dynamics of care in society 1 public health & health care delivery
TRANSCRIPT
Dynamics of Care in Society
1
Public Health&
Health Care Delivery
What Is Healthy People 2020?
A national agenda that communicates a vision for improving health and achieving health equity.
A set of specific, measurable objectives with targets to be achieved over the decade.
These objectives are organized within distinct Topic Areas.
(Activity: See handout)
Identify the different forms of health care organizations illustrating the complexity & diversity of the health care delivery systems
Explain & discuss trends that contribute to the shaping of the health care delivery systems
Describe the major responsibilities of the US Public Health Department (do in Public Health)
Describe at least three services offered by non-profit agencies
Identify the basic organization & types of voluntary agencies
Analyze two types of government agencies Identify 3 current trends in health care
Objectives
Public health professionals
protect people from diseases and encourages them to change harmful behaviors.
Who gets certain diseases and why? Can a common element be changed to
prevent an illness among an entire population?
Does that element require a change in behavior; technology, or the health care delivery system?
How can we motivate individuals to change their behavior?
Can the new technology be developed? How should the health care delivery
system be changed to improve access and treatment?
Public health experts ask…
Click here: TIPH_Poster-FINAL.pdf
http://www.youtube.com/watch?v=cvm7Fqbpqcg
Everybody - The music video! – YouTube 4min
Public Health Achievements
SampleChildhood Immunization Schedule
1. Primary Prevention:include activities that help AVOID a given healthcare problem, it is the most cost-effective
ex: immunizationspromoting use of helmets, seatbelts…health & safety educations (STD prevention, dangers of substance abuse etc)
3 Levels of Disease Prevention
2. Secondary Prevention :include activities that identify & treat persons with known risk factors or early indicators of disease but the symptoms are not present or clinically apparent.
ex: check ups, screening tests, early diagnosis
3. Tertiary Prevention :include activities involved in the care of established disease which attempt to restore highest function, minimize negative effects of disease and prevent disease-related complications
ex: post op PT, routine foot exams for patients with Diabetes
The 20th Century's Ten Great Public Health Achievements in the United
States1. Vaccinations
Programs of population-wide vaccinations resulted in the eradication of smallpox; elimination of polio in the Americas; and control of measles, rubella, tetanus, diphtheria, Haemophilus influenzae type b, and other infectious diseases in the United States and other parts of the world.
The 20th Century's Ten Great Public Health Achievements in
the United States
2. Motor-vehicle safetyImprovements in motor-vehicle safety have contributed to large reductions in motor-vehicle-related deaths. These improvements include engineering efforts to make both vehicles and highways safer and successful efforts to change personal behavior (e.g., increased use of safety belts, child safety seats, and motorcycle helmets and decreased drinking and driving).
3. Safer workplacesWork-related health problems, such as coal workers' pneumoconiosis (black lung), and silicosis -- common at the beginning of the century -- have been significantly reduced. Severe injuries and deaths related to mining, manufacturing, construction, and transportation also have decreased; since 1980, safer workplaces have resulted in a reduction of approximately 40% in the rate of fatal occupational injuries.
The 20th Century's Ten Great Public Health Achievements in
the United States
4. Control of infectious diseasesControl of infectious diseases has resulted from clean water and better sanitation. Infections such as typhoid and cholera, major causes of illness and death early in the 20th century, have been reduced dramatically by improved sanitation. In addition, the discovery of antimicrobial therapy has been critical to successful public health efforts to control infections such as tuberculosis and sexually transmitted diseases (STDs).
5. Decline in deaths from coronary heart disease and strokeDecline in deaths from coronary heart disease and stroke have resulted from risk-factor modification, such as smoking cessation and blood pressure control coupled with improved access to early detection and better treatment. Since 1972, death rates for coronary heart disease has decreased 51%.
The 20th Century's Ten Great Public Health Achievements in
the United States6. Safer and healthier foodsSince 1900, safer and healthier foods have resulted from decreases in microbial contamination and increases in nutritional content. Identifying essential micronutrients and establishing food-fortification programs have almost eliminated major nutritional deficiency diseases such as rickets, goiter, and pellagra in the United States.
7. Healthier mothers and babiesHealthier mothers and babies are a result of better hygiene and nutrition, availability of antibiotics, greater access to health care, and technologic advances in maternal and neonatal medicine. Since 1900, infant mortality has decreased 90%, and maternal mortality has decreased 99%.
