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74 Cards in this Set
- Front
- Back
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What is health care system and what is its purpose?
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Health systems consist of all the ppl and actions whose primary purpose is to improve health
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HCS problems are…
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Caused by:
• Misuse and misallocation of resources |
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The Nation’s Health Dollar, 2007
Where It Came From |
Most from Private Health insurance,
next from Gov't CMS spending |
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The Nation’s Health Dollar, 2007
Where It Went |
Hospital is #1
Physicians are #2 Drugs 10% |
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Describe the evolution of health care in the U.S. from
colonial times to present day |
apothcaries, then lick stick (business), patient care(clinical)
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List the factors that account for changes in U.S. disease
patterns between the 1800s and present day |
acute disease to chronic due to tech, understanding and that kinda shit
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List the characteristics of each 20th Century health care era
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traditional-->old crap
transitional-->business like patient care--> patient focus |
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• Identify the functional roles of government in the U.S. HCS.
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Financial, regulatory, provider
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What was the original hospital?
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charitable institutions, ppl die
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Public health service
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research on general pop. health
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Children Bureau, 1912
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Labor laws for children
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Sheppard-Towner Maternity and infancy act 1921
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provided a system of federal funding to enhance the health and welfare of women and children
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National Institute of Health (1930)
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started NIH, research on stuff that ppl wanted to know
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First insurance plans established when, period?
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traditional, 1929,
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What caused regulation?
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Patent medicines, shitty and mislabeled
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Flexner Report
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showed that there was problems with trainin of health care ppl
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Charters Report 1927
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curriculum for pharmacy, defined the profession, 4 year BS degree
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When FDA created? with what act?
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1938, with Food drug and cosmetics act
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Hill-Burton, 1946
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made hospitals, revamped
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Medicare/Caid created when? what do
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1965, increased demand since more affordable
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1951 Durham-Humphrey Amendment
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Legend and OTC drugs created
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1962 Drug Amendments
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requirement of effectiveness
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What is DRGs and purpose of them?
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Diagnostic related groups, bring down costs, HMO act also brought them down
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Legislative
Judical Executive responsibilities |
create laws
J: interpret laws E:implement and enforce |
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Financer
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Fed: veterans, disabled, employer, medcare/caid
S:medicaid, HC programs, employer L:local hospitals and emergency care facicitlesis |
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Provider
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F: VA, military, indians
S: specific diseases, mental problems L:class based, clinics, vacines and stuff |
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Regulator
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F:implement and enforce (FDA, CDC, CMS, NIH)
S:regulation and liciencsure, insurance L:health codes, water quality, disease patterns |
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Food & Drug Administration (FDA)
• National Institute of Health (NIH) • Centers for Disease Control & Prevention (CDC) |
a
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Centers for Medicare & Medicaid Services (CMS)
• Health Resources & Service Administration (HRSA) • Indian Health Service (HIS) |
a
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Agency for Health Care Research & Quality (AHRQ)
• Substance Abuse & Mental Health Services Administration (SAMHSA) • Administration on Aging (AoA) |
a
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1966 Ninth Floor Project
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UCSF, clinical pharmacy birth
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6 yr Pharm D degrees? era, info sutff, talk about i dont care
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2000
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PROFESSIONAL PRACTICE
Is Not... |
the physical practice site
• a degree qualification • an arbitrary list of practitioner activities |
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Philosophy of Pharmaceutical Care
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Meets a social need: ensure safe and
effective medication use ( morbidity & mortality) • Meets patient-specific responsibilities |
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Drug Related Needs:
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Indicated
Effective Safe Complaint |
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Alliance between practitioner and patient
• Characteristics: |
Mutual respect/trust
• Open communication • Cooperation/Mutual decision making |
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Needs are Met by ensuring that all patient
drug therapy is: |
Appropriately indicated
• The most effective available • The safest possible • The patient is compliant |
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How do you accomplish responsibilities of pharmacist
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identification, resolution,
and prevention of drug therapy problems |
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Pharmacotherapy Workup Framework
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Indication-->Drug product-->dosage regimen-->outcomes-->both effectiveness and safety
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Pharmaceutical Care, Patient Care
Process |
1. Assess the patient’s drug-related needs
2. Develop a care plan 3. Complete a follow-up evaluation |
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Evaluation
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If you don’t follow-up, you don’t care
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Reasons to Document
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• Provide quality patient care
• Manage the practice • Liability issues • Evaluate performance • Justify professional role • Reimbursement |
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Physicians
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a
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Multidisciplinary care
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multi-->divided
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fellowship is?
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specializing
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Nurses
RN LPN CNA |
RN: 4 yrs degree
LPN: 1 yr degree CNA: nurse assistant |
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Advanced Practice Nursing
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ARNP-therapy altering
CNS-specialist CNM-midwife |
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Differentiate between medication errors and
medical errors |
medication errors specifically related to drug, 7th leading cause
medical has to do with any medical error |
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different error types
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human
at-risk reckless |
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Identify ways pharmacists can promote safety
in the health care system |
2 independent checks
change look alikes sound alikes alert stickers magnify lense |
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Cite the potential contribution of automation
and technology to preventing medication misadventures |
tech is good durrrr
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Potential error
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mistake in prescribing that is detected and corrected "near miss"
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What is highest percentage of insurenace claims related to drugs mistakes
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wrong drug dspensed, second is strength wrong
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Swiss cheese effect
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holes in flawed system which if you get through all of them error occurs
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ISMP is?
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istitution of safe medical practices, report problems, nonprofit
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Denver lessons
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dont use abbreviations, U got messed with 0, infant dies
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Punative, and
Blame Free cultures |
obvious
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ADE's
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adverse drug effects
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Florida pharm law
Quality related event |
inappropriate dispensing or administration of a prescribed medication
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CQI is? what are reqs?
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continuous quality improvement
records confidential and learn from incidences |
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Sentinel event
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unexpected event where some1 crokes or loss of function
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CPOE is?
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computer physician order entry,
system is computerized so physicians cant be dumb |
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Quality
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degree to which individuals and populations increase good healthcare outcomes
fairness |
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For the patient
Quality means, that they… |
Accessible_____
Effective Safe_______ Accountable_ Fair____ |
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what are 3 stakeholders of health policy
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payers
consumers providers |
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Iron triangle is
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Quality
Access Cost |
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Invention outcomes
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ECHO-outcomes model
economic- costs and money clinical-medical stuff done humanistic-life quality |
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How is Quality Measured?
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Life Expectancy
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Health disparities
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differences in health status among pops. such as socio-econ status
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health inequity
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- disparities which are unfair or somehow unjust
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SOCIETAL & POLITICAL STRUCTURES THAT
AFFECT PEOPLE’S HEALTH |
policies and practices in labor moarket
income housing |
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4 forces against equality
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Global factors
Societal and political structures individual level and social context health care system |
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globalization
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moves ppl around bad for caring about health think about it
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quality messages, health care must be
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accessible
– sustainable, – affordable – and equitable health care system |
