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75 Cards in this Set
- Front
- Back
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what percentage of the GDP is used for healthcare
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17%
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major department most concerned with health
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department of health and human services (DHHS)
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what subcategories are under the DHHS
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CMS - centers for medicare and medicaid services
CDC - centers for disease control and prevention HRSA-health resources and services administration FDA |
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provides access to essential health care services for people who are low-income, uninsured, or who live in rural areas or urban neighborshoods
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HRSA
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administers the Medicare and Medicaid services
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CMS
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who does Medicare provide coverage for
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people over 65
disabilities end-stage renal disease |
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Part A of Medicare plan
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hospital
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Part B of Medicare plan
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Medical - optional
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Part D of medicare plan
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prescription drug coverage
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Part C of Medicare plan
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combines Part A and B
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who can apply for Medicaid
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pregnant women
children and teens aged, blind, other disabilities very low income individual |
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cost containment strategies for influencing patients in accessing their care
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deductibles - discourage use of medical insurance for unimportant problems
copayments - patients pay a given percentage of medical expenses exclusions - some specific serves are totally excluded |
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cost containment strategies for influencing providers and hospitals
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prospective payment system (diagnosis related groups) - the hospital is given a predetermined amount of reimbursment after a specific type of care
resource-based relative value scale - pay providers more equitably for each outpatient care based on the time spent managed care - attempts to reduces health care costs to the payer, encourage high-quality care with financial incentives |
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strategies in which managed care uses to cut costs
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second opinions
drug formularies preauthorization and referral benefit design - refuse to cover the cost of certain pre-existing conditions financial incentives for providers |
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used of managed care techniques from most used to less
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HMO - most
traditional indemnity health plan - least |
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most tightly managed formed of managed care
primary care provides act as gatekeepers only can see physicians who are affiliated with the plan |
HMO
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networks arranged to supply healthcare services at a discounted cost by providing incentives for members to use designated healthcare providers
members are responsible for a larger percentage of the cost |
PPO
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the prevention of the occurence of a disease, conditions, or injury
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primary prevention - vaccine, seat belts
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the early detection of the potential development of a disease
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secondary prevention - mammograms, pap smears, colonoscopy
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treatment of an existing symptomatic disease
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tertiary prevention
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top five causes of death in the U.S.
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1. heart disease
2. cancer 3. stroke 4. COPD 5. Accidents |
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the top three actual causes of death in the U.S.
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1. tobacco
2. poor diet/physical activity 3. alcohol |
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3 models of health behavior change
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health belief model
transtheoretical model motivational interviewing |
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perceived susceptibility
perceived severity perceived benefits perceived barriers |
health belief model
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contains stages of change
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transtheoretical model
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no consideration to change
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precontemplation - discuess health problems
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limited motivation to change
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contemplation - discuss history of problems and consequences, explore benefits of change
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making small changes
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preparation - refer to appropriate provider, goals for small behavior change
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first 6 months of change
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action - self help materials, relapse prevention
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period after the first 6 months of change
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maintenance - ongoing feedback and support pros of health change
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confrontation frequently leads to resistance, more effective by facilitating a discussion that allows the patient to argue for their own health behavior change
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motivational interviewing
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risk factors for hypertension
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alcohol
excess dietary sodium lack of exercise stress obesity medication - oral contraceptives, diet pill, decongestants age genetics race |
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when does a women's risk increase for developing hypertension
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after menopause
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blood pressure classification
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normal - less than 120/80
prehypertension - 120-139/80-89 hypertension - >140/90 *always go with the higher category if discrepancy |
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lifestyle modifications that reduce systolic blood pressure
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weight loss
DASH diet dietary sodium reduction physical activity decrease alcohol |
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risk factors for having a stroke
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hypertension - single most important
physical inactivity hyperlipidemia advancing age |
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attributed to 30% of all cancer deaths
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tobacco use