The 20th Century's Ten Great Public Health Achievements in
the United States
8. Family planningAccess to family planning and contraceptive services has altered social and economic roles of women. Family planning has provided health benefits such as smaller family size and longer interval between the birth of children; increased opportunities for preconceptional counseling and screening; fewer infant, child, and maternal deaths; and the use of barrier contraceptives to prevent pregnancy and transmission of human immunodeficiency virus and other STDs.
9. Fluoridation of drinking waterFluoridation of drinking water began in 1945 and in 1999 reaches an estimated 144 million persons in the United States. Fluoridation safely and inexpensively benefits both children and adults by effectively preventing tooth decay, regardless of socioeconomic status or access to care. Fluoridation has played an important role in the reductions in tooth decay (40%-70% in children) and of tooth loss in adults (40%-60%).
The 20th Century's Ten Great Public Health Achievements in
the United States
10. Recognition of tobacco use as a health hazardRecognition of tobacco use as a health hazard in 1964 has resulted in changes in the promotion of cessation of use, and reduction of exposure to environmental tobacco smoke. Since the initial Surgeon General's report on the health risks of smoking, the prevalence of smoking among adults has decreased, and millions of smoking-related deaths have been prevented.
National Goals & Agencies Involved
National Health Goals:1. increase span of health life for Americans2. reduce disparities among Americans3. achieve access to preventive services for all Americans
USDHHS◦ CDC ◦ NIH◦ Departments of public health (town,
state) WHO FDA EPA OSHA VA Workmen’s comp AHCPR (agency for health care policy & research est. 1990)
Government Agencies
http://www.hhs.gov/ The Department of Health and Human Services
(HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.
It is comprised of the Office of the Secretary (18 staff divisions) and 11 operating divisions. The agencies perform a wide variety of tasks and services, including research, public health, food and drug safety, grants and other funding, health insurance, and many others.
HHS
Operating Divisions Of Health and Human Services: Administration for Children and Families (ACF)Administration for Children, Youth and Families (ACYF)Administration on Aging (AoA)Agency for Healthcare Research and Quality (AHRQ)Agency for Toxic Substances and Disease Registry (ATSDR)Centers for Disease Control and Prevention (CDC)Centers for Medicare and Medicaid ServicesFood and Drug Administration (FDA)Health Resources and Services Administration (HRSA)Indian Health Service (IHS)National Institutes of Health (NIH)National Cancer Institute (NCI)Office of the Inspector General (OIG)Substance Abuse and Mental Health Services Administration (SAMHSA)
http://www.cdc.gov/ The Center for Disease Control &
Prevention: Mission is to collaborate to create the expertise, information, and tools that people and communities need to protect their health – through health promotion, prevention of disease, injury and disability, and preparedness for new health threats.
CDC
http://www.fda.gov/default.htm The Food and Drug Administration is
responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation, and by regulating the manufacture, marketing, and distribution of tobacco products.
FDA
http://www.nih.gov/ The National Institute of Health’s
mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce the burdens of illness and disability.
NIH is made up of 27 Institutes and Centers, each with a specific research agenda, often focusing on particular diseases or body systems.
NIH
WHO http://www.who.int/en/ The World Health Organization is the
directing and coordinating authority for health within the United Nations system.
It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.
http://www.epa.gov/ The Environmental Protection Agency’s
mission is to protect human health and the environment
EPA
http://www.osha.gov/ The Occupational Safety and Health
Administration’s mission is to assure safe and healthful workplaces by setting and enforcing standards and by providing training, outreach, education and assistance
established in 1971
OSHA
The Veterans Administration (Veteran Affairs)http://www.va.gov/
Provides a medical benefits package to all enrolled Veterans.
This comprehensive plan provides a full range of preventive outpatient and inpatient services within VA health care system, you can be seen at any VA facility across the country.
New Jersey Workers' Compensation
Providing workers' comp information, news, facts, and contact information for employees, employers, insurers, and medical providers.
