers, health insurance plans, and employers.
-It established standards for privacy and security of health information

66
Q

Balanced Budget Act

A

1997
State Children’s Health Insurance Program (SCHIP or CHIP)-provides funds to states for health insurance to families with children. Designed to cover uninsured children in families that are modest but too high to qualify for Medicaid.

67
Q

Children’s Health Reauthorization Act of 2009

A

-Barack Obama expanded the healthcare program to an additional 4 million children and pregnant women, including first time legal immigrants without a waiting period.

68
Q

Medicare Prescription Drug, Improvement and Modernization Act

A

2003

Medicare Part D

69
Q

Patient Protection and Affordable Care Act

A

2010
PPACA AKA OBAMACARE
-Aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care.

70
Q

Private Sector

A

In 1987, the private sector accounted for 68.5% or $353.6 billion of total US health expenditures

  • Serves primarily the regularly employed, middle and high-income families with continuous health insurance coverage.
  • Broken up into two system:
    1. Non-Health Plan enrollee
    2. Health Plan enrollee
71
Q

Advantages and Disadvantages of Private Health Care System

A

Advantages: individual choice, individual is a decision maker, can go elsewhere is dissatisfied
Disadvantages: availability of money to pay, availability of providers and facilities.

72
Q

Federal system divided into two groups

A
  1. DHHS (Department of Health and Human Services)

2. Outside DHHS

73
Q

DHHS

A
  1. Public health service services (PHS)-provides service for DHHS via the Indian Health Services (IHS)
  2. Health Resources and Service Administration- Health care delivery in manpower shortage areas, medically underserved areas, special service populations. Responsible to provide access to health care services for people who are uninsured
  3. Centers for Medicare and Medicaid Services
74
Q

Outside DHHS

A
  1. Federal Employees’ Health Benefits Program- health insurance for federal employees, retirees, and dependents
  2. Department of Defense- TRICARE-provides care for dependents,career retirees, survivors of killed active personnel.
  3. Veteran Administration- health care for retired, disabled and otherwise qualified veterans of previous military service.
75
Q

Differences between the public and private health care systems

A
  • Public sector has to meet special eligibility requirements established by respective federal program
  • Private patients have the freedom of choice of providers and facilities. If a private patient is dissatisfied with care free to seek care elsewhere.

Pharmacy and Health Care Delivery (1 decks)

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