General Principles Of Health Care.docx

GENERAL PRINCIPLES OF HEALTH CARE CONCEPTS OF HEALTH HEALTH -Old English word for “heal” (hael) “WHOLE” Whole person and his or her soundness, or well-being

integrity,

HEALTH -Is the state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (WHO) -Is the quality of life involving social, emotional, mental, and biological fitness on the part of the individual, which results in adaptations from the environment 2 COMMON MEANINGS OF HEALTH FOR EVERYDAY USE THE DIMENSIONS OF HEALTH  PHYSICAL HEALTH  MENTAL HEALTH  EMOTIONAL HEALTH  SOCIAL /ENVIRONMENTAL HEALTH  SPIRITUAL HEALTH HOLISTIC HEALTH is an approach that identifies components of health that function interdependently to influence an individual’s health WELLNESS Wellness is well-being. It involves engaging in attitude and behavior that enhance quality of life and maximize personal potential well-being is a subjective perceptive of balance, harmony and vitality Wellness is a choice Wellness is a way of life Wellness is the integration of body, mind and spirit Wellness is the loving acceptance of one’s self Wellness can also be described as "the constant, conscious pursuit of living life to its fullest potential. Travi’s Wellness Model

ILLNESS is a personal state in which the person feels unhealthy is a state in which a person’s physical, emotional, intellectual, social, developmental or spiritual functioning is diminished or impaired compared with previous experience Precursor of Illness  HEREDITARY – family history for diabetes mellitus, hypertension, cancer 

BEHAVIORAL FACTORS – cigarette smoking, alcohol abuse, high animal fat intake

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ENVIRONMENTAL FACTORS overcrowding, poor sanitation, supply of potable water

– poor

Stages of Illness 1. SYMPTOM EXPERIENCE Examples: Transition stage -The person believes something is wrong -Experience some symptoms 3 aspects:  Physical – fever, muscle aches, malaise, headache  Cognitive – perception of “having Flu”  Emotional (worry on consequences of illness) 2. ASSUMPTION OF SICK ROLE Examples: -Acceptance of the illness -Seeks advice, support for decision to give up some activities 3. MEDICAL CARE Examples: -Seeks advice of health professionals for the following reasons -Validation of real illness -Explanation of symptoms -Reassurance or prediction of outcome 4. DEPENDENT PATIENT ROLE Examples: -The person becomes a client dependent on the health professional for help -Accepts/rejects health

professional’s suggestions -Becomes more passive and accepting -May regress to an earlier behavioral stage

hereditary factors, or prenatal infection; present at birth

5. RECOVERY/REHABILITATION Example: -Gives up the sick role and returns to former roles and functions

Metabolic

DISEASE -an alteration in body functions resulting in reduction of capacities or a shortening of the normal life span

Deficiency

Common Causes of Disease

Traumatic Allergic

1. Biological agents 2. Inherited Genetic Diseases 3. Developmental defects 4. Physical agents

5. Chemical agents 6. Tissue response to irritation 7. Metabolic process

8. Emotional/Physical reaction to stress Risk o o o o

microorganisms Achondroplasia imperforate anus Cleft palate hot and cold substances, radiation, ultraviolet rays lead, emissions from smokebelching cars fever, inflammation inadequate iodine causing goiter, inadequate insulin in diabetes mellitus anxiety, fear

Neoplastic

Idiopathic

Degenerati ve

Iatrogenic

due to disturbance or abnormality in the intricate processes of metabolism results from inadequate intake or absorption of essential dietary factors due to injury due to abnormal response of the body to chemical or protein substances or to physical stimuli due to abnormal or uncontrolled growth of cancer cells cause in unknown; selforiginated; of spontaneous origin results from the degenerative changes that occur tissue and organs results from the treatment of a disease

Factors of a Disease Genetic and Physiological Factors Age Environmental Lifestyle

Classification of Disease  According to Etiologic Factors Hereditary due to defect in the genes of one or other parent which transmitted to the offspring Congenital

due to a defect in the development,

 diabetes mellitus hypertension

cleft lip, cleft palate

diabetes mellitus hyperthyroidis m osteomalacia, which is vitamin D deficiency in adults fractures asthma, skin allergy

cancer

osteoporosis, osteoarthritis

hypothyroidis m after thyroid surgery; alopecia (hair Loss) after chemotherapy

According to Duration or Onset

Acute illness Chronic illness

usually has a short duration and is severe usually longer than 6 months and can also affect functioning in any dimension

appendicitis hypertension

a.Remission

b.Exacerbation

Sub –acute

7. Endemic – present more or less continuously or recurs in a community Examples: malaria in Palawan, goiter in Mountain Province

period during which the disease is controlled and symptoms are not obvious

8. Pandemic – an epidemic disease which is extremely widespread involving an entire country or continent

The disease becomes more active again at a future time, with recurrence of pronounced symptoms symptoms are pronounced but more prolonged than in acute disease