Find rules, statutes, forms, and professional help relating to workplace injuries and disabilities in the state of New Jersey. Department of Labor and Workforce Development | Workers' Compensation
Leading Causes of Death by Age Ages 15–24
◦ Unintentional injuries
◦ Homicide◦ Suicide◦ Cancer ◦ Heart disease◦ Congenital defects◦ HIV/AIDS
Ages 25–44◦ Unintentional
injuries◦ Cancer◦ Heart disease◦ Suicide◦ HIV/AIDS◦ Homicide◦ Chronic liver
disease
Leading Causes of Death Overall Heart disease Cancer Stroke Chronic lower respiratory diseases
(emphysema, chronic bronchitis) Unintentional injuries (accidents) Diabetes
http://www.medicinenet.com/mens_health_screening_tests_pictures_slideshow/article.htm
http://www.medicinenet.com/disease_prevention_in_women_pictures_slideshow/article.htm
View these slide shows…health screening for men & women
Take a few Self Tests…CDC Features - Test Your Knowledge: Health and Safety Quizzes and Tools
Women’s Health Screenings
Blood pressure screening. Starting at age 18, every woman needs to have her blood pressure checked at least every two years.
Cholesterol check. Women should have their cholesterol checked at least every five years starting at about age 20.
Pap smears and pelvic exams. Beginning at age 21, or earlier if you are sexually active, women need to have a pelvic exam and Pap smear every two years to check for any abnormalities in the reproductive system.
Mammograms and breast exams. Starting around age 20, women should have a clinical breast exam at least every three years until age 40, when this should be done annually, according to most experts.
Bone density screen. Women should start getting screened for osteoporosis with a bone density test at age 65. Women with risk factors for osteoporosis, such as having a slender frame or a fractured bone, should be screened earlier.
Blood glucose tests. Women should get a blood glucose test every three years starting at age 45 to test for diabetes or pre-diabetes.
Colon cancer screening. Colon cancer screening tests for women generally start at age 50.
Body mass index. A full yearly physical exam includes measurements of your height and weight and a calculation of your body mass index (BMI).
Skin examination. Women should examine their skin every month starting at age 18, and by the time they’re 20, a doctor or dermatologist should conduct the examination during a routine check-up.
Dental check-up. Good dental health is important from the moment your first baby tooth sprouts, and all adult women need twice-yearly dental check-ups and cleanings.
For women between the ages of 20 and 39, the following screenings are
recommended: Pelvic exam: every year.Pap test: every year until three satisfactory tests
have been completed, and then at the doctor's discretion.
Breast: at least every three years.Skin: at least every three years.
Recommended immunizations, health screenings, physicals, procedures & tests
For women between the ages of 40 and 49, the following health screenings are
recommended: Blood pressure: at least every two yearsCholesterol test: every five yearsSkin exam: every yearBreast exam: every yearPelvic exam: every yearPap test: every year (or at the doctor's
discretion)Mammography: every one to two years
(depending on risk)Fasting plasma glucose test: to check for the
possibility of diabetes, every three years after age 45
After age 50, women should have the following screenings:
Blood pressure: at least every two yearsCholesterol: every 5 years (or every 3 years begin at
age 65)Skin exam: every yearBreast exam: every yearMammogram: every yearFecal occult blood test: every yearPelvic exam: every yearPap test: yearly (or at the doctor's discretion)Bone mineral density test: once as a baselineFasting plasma glucose test: for diabetes, every 3yearsThyroid-stimulating hormone test: every 3-5 years begin
age 65 Colorectal cancer test: every five to ten yearsRead more:
Health screening, Information about Health screening http://www.faqs.org/health/topics/72/Health-screening.html#ixzz1CBElER7D
Men’s Health Screenings
Blood pressure checked every three years throughout life.
Cholesterol Have a lipid panel test at least once every five years.
Diabetes Have a fasting blood sugar test at least every three years if you are at risk for diabetes.
Skin cancer Have a full-body examination at least once every five years.
Colon and rectal cancer Screening for colon and rectal cancer normally begins at 50.
Prostate cancer Screening normally begins at 50. Men with strong family histories of prostate cancer should consider seeking early screening in their 40s.
Abdominal aortic aneurysm Consider an abdominal ultrasound at age 65 if you have ever smoked.
Osteoporosis checkBegin discussing with your doctor at age 60.
Testicular Self-Exam A simple check of the testes to check for lumps, beginning in teens.
