Public Health 3010 Lecture Notes Week 2
Public Health 3010 Lecture Notes Week 2 SPHU 3010
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This 6 page Class Notes was uploaded by Cara Macdonald on Thursday September 8, 2016. The Class Notes belongs to SPHU 3010 at Tulane University taught by Arthur Mora in Fall 2016. Since its upload, it has received 4 views. For similar materials see Foundations of Health Care Systems in Public Health at Tulane University.
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Date Created: 09/08/16
Week 1 Recap: Legitimacy of traditional medicine was gained through scientific discoveries about the foundations of disease. Advancement of technology→ hospital improvement • “Traditional” Public Health: o Primarily through education, clinical intervention and community intervention § Community intervention example: seat belt laws, fluoridated water, bicycal helmets, etc § Clinical intervention: vaccinations o Continuum of interventions and care: § Primary interventions: basic information not targeted at a specific group to present disease down the road § Secondary interventions: identify at -risk group, find ways to treat and find more effectively Ex. mammogram, blood pressure screening § Tertiary: already have dise ase, efforts to manage and treat it § Categorized by services provided, settings where they are provided • Need to separate locations from settings; rehabilitation care can be provided in a variety of locations o Acute care: defined as short -term, intense medical care providing diagnosis and treatment of communicable or noncommunicable disease, illness or injury § Delivered in many settings: primary physician, emergency care in the ambulance, other pre-hospitalization services o Outpatient care: any care provided that doesn’t require a hospital stay § Pre-hospital care: anything provided prior to relocation to the hospital provided by local, community -based providers • Ambulance services • Stabilization of injury • Includes: o Primary care: routine treatment of illness and disease § Ex: at campus clinic; doctors may refer to other physicians for severe diseases o Urgent care: appropriate for illness, injury or condition that is serious enough for a reasonable person to seek care right away but not so severe to require ED care § Convenient, cover wide range of services; meant to deter people from emergency department • Unfortunately, we are not all qualified to determine whether something calls for emergency services o Emergency care: provides immediate care for sudden, serious injury § Classified by ESI triage levels: • Immediate: less than one minute 1.1% • Emergent: 1-14 minutes, 10.2% • Urgent: 15-60 minutes 43.4% • Semiurgent (61-120 minutes) and nonurgent: 121 min-24 hours 45.3% § Unfortunately, since the ED cannot turn people away for lack of insurance, it is frequently utilized for nonurgent care by individuals who are uninsured or underinsured o Speciality care: focus on particular body system or specific disease or condition o Chronic care: continual care and monitoring of conditions that can be controlled but not cured • Inpatient care: o Tertiary care: involves hospitalization for specialty care that requires highly specialized equipment and expertise and involves more complex therapeutic interventions § If a community hospital doesn’t have the necessary specialization or equipment, you may be referred to tertiary care § Ex: Oschner, Tulane o Quaternary care: very complex, specialized and often experimental care for the most unusual cases § Ex: advanced trauma and organ transplantation o Rehabilitation: aimed at restoring a patient to original state of health § Includes physical therapy, occupational therapy, speech and language pathology and psychiatric rehabilitation • Long-term care: range of services and support- mostly nonmedical- for people who have lost independence because of a medical condition (any setting) o Aging population & increase in longevity creates challenge of how to care for elderly population o Provides assistance with activities of daily living (bathing, dressing, eating, medicating) § End-of-life Care: care provided in final hours or days of an individual’s life and includes physical, mental and emotional support (any setting) o Much more holistic than the rest of medicine • Includes palliative care (ensuring comfort, maintaining disease), treatment of discomfort, symptoms and stress of serious illness § Extremely underutilized in the US § Usually brought in during the last few days of life • Hospice care is end of life care provided when an individual is expected to live 6 months (any setting) • Example: stroke o Time is of the essence; certain amount of time increases chances and efficiency of recovery o Chronic conditions being managed by primary care physician or specialist § Call 911 § Taken to a hospital to receive care § Treated inside the hospital § Admitted to the hospital for 3 -4 days • Could be ICU: much smaller ratio of nurses to patients o Specialists evaluate necessary post -hospital care § LTACs: Long-term acute care hospitals ensure patients do not develop infection in the hospital while they are comatose, etc. • Provide basic services to make sure patient stays healthy while on a ventilator, etc. • Example: hip replacement o Chronic pain overseen by a physical surgeon o Hip replacement therapy is a routine procedure o Subacute care: extensive care, special care, intensive rehabilitation o Emergency services NOT necessary o Receive secondary care, tertiary care or quaternary care but should not require subacute care unless something goes wrong § Probably won’t take a severely ill patient in for an elective procedure o Start physical therapy that night, stay 3 days in hospital to continue § Protects from blood clots, increases mobility/stability in hip, etc. • Example: ruptured ACL o Evaluation and diagnosis of problem but no doctor oversight o Can be done in a hospital or not • PUblic health organizations: o State health departments o Local health departments o Community health centers: for the uninsured • Non-governmental organizations (NGOs): • Physician Organizations: o Solo practices: physicians that work independently • Group practices: Most physicians in a practice together in more complex, multi -speciality clinics **missing next few* • Telemedicine: remote ly, see physician on a screen o Popular in suburbs • Retail clinics: ex. Walmart clinics have no wait, administer shots and first aid • Free-standing ED: doesn’t even have to be near a hospital • Pharmacies: able to give shots/vaccinations • Federally qualified he alth care: regardless of ability to pay, they provide services • Types of hospitals: o Community hospitals: nonfederal, short-term hospitals accesed by the general public o Federal hospitals o Nonfederal psychiatric hospitals o Specialty hospitals § Cardiac § Orthopedic § Surgical § Others including: veterans administration, department of defense o Home health agencies: o Long-term care: organizations on a spectrum § Independent living facilities→ assisted living facilities→ nursing facilities Lecture 4: The Health Workforce 9/8/16 • It’s GIANT; may be largest workforce in nation o Almost ⅓ of professional degrees are in health care o Includes technicians and secretaries, not just obvious things like pharmacists and physicians § Includes those with little education ranging to those with lots of education o Offers job security: § In 2008’s recession, healthcare jobs increased by 10.75% while all other industries sunk § Health care is NECESSARY • *Baby boomers were all reaching retirement age at this time, requiring more care • Our population is still aging, which means jobs will continue to increase § Insurance coverage means you don’t have to pay much out of pocket § Doesn’t follow typical supply/demand • Team settings are growing; physicians are no longer indepen dent o Even non-clinical people may be part of this team • Largest healthcare occupation sectors: those who actually touch people o RNs, nursing assistants, personal care aides, home health aides, etc. o Also have lots of people behind the scenes § Due to increasing technology • Primary care professionals: first point of contact for your needs o Can be MDs (medical doctors) or DOs (specialize in internal medicine, family practice, or pediatrics) § Foundation of DOs around holistic medicine, however their practices have become very similar to those of MDs § Both are required to go through medical training, residency and certifications § DOs typically focus more on primary care o Pediatricians and OB/GYNs can also be PCPs § Specializing either in children or wome n’s health o These practitioners can be “gatekeepers” for referrals to specialists § Primarily protect and monitor the basic health needs of their patients through: • Performing physicals • Administering vaccines, strep tests, blood tests, etc. • Patient counseling § PCPs receive patients, direct them to a specific doctor • Rather than going to physician after physician before finding the root of a problem o Nurse practitioners (NPs) are nurses with graduate training § Nurses that have gone back to school for an addit ional degree to have a little more autonomy § Can serve as a primary care provider, pediatrics, adult care or geriatrics § May work in women's health § Can prescribe medicine § Services may include: patient history, physical exam, order lab tests, writing prescriptions/referrals, providing handouts on disease prevention and healthy lifestyles, certain procedures such as bone marrow biopsy and lumbar puncture § Some NPs work in cli nics without doctor supervision, others work together with