9. Sporadic – a disease in which only occasional cases occur Example: Dengue during rainy season, leptospirosis during floods Health    sub-acute bacterial endocarditis

Promotion Model INDIVIDUAL PERCEPTIONS MODIFYING FACTORS PARTICIPATION IN HEALTH

Individual Perception -Perceived susceptibility to an illness Example: Family history to diabetes mellitus increases risk to develop the disease -Perceived seriousness of an illness Example: diabetes mellitus is a lifelong disease

Others. Diseases may also described as: 1. Organic –any health condition in which there is an observable and measurable disease process, e.g. inflammation or tissue damage

-Perceived threat of an illness Example: Diabetes mellitus causes damage to the brain, heart, eyes, kidneys, blood vessels

2. Functional – no anatomical changes are observed to account for the symptoms present, may result from abnormal responses to stimuli

Modifying Factors -Demographic variables Examples: Age, Sex, Race

Examples: irritable bowel syndrome

-Structural variables Example: knowledge about the disease

3. Occupational – results from factors associated with the occupation engaged in by the patient Examples: workers

cancer

among

chemical

factory

4. Familial – occurs in several individuals of the same family Examples: hypertensive, cancer 5. Venereal – usually acquired through sexual relation Examples: AIDS, gonorrhea 6. Epidemic – attacks a large number of individuals in a community at the same time Examples: SARS

-Socio-psychologic variables Examples: social pressure or influence from peers -Cues action Examples: internal: fatigue, uncomfortable symptoms; external: mass media, advice from others Leavell and Clark’s Agent HostEnvironment Model 1. AGENT – any factor or stressor that can lead to illness or disease 2. HOST – persons who may or may not be affected by a disease 3. ENVIRONMENT – any factor external to the host that may or may not predispose the person to a certain disease

HEALTH STYLE -the sum of personal health decisions that affect the individual and the community both very personal and very interpersonal -It is described as being influenced by: -The information you have about your health -Your values -Your social support -Your health-related skills -Your health-related resources -The momentum developed by your healthrelated decisions Indicators of Health Status  PERSONAL HEALTH STATUS Satisfaction with life Zest for life Functional level of physical fitness Minimum of illness

HEALTH BACKGROUND -Sickness has been one of man’s greatest adversaries -To identify or diagnose a specific disease or injury Physicians, pharmacists, and other health care professionals utilize clues

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COMMUNITY HEALTH STATUS

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MORBIDITY refers to the rate of illness in a group. MORTALITY refers to the rate of death in a group

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LIFE EXPECTANCY refers to the number of years a person is expected to live

FACTORS that affect HEALTH Behavior and Status  Race  Sex  Income -Caucasian American have longer life expectancy than African American -Women live longer than men middle, high-income than in low-income groups Predisposing, Reinforcing, and Enabling Factors

MEDICINE -Latin word “medicus” -It is a healing art -Aims to help people become more active and live longer and happier lives with less suffering and disability -Constant search -New drugs -Effective treatments -More advanced technology -Health care professionals can prevent, control or cure hundreds of diseases -Has become a part of the health care industry -One of the largest industries in the world -One of the leading employers in most communities -At the turn of the 20th century (1900) Men and women were frail by age 40 Life expectancy was 47.3 years Effective treatment for diseases were so scarce

PREDISPOSING FACTORS Life experience Knowledge Cultural and ethnic heritage Beliefs and values

-By the end of the 20th century Medical advances Life expectancy increased to 76 years

ENABLING FACTORS Abilities Mental and Emotional capabilities Resources Facilities REINFORCING FACTORS Support Encouragement and discouragement people in your life

Activities to Promote Health and Prevent Illness -Have a regular physical examination (yearly) -Women: Regular PAP test, Monthly BSE (breast self-examination) -Men: Regular testicular self examination -Annual dental examination -Regular eye examination -Exercise regularly (3x/wk for 30 mins.) -Do not smoke, avoid second hand smoke -Avoid alcohol, “recreational drugs” -Reduce fat and increase fiber in diet -Sleep regularly -Maintain ideal body weight

-Today People in their 80s and 90s are independent and physically active Medical expansion has been expensive from