For men between the ages of 20 and 39, the following screenings are
recommended:
• Blood pressure: at least every two years• Cholesterol: every five years• Skin exam: every three years• Testicular exams monthly
For men between the ages of 40 and 49, the following screenings are
recommended:• Blood pressure: at least every two years• Cholesterol: every five years• Skin exam: every year• Fasting plasma glucose test: to check for
diabetes, every 3 years after age 45
Men who are 50 years or older should have the following
screenings:
• Blood pressure: at least every two years• Cholesterol: every five years(or every
three years starting at age 65)• Skin exam: every year• Digital rectal exam: (to check for
prostate cancer) every year• Prostate specific antigen (PSA) test:
every year• Fasting plasma glucose test: (for
diabetes) every three years• Colorectal cancer test: every five to ten
years
Guidelines for the Early Detection of Cancer
For Both: colorectal, skin
For Women: breastcervical
For Men: prostatetesticular
Defined as: A nonprofit organization is formed for the purpose of serving a public or mutual benefit. They are private as opposed to governmental, not for profit, self-governing, voluntary and for public benefit.
Examples: March of Dimes, Easter Seals, Cancer Care, American Heart Association…
(see handout & assignment)
Non-profit or Voluntary Agencies
Support & Self Help GroupsSelf-help groups, AKA mutual
aid, or support groups, are groups of people who provide mutual support for each other.
In a self-help group, the members share a common problem, often a common disease or addiction.
Their mutual goal is to help each other to deal with, if possible to heal or to recover from, this problem.
Group helping sufferers to cut free the chains of OCD
New Jersey Self Help Group Clearinghouse1-800-367-6274 or 1-800-FOR-M.A.S.H. (Mutual Aid Self-Help)
Addictions Adult Children Bereavement Caregivers Cultural Disability Disease specific Economic/financial
Faith-Based Family Men or Women Only Mental Health Online Groups Older Adults Parenting Siblings Wellness & Recovery
(mental health) Youth
Types of Supportgroups
1. Confidentiality first. What is said in the group, stays in the group.
2. Share feelings and experiences, but not advice. 3. Accept each other without making judgments. 4. Listen to each other. Give everyone an
opportunity to share. 5. Avoid interrupting or having side conversations. 6. No offensive language, no cell phones, no
headphones…7. Be honest.8. Have a positive attitude, be supportive and
encouraging 9. Be on time. 10. Be respectful and sensitive to others.
Support Group Ground Rules
Support Group\Creating and Facilitating Peer Support Groups.mht go to section - How do you facilitate a peer support group?
YOUR NAME
Rate your experience in the group today 1-5 (5 = best)
Which topic that came up in group today, do you wish you could continue to discuss at your next meeting
Name the facilitator that emerged (N/A if none)
Best moment Worst moment
Support Group Exit Ticket
4 Current Trends in health care
Cost Containment
Home Health Care
Geriatric Care
Wellness
Old interaction vs. new interactionBetween doctor/NP/PA and patient
Between patient and care team
Face-to-face Multiple methods
Problem-initiated and focused
Based on care plan: “planned visit”
Topics are clinician’s concerns and treatment
Collaborative problem list, goals and plan
Ends with a prescription
Ends with a shared plan of care
What one word describes the change inapproaches to health care & public health:
Complementary and Alternative Medicine
Pretest:Do you know the difference between acupressure and acupuncture? Take the alternative medicine quiz! : Discovery Channel
Conventional (allopathic or Western) medicine is practiced by holders of M.D. and D.O. degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses.
Complementary (integrative) medicine
refers to use of alternative medicine
together with conventional medicine
Alternative (sometimes Eastern) medicine refers to use of healing arts not taught in traditional Western medical schools, in place of conventional medicine.
“Western” Medicine or Biomedical Health Care
Based on the cause of disease & eliminating, treating, or preventing those causes
Providers receive training and are licensed to practice as professionals
Beliefs of this system include:◦ Encouraging patients to learn about their
illness◦ Teaching self-care◦ Using medications and technology to treat
illness◦ Teaching preventive care
Most people use CAM therapies in addition to conventional medical treatmentConsiderations:
Safety, Effectiveness, Timing, Cost
Complementary and Alternative Medicine (CAM)
Traditional Indigenous Systems
Alternative Health Care Methods◦Nutritional/biological methods – organic, herbs, vitamins, special diets, shark cartilage…
◦Mind and body control methods – meditation, hypnotherapy, biofeedback, dance therapy, prayer…
◦Energy therapy –magnets, cupping, therapeutic touch, Reiki…
◦Manipulative body based methods - chiropractic, yoga, tai chi, osteopathic, massage, reflexology…
◦Spiritual methods – faith healing◦Homeopathy, an unconventional Western medical system –remedies are derived from substances that come from plants, minerals, or animals
National Center for Complementary & Alternative Medicine | NCCAM