FMPH 50- UC San Diego Winter 23

primary care

the provision of integrated accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family & community

6 c’s of primary care

first contact, continuity, comprehensive, coordination, context, cost effective

public health

what society does collectively to ensure public wellbeing

6 core fields of public health

epidemiology, statistics, biomedical sciences, cognitive & behavioral science, environmental science, health policy & management

incidence

rate of new cases over a specific period (new cases/population at risk)

prevalence

total number of individuals in a population that has disease over the period, shows burden of disease (all cases/pop)

morbidity

sum of imparments/disability

mortality

sum of deaths

risk factor

attribute that increases the likelihood of contracting disease

determinates of health

environmental conditions that affect one’s overall health (five determinates: biology & genetics, individual behavior, social environment, physical environment, health services)

health disparities

higher burden of illness experienced by one population group relative to another

global burden of disease

accumulation of direct & indirect costs

direct cost

spent on specific medical care

indirect cost

have impact on society but not specifically medical

screening

checking for something before symptoms

diagnostic test

a patient is already having symptoms

primary prevention

keeping the disease from occuring

secondary prevention

patient already has the disease but treated before the person has symptoms, early treatment and care

tertiary prevention

targets people who have symptoms of the disease to prevent complications and suffering

healthy people 2030

a government program built with the vision of a society where people live long, healthy lives

first contact

the primary care doctor is the first person the patient goes to

continuity

ongoing care with a common goal

comprehensive

address acute issues as well as chronic issues, preventative issues

coordination

point the patient to specialists

context

considers patient’s unique circumstances

cost effective

the most efficient and least expensive approach to providing health care & preventive services

medical neighborhood

the healthcare system that makes up a person’s network of care

accountable care organization

groups of doctors, hospitals, and other health care providers who come together to give coordinated high quality low cost care to their patients

quality healthcare

right thing at the right time, in the right way, for the right people, for the right results

fee for service

separate fee for each service

single fee

focuses on a larger sum, gives bonus for safe care

antigens

molecules to which our bodies recognize and mount a response

antibodies

proteins our immune system makes to target and inactivate antigens

herd immunity

chances someone will get infected is lower when there are more vaccinated people

critical mass

a large group of vaccinated people

live activated vaccine

live, replicating, and activated without spreading disease (ex: MMR)

killed whole organism vaccine

inactivated vaccine is a vaccine consisting of virus particles, bacteria, or other pathogens that have been grown in culture and then killed to destroy disease-producing capacity (ex: flu)

toxoid vaccine

use toxoids (as antigens) to induce an immune response in protecting against diseases caused by toxins secreted by specific bacteria (ex: tetanus)

DNA & RNA vaccine

use nucleic acids for body to make protein and antibodies against it (ex: COVID)

healthcare disparity

systematic differences between groups in insurance coverage, access to and use of care, and quality of care

social determinates of health

conditions in environments that affect a wide range of health, functioning, quality of life outcomes, and risks

allostatic load

chronic stress response and systemic inflammation

explicit bias

consciously held and expressed

implicit bias

outside of conscious awareness and control

confirmation bias

selective collection of evidence

family planning

proactively managing the number and spacing one’s children

5 p’s of sti assessment

partners, pregnancy, protection, practice, past history

partners

how many, what kind of sex, sex work, rape/assault

pregnancy

status, wanting/trying

practices

how someone is having sex (must be specific)

protection

how (if anything) they are trying to prevent sti’s

past history

past stis

6th p of sti assessment

pronouns!

PreP

pre-exposure prophylaxis, for any sexually active person without HIV to prevent it

PEP

post-exposure prophylaxis, meant for people who were exposed to HIV to try and prevent it

HPV

most common sti

chlamydia

most frequently reported bacterial std

mental health

state of internal equilibrium that enables individuals to use ability in harmony

mental health outcomes

resilience, temperamental flexibility, emotional expression & regulation, healthy relationships, physical functions, freedom

mental illness

a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior that reflects a dysfunction in the processes underlying mental functioning.

anxiety

a physiological state/emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure

depression

persistent neurogenerative and cognitive symptoms associated with withdrawal, decline in activity, & significant improvement in function

high risk factors for suicide

a decline in mental health, hopelessness, access to lethal means, lack of support, rise in substance use, sudden loss

population analysis model

works with both a case manager and primary care doctor in order to receive mental healthcare

substance use

any scope of drug use

substance use disorder

recurrent use of alcohol and/or drugs that can cause clinically significant impairment in function

addiction

person’s inability to control the impulse to use drugs even with negative consequences

daly

disability adjusted life years (sum of years lived with disability and years life lost)

yld

years lived with disability

yll

years life lost

chronic medical illness

lasts one year or more and limits function OR impacts ADLs

impaired control

larger or more often amounts of substance

social impairment

failure to fulfill social roles

risky use

recurrent use in physically harmful siutations

pharmacological criteria

meets the medical criteria for substance abuse

universal prevention programs

addresses risks common to all youth

selective prevention programs

addresses youth at high risk

indicated prevention programs

addresses youth that have already started using

outpatient support groups

na, aa, other community programs meant to target substance use

IOP

a clinical outpatient program designed to target substance use in a more controlled environment

residential facility

a program where someone gives up their life to build a new foundation, good for people who need complete isolation from outside life

recovery homes & sober living

facilities meant as a “step down” where people are living with other addicts and receiving extra support for recovery

harm reduction approach

meeting someone where they are at and reducing likelihood for harm while patient is still using (ex: reduction of overdose and stis)

methadone

full agonist, heavily regulated as it can still be boiled down and injected

naltrexone

full antagonist, has to be clean for 7-10 days to use

buprenorphine

a lifesaver for clinics, a partial agonist/antagonist that can be given a weeks worth in clinic

soboxone

increases safety in case of overdose, has buprenorphine & naloxone (naloxone is a full antagonist that reduces the rate of people shooting up on this drug)

common goals of pc & ph

disease & injury prevention, promotion of health & well being

shared priorities of pc & ph

reduced healthcare costs, improve population health, address social enviro determinants of health, utilize health data, advocate for health policy change

SDOH

neighborhood & built enviro, health & healthcare, economic stability, education, social & community context

USPSTF

strives to make accurate, up-to-date, and relevant recommendations about preventive services in primary care

patient centered medical home

has a personal physician who directs care, whole-person orientation, increased access, care is coordinated & integrated, and is quality & safe

health equity

state in which everyone has a fair and just opportunity to attain their highest level of health

LARCs

long acting reversible contraceptives (ex: iud & nexplanon)

irreversible contraception

surgical procedures to permanently end contraception (ex: sterilization)

hormonal short term methods

oral contraceptive pill, patch, ring, shot, plan b

emergency contraceptive

fast acting birth control that reduces the chance of pregnancy after unprotected sex

barrier methods

anything that creates a barrier between two genitals (ex: diaphragm, cervical cap, condoms, cervical sponge)

fertility awareness method

tracking basal body temps, cervical mucus, and/or tracking via calendar

lactational amenorrhea

have not started menses after pregnancy and is exclusive breastfeeding