doctors as a joint healthcare team • Their scope of practice and authority depends on state laws o In some places, they may be able to work completely alone whereas in others, they must have a doctor i n the room o A physician assistant (PA) can provide a wide range of services working alongside the physician § Prepared academically and clinically to provide health services under the direction and supervision of an MD or DO. PA functions include performing diagnostic, therapeutic, preventive and health maintinence services § Practice in a variety of settings in nearly every medical and surgical industry o RNs have graduated from a nursing program, passed state board exam and are licensed by the state o Licensed practical nurses (LPNs) are state -licensed caregivers who have been trained to care for the sick o Advanced practice nurses have education and experience beyond the basic training and licensing required of all RNs. Inclued NPs and the following; § Clinical nurse specialists (CNSs): training in fields such as cardiac, psychiatric or community health § Certified nurse midwives (CNMs) have training in women’s healthcare § Certified registered nurse anesthetists (CRNAs) have training in anesthesia § *Goal is to expand each of these professions to decrease the amount of trained professionals necessary to carry out an operation or procedure* o ALL of this clinical care is what people have in mind when they think “public health” § BUT it is so much more: there are people that ensure safe places to exercise, accessibility of healthy foods, etc. o Education requirements: § NO formal training: personal care aides, medical secretary § Post-secondary education: surgical technicians, LPNs, EMTs § Associate degree: dental hygienists, res piratory therapists, Lab technicians, RNs § Postgraduate: physicians, pharmacists, physical therapists, optometrists, physician assistants, nurse practitioners § The ability to work toward these high -paying jobs makes medicine an attractive workforce • Critical issues: o Little national health workforce planning § Healthcare system continues to absorb all these new workers § Utilization increases limitlessly if we do not have a systematic way to plan for the workforce o Supply-and-demand market approach o Shortcomings: § Tied to current care delivery models § Treats each health professional independently o 30% population in AZ, NM, LA MS, AL do not have enough access to healthcare § U.S. overall 18.7% lacking o Emergency rooms overused because we are lacking the “ga tekeeper” function § People come in for walk -ins, strep throat, acid reflux, etc. o HRSA projects a shortage of 20,400 PCPs o In 2012, about half of NPs were practicing in primary care settings § Studies show that NPs can manage 80 -90% of care provided by PCPs • Physicians with 8 years of training may argue that a nurse with 4 years cannot replace them BUT o Evidence shows that primary care outcomes are comparable between patients served by NPs and patients served by PCPs § Ex. Optometrists vs ophthalmologists in LA arguing about who is certified to perform Lasik surgery • Who gets the larger scope of service? Why pursue more education if the opportunity for potential with more training goes down? o Public health agencies are NOT immune to economic downturns the way healthcare is; they are experiencing severe and increasing workforce shortages § Recent loss of 46,000 state and local positions due to budget cuts § Foreseen necessity of 200,000 new workers o Physician workforce diversity: the health workforce should accurately reflect the people it serves § We are more likely to listen to someone if they look like us § People of the same race are more likely to understand potential health problems and barriers to public health in a racial community • Ex. Hispanic educator more likely to effectively teach in a hispanic community o As healthcare evolves into a high -tech industry, the workforce will require more technicians and employees who understand how this techn ology works § Healthcare is in the relative dark ages compared to industries like banking o Seeing curriculum changes and examination changes in medical schools § Taking a more holistic view, incorporating interpersonal skills, wellness, nutrition o Health administration: medical and health service managers, etc. in management occupations § Need health leadership, not just management • Seeing 17% growth § 34% of people with this training go to hospitals/health systems, others seek additional education § Roles of finance, physician relations, human resources, etc. § In the future, we look toward increased roles entailing: • Retail medicine • Medical home coordination • Robotics • Destination medicine • Patient experience • Population health • Social media • Longevity health
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