HCA Final

which of the following is not a type of secondary prevention service? A. Mammogram

B. Immunizations

C. Ultrasound

D. EKG

B. Immunizations

You drive your friend to an urgent care center for treatmennt of a suspected sprained ankle, there she will receive which type of care from the following?

A. Ambulatory care

B. Prehospital care

C. Home care

D. Tertiary care

A. Ambulatory care

Which of the following healthcare practitioners do not provide primary healthcare?

A. Cardiologists

B. Family Medicine Physicians

C. Nurse Practitioners

D. Internists

A. Cardiologists

which of the following is a collaborative network of providers who work together in a coordinated fashion to provide a continuum of care to a particular patient population or community?

A. Urgent care center

B. Integrated care delivery system

C. Home care agency

D. Public health department

B. Integrated care delivery system

Which of the following is a type of care provided to terminally ill patients?

A. Tertiary hospital care

B. Sub acute care

C. Rehabilitation care

D. Hospice

D. Hospice

Schools of allopathic medicine grant what types of degrees?

Doctor of Medicine (MD)

Advance practice professionals include which healthcare practitioners, choose all that apply:

A. Nurse practitioners

B. Physician assistants

C. Nurse clinical specialists

D. Nursing assistants

Advanced practitioners like A, B, and C are highly trained healthcare providers with specialized skills, while D refers to non-licensed support staff.

true or false: nurse practitioners and physician assistants have similar educational tracks

False, PAs do masters after bachlors, NP need initial RN

true or false: the US has more specialists that primary care physicians

True, less PCPs

Which facilities provide the most outpatient care?

hospitals

What is outpatient care?

also ambulatory care, services not provided w/ an overnight stay

• used synonymously w/ community medicine

• diagnostic & therapeutic services for the walking pt

What is the foundation for ambulatory health services?

primary care

What is the scope of outpatient services?

Outpatient services encompass preventive care, diagnostic testing, follow-up treatments, and various therapeutic interventions that do not require overnight hospitalization.

What is primary care?

overall health management, central role in healthcare delivery, less complex & specialized

What is secondary care?

level of healthcare that provides specialized medical services after PCP referrals

• outpatient treatments

• diagnostic tests/procedures

• specialist consults 

• hospitalizations 

What is the history of medicine?

• Paleolithic medicines, 

• 1st pharm med was made in 1804

• oldest prescription —> 2100 BC 

What are the 2 oldest medicines still in use today?

• cannabis

• willow tree bark (aspirin) 

What was the 1st recorded prescription? 

opium

What was the 1st pharmaceutical?

morphine, from opium

How did the pharmaceutical industry emerge?

late 1800s → started isolating compounds from plant med

• 1st US company (1849) → Pfizer

• low barrier to entry, anyone make/sell meds

• evolution guided by unfortunate trial & error

What is the drug importation act?

1848, adulterated drugs provided to the US army during the Mexican-America war = soldiers died

• required imported drugs to meet standards for strength & purity

What is the Biologics Control Act?

1902, vaccines made in the US were contaminated = children death

• required companies to be licensed to ensure safety

• 1st step in controlling pharm

What is the Pure Food & Drug Act?

1906, gov got reg authority over manufacture, sale, advertising of all foods, drugs, vaccines

• food/drugs need accurate labels & meet standards

• birth of FDA

• size of industry shrunk 

Why was the Food, Drug, & Cosmetic Act passed?

added requirements for proof of safety due to loopholes causing deaths

• companies now needed to test imported drugs, safely make, and test for safety

What did the 1962 amendment to the Food, Drug & Cosmetic Act do?

required proof of safety & efficacy

• laid framework for development package

• est minimum for drugs to be tested in humans

• foundation of randomized clinical trials 

What are key takeaways about the pharm industry?

• pharm industry is still in its infancy

• evolution has been reactionary

• potential to be deadly w/o regulation

What is a combination product?

drug & device together

• asthma inhaler, IUD, insulin autoinjector

What is a medical device?

instrument, machine, implant intended to diagnose, treat, prevent or mitigate disease

• hearing aid, ventilator, tongue depressor, blood glucose meters

What is a drug?

medicine or substance w/ physiological effect

• tylenol, omeprazole, amoxicillin

What is the role of the pharmaceutical industry in the US?

develop, manufacture & sell drugs, devices, combo products

What is development?

overall process of bringing a new drug, device or combo product to market 

• current legislation makes it long & highly regulated 

• ~10 years average development, cost up $3B

• drug discovery, chem, pharm, nonclinical safety, manufacturing, clinical trials, regulation

What are the 5 stages of development?

1. discovery

2. preclinical

3. clinical

4. FDA review

5. post-marketing safety monitoring 

What occurs in the discovery stage?

new meds discovered

• testing limited to in vitro or animals to test for therapeutic effect

• 1/5K drugs IDed make it to market approval

• few people involved, candidates not yet considered potential therapies

What occurs in the preclinical stage?

candidate has therapeutic activity, ensure safe to be tested on humans

• standardized, results sent to/reviewed by FDA

• FDA involved if input needed, usually few people involved 

What occurs in the clinical stage?

testing drug in humans in clinical setting to understand safety & efficacy

• longest & most complicated stage

• 3 phases

• FDA heavily involved, review protocols before study starts & data once done

• others involved → KOLs, hospitals, academics, pts, med associations, PAG

What are the phases of clinical studies?