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what percentage of the US smokes
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21%
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what is the percentage decrease risk of having an MI from smoking cessation for 1 year
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50% decrease
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two important questions to ask to see how addicted the patient is to tobacco
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how soon after you wake up do you smoke your first cigarette
how many cigarettes do you smoke |
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contraindication of buproprion use for smoking cessation
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history of seizures
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what smoking cessation produce can you not combine with others
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verenicline
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5 A's for smoking cessation
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Ask - identify user
Advise - strongly urge to quit Assess - willingness to quit Assist - help the patient quit Arrange - schedule follow-up contact |
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7 fist line drugs for smoking cessation
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nicotine patch
nicotine gum nicotine nasal spray nicotine inhaler nicotine lozenge Buproprion Verenicline |
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accounts for more than 34% of all deaths
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coronary vascular disease
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major risk factors of CHD
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smoking
dyslipidemia hypertension age (M>45, F>55 or postmenopausal) family history |
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the one negative risk factor of CHD
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HDL cholesterol (>60)
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CHD risk equivalent
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Diabetes - confers same risk as previous MI
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when is a 10 year risk assessment performed for CHD
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for patients with multiple (2+) risk factors
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LDL goal and when to consider drug therapy for patients with CHD of CHD equivalent (diabetes)
10 year risk is > 20% |
LDL goal < 100
if LDL >130 need to consider drug therapy |
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LDL goals and when to consider drug therapy for patients with 2+ risk factors for CHD
10 year risk is 10-20% |
LDL goal < 130
if LDL > 130 need to consider drug therapy |
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LDL goals and when to consider drug therapy for patients with 2+ risk factors for CHD
10 year risk is <10% |
LDL goal < 130
if LDL > 160 need to consider drug therapy |
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LDL goal and when to consider drug therapy for patients wit 0-1 risk factor for CHD
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LDL goal <160
if LDL >190 need to consider drug therapy |
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TLC diet
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reduce intake of cholesterol-raising nutrients - saturated fats and dietary cholesterol
LDL-lowering options - plant sterols and soluble fiber weight reduction increase physical activity |
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positive TB reaction if induration is >5 mm is which patients
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HIV positive
recent contacts with TB case fibrotic changes on CXR immunosupressed |
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positive TB reaction if induration is >10 mm is which patients
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recent arrival fro high-prevelance country
IV drug user health care worker children < 4 years |
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positive TB reaction if induration is >15 mm is which patients
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no known risk factor for TB
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factors for may give false-positive TB skin test
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nontuberculous mycobacteria
BCG vaccination |
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factors that may yield false-negative TB skin test
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recent TB infection (8-10 weeks)
recent live-virus vaccination very old TB infection |
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when is boosting for TB test necessary
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Health-care workers from foreign country
some people with latent TB infection may have negative skin test reaction initially - 2 step testing |
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less than half of children participate in adequate physical activity
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**
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aerobic activity recommendations for substancial health benefits
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150 minutes of moderate-intensity aerobic activity
75 minutes of vigorous-intensity aerobic activity **each week |
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eating this food inhibits platelet aggregation
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omega 3 - fish
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a patient on antibiotics that doesn't eat any green vegetables, canola or soybean oil may have trouble with what
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blood coagulation - vitamin K
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when you first start a patient on coumadin, what should they not change their daily intake of
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green vegetables
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first-line therapy in reducing hypertension in patients
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restrict sodium intake
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which lipoprotein delivers dietary cholesterol to the liver
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chylomicron remnants
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which food consitituent is transported with chylomicrons from the intestine to the liver
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vitamin E
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delivers triglycerides from the liver to muscles and fat cells
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VLDL
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who makes more VLDL
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overweight individuals
weight loss decreases VLDL synthesis |
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what food source lower LDL cholesterol concentration by more than a percent with each daily serving
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oats and fruits
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anti-oxidants that protect lipoproteins from oxidation
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alpha-tocopherol
carotenoids *found in vegetables |
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what explains the high susceptibility of LDL to oxidation
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high content of polyunsaturated fatty acids
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what does exposure to free radicals change of the metabolic fate of LDL
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more end up in extra-hepatic tissue
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what does exercise do to HDL levels
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increase - promote cholesterol transport from the arteries to the liver
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