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99 Cards in this Set

  • Front
  • Back
US Health System is a complex network of: (3)
3)payers (insurance)
Only constant in US Healthcare system is...
Cost of US Healthcare system
a)by %GNP is (1991 and 2000)
b)by $
a)12%, 17%
b)$1.6 trillion
Biggest health care problem?
37million w/o health insurance (15% of population)
Medicaid patients are being moved into....(2) and problem with this
managed care or HMO

provides incentive to not get minimum wage job that does not provide health insurance
Biggest problem with hospitals todaY?
move to "for profit" instead of "nonprofit"
As a major component of the US Healthcare system, pharmacy is influenced...(5)
1)in professional roles
2)patterns of practice
3)items dispensed
4)patterns of reimbursement
5)delineation of practice sites for entry-level practitioners
____ defines what pharmacists can and can not do
Pharmacy Practice Act
Stats on the elderly concering their Rx's (3)
1)$1,500 spent annually
2)consume 42% of Rx drugs
3)28.5 Rx's per year
a)# w/ medicare benefits
b)% of the US population
Compared to general population the elderly spend ___ as much on Rx drugs per year
4x as much
Where do our Social Security taxes go?
into gov't spending accounts
____ was first to have Rx drug benefit
Medicare Part D
Ppl on drug reviews boards are getting $ from drug companies, T or F?
Who owns OU Medical Center?
The # of old ppl are...
Who lives longer men or women?
Are ppl more or less educated than in the past?
more educated
Where and how do most old ppl live?
in traditional community w/ spouse
Trends in poverty levels among young and old
poverty level of old in decreasing

poverty level of young is increasing
Where do old get most of their income? What part of their income is increasing now and why?
Social security

From income b/c elderly are going back to work
What income ranges are most elderly ppl found?
high/middle incomes
The difference in life span b/w men and women is ___ and why?
shrinking due to increasingly similar lifestyles b/w men and women
#1 killer of old ppl, but is decreasing and why(3)?
diseases of heart

decreased smoking, treating high cholesterol and monitoring BP
Trends in cancer death rates among the old?
neither rising or falling
Top 3 chronic diseases in old ppl?
2)heart disease
Perception of the old is that they are ___ and ___ but it is FALSE
depressed and living in nursing homes
OBESITY is INCREASING in the elderly which leads to...(2)
1)increased rates of DM
2)increased rates of arthritis
Problem with the %age of women smoking (in elderly population)?
It is not decreasing like the %age of men smoking is
The majority of health care costs come from...?
The highest %age of drugs costs in the OLD are paid by...
out of pocket
4 distinct periods of development of US healthcare
1)prefederal build up era
2)federal buildup era
3)federalization of system and cost containment
4)emergence of competitive market and de-federalization
The 1989-1991 measels outbreak is attributed to...
increased vaccine prices
Main health concerns in the prefederal build up era (3)
2)infectious disease
3)disease transmission b/w Euros, africans, indians
Most common diseases in pre era (3) and they had epidemics of...(3)
3)respiratory infexns

2)yellow fever
Cause of early war b/w colonist and indians was...
malnutrition due to long drought and indians weren't sharing food anymore
Major smallpox outbreak in the early americas was due to....
steamboat going up the missouri river
Early european colonists death rates
a)in virginia
b)in massachusetts
a)80% died in first years
b)50% died in first winter
Why were death rates so high in early americans? (4)
1)british didn't implement public sewer/water policies
2)few physicians migrated to colonies
3)little medical training available in north america
4)few "doctors" had received formal training (didn't need a certificate to practice medicine)
Due to epidemic outbreak what did the american colonies do? (3)
1)enacted some health legislation
2)mostly consisted of blocking sick ppl from coming into town
3)used poor houses to quarantine sick poor ppl
Medical treatments of the american colonies? (4)
3)natural, non-medical treatments
4)Rush's thunderclappers
Rush thunderclappers ingredients (3)
1)6 parts mercury
2)1 part chlorine
3)1 part jalap
Medical kit for Lewis & Clark (8)
1)50 dozen of Rush's thunderclappers
2)peruvian bark
3)opium and laudanum
4)glauber salts
6)tarter emetic
7)1lb of mercury
8)mercury ointment
Focus of meds in Lewis & Clark's day...
flush the body out
# of ppl that died during the Lewis and Clark expedition?
Death in the 1800-1900s due to...(and top 4 causes)

3)respiratory infexns
Top 5 leading causes of death from 1992-2003? (and what type of diseases)
1)heart disease
4)pulmonary disease