1. test for safety in healthy volunteers, inform on human dosing

2. 1st study in pt population, tests safety & efficacy

3. confirms efficacy, tests drug in target population

What occurs in the FDA review stage?

end development, NDA or BLA → summarizes every piece of data for FDA review

• FDA has 8-12 months to review app & decide to approve/reject based on risk/benefit assessment

• stakeholders can be involved → KOLs, PAGs, pts, lobbyists

What is post-marketing safety surveillance stage?

ongoing observation & assessment of drug on market

• possible for rare safety signals not be seen in clinical studies

• all Drs, nurses, pts participate 

What is manufacturing?

process of maintaining supply chain for the market

• details of process included in NDA

• any & all changes need to be well-documented & submitted to FDA

• supply chain issues, recalls, quality problems managed by HCPs, pts may need to discontinue or change meds

What are pharm sales?

final act of getting final, approved drug to pt

• label negotiated during FDA review & approved w/ NDA, rules for prescription

• has most stakeholders (HCPs prescribing, pharms filling, insurance paying, pts using meds)

How can HCPs use a drug off label?

yes, can prescribe something for it unintended but positive side effects

• pharma companies can’t promote it, only medical community can

What are the profit motives impacting pharm pricing?

• way drug prices are determined (controversial, lacks transparency)

• initial pricing set by pharm company developing & manufacturing it

• influence by health insurance companies & pharmacy benefit managers

• for-profit drug & health benefit companies have fiduciary obligation to benefit organization & shareholders

What is the influence of science & industry on medicine?

• conflicts of interest & influence on pharm industry on healthcare providers & scientists

• concern around providing minimal benefits/meals to physicians listening to pharm reps

• DeJong study → 63K of 279K docs got payments associated w/ 4 target drugs 

What is the fifth vital sign?

pain

What factors contribute to the opioid crisis?

• pressure from HCAPS survey ?s

• overmarketing, lack of transparency on addictiveness

• change from short term labeling to approval for long term use

• overprescribing 

What is the economic impact of the pharm industry?

• 1M jobs

• $300B domestic revenue 

Safe

avoiding injuries to pts from care intended to help them

Quality must start w/ ______

personal philosophy of excellence

What famous quote on quality did Aristotle make?

(ethics & happiness), “these virtues are formed in a man by his doing the actions)

• Durant’s summary → we are what we repeatedly do. excellence is not an act but a habit. 

What is the quadruple aim?

1. pt experience

2. population health

3. reduce costs

4. Hc provider wellbeing 

focuses on → cost, access, quality 

When did quality focus begin?

1980s as a response to rising healthcare costs and demand for improved patient care.

• started w/ Institute of Medicine Reports

  • 1999 → to err is human, 100K lives lost to HAI

  • 2001 → crossing quality chasm 

• goal → elim preventable medical errors, reach STEEP goals 

What are STEEP goals?

Safety, Timeliness, Effectiveness, Efficiency, Equitable, Patient Centered

Which institution makes the quadruple aim?

Institute for Healthcare Improvement (IHI)

What is root cause analysis?

A systematic approach to identifying the underlying reasons for an event or problem, particularly in healthcare settings, to prevent future occurrences.

What is the Swiss cheese problem?

A model used to represent how layers of defenses can fail and lead to a risk event, where holes in each layer can align to allow hazards to pass through.

The first pharmaceutical medicine (isolated compound) invented in 1804 was:

A. Aspirin

B. Morphine

C. Penicillin

D. Opium tincture 

B. Morphine

Which Federal agency is responsible for "protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices"?

A. CDC

B. NIH

C. FDA

D. CMS

C. FDA

Which of the following is a major reason America’s population is aging?

A. Increased immigration from younger countries

B. Decline in life expectancy

C. Higher birth rates in the 2000s 

D. Longer life expectancy & lower birth rates 

D. Longer life expectancy & lower birth rates 

What percentage of adults age 65 and older will need some form of long-term care?

A. 30%

B. 50%

C. 70% 

D. 90%

C. 70%

Which federal program primarily funds long-term care services for people with limited income and assets?

A. Medicare Part A

B. Social Security

C. Medicaid

D. Medicare Part D

C. Medicaid

Which statement about Medicare coverage is true?

A. Medicare fully covers assisted living costs

B. Medicare only covers short-term skilled nursing or rehabilitation after hospitalization

C. Medicare covers all in-home care services for older adults

D. Medicare pays for all prescription drug costs automatically 

B. Medicare only covers short-term skilled nursing or rehabilitation after hospitalization.

Which of the following best defined equitable care?

A. Treating every pt the same way regardless of their background

B. Providing care that results in equal outcomes across all groups

C. Offering free healthcare to all pts

D. Eliminating cultural discussions in treatment planning 

B. Providing care that results in equal outcomes across all groups

How does equity differ from equality in healthcare?

A. Equity focuses on identical treatment, equality adjusts to individual needs

B. Equity focuses on fair outcomes, equality treats everyone the same

C. Equality ensures fairness in outcomes, equity enforces uniform standards

D. Equity & equality mean the same thing

B. Equity focuses on fair outcomes, equality treats everyone the same.