intro to healthcare ch 1

what are the paradoxes of the US healthcare system

high health standard, advanced technology, high spending, BUT high medical error, fragmentation of regulation, not everyone with adequate health insurance

native american contracted disease from colonists and european settlers and had high mortality due to

malnutrition, violence, accidents, fungal infection, tapeworm, tuberculosis, syphilis

what did european settlers bring?

influencza, yellow fever, malaria, smallpox, measles (native americans had no immunity)

british government had overall ______ implementation of public health

poor

colonial officlas paid attention to extensive

public health policies (sanittation and disinfection)

was it common for women to physically support the sick outside of officials?

yes

when sick, who did people depend on for healing arts, human/religious comforts

community members

orthodox physician (allopathic/regular)

some with medical education, heroic medicine

sectarian (irregular)

alternative practices, no formal training

what was heroic medicine used for

depletive measures (drug/procedure vaused visible change in secretion/excretion

services in physicians were sought by ______/______ class

middle/upper

_______/_________ require payment at time of service

orthodox/sectarians

hospital origins in poor and isolated house caused

selective admission based on patient/morals

chartiable dispensary used by

poor class

autonomous hospital located in

urban and provides outpatient services

when were consulting physicians established

late 19th century

when was germ theory of disease accepted

late 20th century

effect of accepted germ theory

improve tech, aseptic/antiseptic technique, reject galen theory (focused on 4 humors), hospital # grew from 100 -600

new hospitals were financed by

religious/ethnic/women physician group

manufacture of medicine changed the

function of practitioners, physician dispense from office and pharmacist open stores

Pure Food and Drug Act of 1906 addressed

accurate labeling and safety

what planned construction of new hospitals

national hospital survey and construction act of 1946 (hill burton act)

when did medicare and medicaid begin

1960s

how did medicare and medicaid impact hospitals

emphasis on preventative health, cost cutting efficiency measures, adopt patient centered care to get satisfaction and make hospital more pleasant

concerns of introduction of electronic record and interprofessional education

less patient interaction, workforce shortage, future of medical mecca, health facility competition in community, financial imperatives in insurance

crossing quality chasm is a

call by IOM to change US healthcare to close quality gap (new health system for 21st century-2001)

crossing quality chasm caused

redesign of care process, info tech, knowledge management, team and coordination of care, performance measurement

patient centered care is a

way to prevent fragmented healthcare

managed care

system to reduce cost and maintain quality

consumerism

product interest of consumers

social mession of hospitals

serve patient first to provide compassionate healthcare to all

medicine in 1910

reengineers medical education, abandoned apprenticeship mode, allopathic physician legally recognized

medicine after WWII

medicine adopted biomedical model (emphasis on molecular level of life)

medicine 1970s

emphasis on social inequities

medicine 1980-1990

response to managed care, concern about physician autonomy & patient care quality

medicine 21st century

explored new patient care models

pharmacy 1860-1870

pharmacy curriculum based on physical science and lab, challenged apprenticeship training

pharmacy 1960s

years of revolution in pharmacy, community/hospital push for new identity, pharmacist is drug expert responsible for theraputic advising

1969 revision of APha Code of Ethics

pharmacist render to each patient to their full ability

pharmacy 20th century

50+ colleges, minimal standard for admission, combination of scientific and apprenticeship, emergence in prepaid health services

Pure Food and Drug Act and FDCA increased role in

regulation

Hill burton act and Medicare increased role in

funding

E-pharm/internet mail order

unaffiliated physician Rx filled then mailed to patient

E-pharm/internet info and counsel

service other than dispensing (for fee), info, counsel

E-pharm/internet prescribe/dispense

patient complete medical survey, review and prescribe Rx, fees for survey/shipping/safety/etc.

verified internet pharmacy practice site (VIPPS)

voluntary NABP program, certified on 19 criteria, seal displayed, no federal legislation, some require dispensing pharmacist to be licensed in same state as patient

pharm tech roles

assist pharmacists, maintain med inventory/control, active administration, certificated for 600 hrs over 15 weeks

American Pharmaceutical Association, APhA (1852)

the first organization, now known as american pharmacists association, national standard of quality drugs

American Society of Health-system pharmacists (ASHP)

accreditation of residency programs

Academy of Managed Care Pharmacy (AMCP):

 improve patient care/quality/cost/effective medication

corporate memberships

-Institute for safe medication practices (ISMP)

-National assoc. of chain drug stores (NACDS)

-pharm researchers and manufacterers association (PHRMA)

-generic pharm industry assoc. (GPHA)

education and regulatory

-National assoc. of boards of pharm (NABP)

-american council for pharmacy education (ACPE)

-american assoc. of colleges of pharmacy (AACP)

-american foundation for pharma education (AFPE)

benefit for pharmacist who join professional pharmacy organizations

info dissemination, keep competency, career plan assistance, financial benefit, participation in goverance

what role played in professional pharmacy organizations

educate/support/unify pharmacists, bring opportunity for branches of pharm, monitor and influence pharm legislation

medication therapy management model

importance of meds in public health, natural collab among pharmacists with other health care professionals, clear model for implementation

postgraduate educational opportunities for pharmacists

residences, fellowship, advanced degree, hospital branch (drug info, therapeutic monitor, pharmacokinetic dose)

pharmaceutical care model

identify, resolve, prevent drug related problems

pharmaceutical care model outcome

cure of disease, eliminate symptomatology, slow disease process, prevent disease

barriers in pharmaceutical care model

drug focus, service focus, other health care professionals, lack of incentive, logistical, lack of reimbursement for clinical services (ashville/medicare)

Medicare Prescription Drug Improvement and Modernization Act of 2003

created medicare part D, pharmacy natural choice for pharm care, service envisioned not mandated

Asheville Project

improve outcome/save money, private sector where pharmacists are reimbursed for pharm care (mainly for diabetes)

drug focus

dispensing is primary

service focus

distant service without regard for patient or outcome

other health care professionals

infringement on other/politics

lack of incentive

compensation based on dispense production rather than patient care

logistical

pharmacy not designed to do consult/disease monitor, drug info

way that pharmacist role expanded over years

change in health care organization, pharm curriculum, legitimized pharm research, rebrand as therapeutic advisor, blamed itself bc of deemphasized training, increase # of post pharm D program, pharm D became entry level

pharmacy practice before 1940s

no credibel standard, first legislation (pure food and drug act), elixir sulfanilamide incident

exilir sulfanilamide incident

new oral preparation made with diethylene glycol (antifreeze), impetus for FDCA, 73-107 deaths, manufacturer fined for improper label (exilir instead of solution), outrage motivated way for FDCA

FDCA

food druG Cosmetic acid of 1938

before the 1940s who had more authority FDCA or FDA

FDCA

pharmacy practice 1940-1970s

expansion era, hill burton act, title 18/19 amend 1935 social security act, change in pharm curriculum

pharmacy practice 1970 - present

mirror to hospital pharm, dichter institute study, millis commision report (1975), HMO, DRGS

health maintenance organization (HMO):

act of 1973 increased managed care and cost containment

diagnosis groups (DRGS)

created taxonomy for medicare patients setting reimbursement schedule for disease state and condition regardless of length/intensity of care, discharge patients "sicker and quicker"

millis commision report (1975):

pharmacist not prepared in system analysis/management/communcation

dichter institute study (APHA)

people saw pharmacists as businessmen instead of healthcare provider

mirror to hospital pharmacy (ASHP)

pharmacy lost its way in producing professionals