3 things that have creeped in to the top 10 causes of death since 1992?
An increase in ____ has happened due to overuse of Abx
MRSA infections
Life expectancy in 2002 trends? (2)
1)longer in whites than blacks
2)longer in females than males
Primary reason for dramatic improvements in health? and what do most ppl think it is?
a)changes in public health measures and lifestyle (clean sewers, water, air)
b)NOT, physicians practice of medicine & therapeutics
Modern day health challenges: (5)
1)chronic diseases
2)affect 1/2 of population
3)1/3 obese
4)1990 costs $470 billion
5)healthcare system geared toward acute disease
How is the US health care system geared towards acute disease?
doesn't prevent disease, treats it when it occurs
Health in early america: (3)
1)access to health was privilege and geographic dependent
2)had to self pay everything
3)general well being a fxn of wealth & social class
Rural health (in early america) was usually given by...(3)
1)Itinerant healers
2)medicine men
3)self care
Orthodox physicians (in early america)
2)who they treated
3)____ type of medicine and desc
4)treatments (4)
1)apprenticeship, some type of education/training
2)middle-upper class (urban)
3)heroic medicine, patients can see visible signs in secretions and excretions
4)leeches, bleeding, purging, puking
Drug therapy in early americas:
a)overall aim
b)drugs must...
c)not for...
d)categorized by....(3)
a)adjust body's internal equilibrium
b)MUST show visible changes
c)not for specific diseases
d)physiologic effect: diuretic, cathartic, narcotic
First manufacturing of medicine's occured when?
early 1800's
a)Role of physicians w/ medicines
b)Role of pharmacists w/ medicines (3)
a)prescribed and dispensed
b1)started apothecaries
b2)compound, diagnose, treat (either from physicians Rx or patient requests)
b3)sold own concoctions
Most common ingredient in "concoctions"
Colonial life expectancy
25 years
4 Health theories of 19th century america
1)contagion therapy
2)disease-result of supernatural causes
3)health was individual responsibility not gov't
4)miasma theory
Contagion theory (19th century policy)
healthy ppl should avoid sick ppl so isolate the sick
Disease-result of supernatural causes (19th century policy) (2)
1)punishment from god for sin
2)therefore, do not intervene (especially if person is poor)
Miasma theory (19th century policy)
relationship b/w disease and atmosphere
Emergence of hospitals
c)fxn (2)
d)bad parts (2)
a)pre-civil war period
b)poor houses
c1)charitable and welfare fxn
c2)protect community from "sick" persons
d1)NO antiseptic practices
d2)workers often former patients
When did REAL hospitals come about and why?
Post-civil war

need to place to put ppl who are hurt
Federal buildup era Acts (5)
1)US Public Health Service
2)Pure Food and Drug Act
3)Federal Food, Drug and Cosmetic Act
4)National Cancer Act
What act said that you have to say what is in your medicine?
Pure Food and Drug Act
From 1946 to 1970 what happened to make health care better? (6)
Heavy Federal investment in healthcare:
1)basic and clinical research
2)health facilities
3)health providers
4)medical care financing
5)health care delivery system
How did WW2 help create the drug industry?
b/c massive amounts of penicillin were needed
Hill Burton Act?
Provided federal aid to states for purpose of hospital and health center construction
Hill Burton Act led to construction of...(4)
2)nursing homes
3)emergency rooms
4)long term care facilities
Development of US health system after WW2 was mainly done by:
putting lots of $ into training more health professionals in the 1950s
Acts that led to increased numbers of health professionals (6)
1)Health Amendments Act
2)Health Professional Educational Assistance Act
3)Nurse Training Act
4)Allied Health Professions personnel Act
5)Health Training Improvement Act
6)Comprehensive Health Manpower Training
Purpose of Health Amendments Act?
increase # of physicians and other health care persons
Trends in Pharmacy in the following fields:
a)Order fulfillment
b)Primary services (and def.)
c)2nd/tertiary services
d)indirect/other services
b)major incr (MTM)
c)major incr
Largest mail order entity is....
Where is the biggest shortfall of pharmacists predicted to occur?
In primary/secondary/tertiary services
Why is order fulfillment predicted to decrease? (4)
due to:
1)information technology
4)supportive personnel
Most Americans encounter a pharmacist where?
in community setting
___ is greatest employer with the greatest demand of pharmacists (and % of pharmacists they employ)
Retail settings

4 major components of community pharmacy industry include...
1)independent pharmacy
2)chain drug stores
3)supermarket pharmacies
4)mass merchandiser pharmacies
Independent pharmacy def.
often owned by pharmacist w/ less than 4 outlets
Chain drug store def.
corporate ownership w/ 4 or more outlets
Mass merchandiser pharmacies def.
pharmacy in place like walmart, target
The percent of pharmacists employed by retail and interesting thing about this
Total # of pharmacists #'s from 92-98 and affect on our income?
has incr from 170,000 to 190,000 but income is going up faster than # new pharmacists in field
Prescription drug spending trend (in $) from 93-05 and the % these make up of total health spending
93- $50 billion, 5.6%
05- $185 billion, 10.3%
Trends in national spending on
a)Rx drugs
b)physician services
c)hospital care
d)why are these trends occuring?
a)major increase
d)have controls on latter 2 but not on Rx drugs
Increase pharmacist demand via...(6)
1)incr TP Rx coverage
2)growth of economy
3)intro of new drug therapies
4)direct-to-consumer marketing
5)greater freq of refills
6)incr # of Rx providers
What is in part responsible for the large incr in mail order prescriptions?
some insurace companies mandate use of online pharmacies
Independent pharmacies fill what % of prescriptions?
Mass merchants/Supermarkets make what % of their income on Rx's? and why?
And compare this % to independents?
Only 5% for MM/10% for supermarkets, have Rx business just to get ppl in store

90% for independents
# of Rx's increase in # and % from 92-98?
1,900 million to 2,800 million, 44.1% INCREASE
Problem with patient counseling in a retail setting?
NO economic incentive to provide such services
# of Rx's old use compared with other age groups?
4-5x more
Amount of busyness increase from 92-99
10x increase in busyness
If recent growth rates in Rx volume contine....(2)
1)# of Rx's per community pharmacy will contine to incr
2)current shortage will worsen