HISTORY OF HEALTH CARE Prehistoric medical practice Study of ancient pictographs that show medical procedures and surgical tools uncovered from anthropological sites of ancient societies Serious diseases were of primary interest to early humans but they were not able to treat them effectively Diseases were attributed to the influence of malevolent demons Diseases were believed to project an alien spirit, a stone, or a worm into the body of the unsuspecting patient Demons and Disability It was once thought that demons or evil spirits could cause disabilities such as mental illness and physical deformities. Diseases were warded off by incantations,dancing, magic charms and talismans, and various other measures Make the body uninhabitable to the demon by beating, torturing and starving the patient Trepanning -Alien spirits are expelled by potions that caused violent vomiting, or could be driven out through a hole cut in the skull -Remedy for insanity, epilepsy and headache Trepanated skull, Iron age. The perimeter of the hole in the skull is rounded off by ingrowth of new bony tissue, indicating that the patient survived the operation. The Spinning Treatment was one of many treatments that attempted to rid the body of mental illness through physical means The Spread Eagle Cure was used to treat disorderly patients. Cold water was poured from a height over the persons face until the patient is "calm" Mild electric shock was used to stimulate the muscles and the mind in this 19th century cure for mental illness known as Faradization. Surgical procedures practiced in ancient societies Cleaning and treating wounds by cautery (burning or searing tissue), poultices, and sutures Resetting dislocations and fractures, and using splints to support or immobilize broken bones Additional therapy included laxatives and enemas to treat constipation and other gastrointestinal diseases

Discovery of the narcotic and stimulating properties of certain plant extracts Many are still of use today  Digoxin, a heart stimulant extracted from foxglove (Digitalis purpurea)  Opium poppy (Papaver somniferum) is the species of plant from which opium and poppy seeds are extracted. Opium is the source of many opiates, including morphine (and its derivative heroin), thebaine, codeine, papaverine, and noscapine. Systems of medicine, based on magic, folk remedies, and elementary surgery, existed before the coming of the more advanced Greek medicine about the 6th century B.C. HEALTH CARE PROFESSIONALS 11.6 million people work in health care in other countries 778,000 physicians, 2.1 M nurses and 160,000 dentists Work in health care services, involved in the diagnosis and treatment of patients Research, teaching or administration of medical facilities PHARMACIST Has a unique body of knowledge and skills to contribute in our health care system Dispenses the appropriate drug product and has the knowledge to assure safe and rational use of drugs EARLY FUNCTIONS OF PHARMACISTS -Assisting in the selection of appropriate drug therapy -Preparing, compounding and manufacturing drugs for individualized patients -Dispensing and packaging the prescribed drug products including proper labeling -Advising and educating patients on proper use of drugs -Monitoring the outcome and responses of patients to the effect of drugs, both beneficial and adverse -Serving as a community resource person on drug and health information THE TEN STAR PHARMACIST Pharmaceutical Care Giver Researcher Manager Communicator Leader Life-long learner

Decision-maker Teacher Entrepreneur Agent of Positive Change

Welfare of humanity and the relief of human suffering is the primary concern Must learn to view medication’s use from the patient’s perspective

CONCERNS AMONG HEALTH CARE PROVIDERS Potential abuse, misuse and inappropriate Increase in health care cost Patient suffering

AN OATH “ I will use knowledge and skills to the best of my ability in serving the public and other health professionals”

THE PATIENT-ORIENTED PROFESSIONAL Able to apply and provide drug knowledge to improve drug use in the health care system PRIMARY AIM To attain success in the goals for therapy, pharmacist must approach the patient– counseling encounter as a HELPER and an EDUCATOR THE TRADITIONAL PHARMACIST Involved in the preparation and dispensing of medications At the direction of the physician Strongly allied with the medical profession View that the health professional should be in control of the patient THE MODEL Shift in the model of pharmacy From focus on the medication to a focus on the patient Need for a shift in the pharmacist’s approach From the health professional–centered MEDICAL MODEL to the patient–centered HELPING MODEL MEDICAL MODEL Patient is passive Trust is based on expertise and the authority of pharmacist Pharmacist identifies problem and determine solutions Patient is dependent on pharmacist Parent–child relationship HELPING MODEL Patient is actively involved Trust is based on personal relationship developed over time Pharmacists assist patients in exposing problem and possible solution Patient develops self-confidence to manage problems Equal relationship PQL (Patient Quality of Life)

HEALTH A goal to strive for. It is not obtainable. No one ever achieves a “state complete mental, physical and social well being” CURE Latin word “cura” CARE CARE Providing for the welfare of another Attentive conscientiousness of devotion Conveys a compassionate state of being and not merely an attitude Involves a profound respect for the “otherness” of the other CHARACTERISTICS OF A CARING BEHAVIOR: VITAL COMPONENTS OF A THERAPEUTIC RELATIONSHIP Mutual respect Honesty/Authenticity Open communication Cooperation Collaboration between patient and practitioner Empathy Putting the patient first Offering reassurance Confidence Paying attention to the patient’s physical and emotional comfort Offering advocacy Being willing to be held accountable for all decisions made and recommendations given Competence Trust Exercising patience and understanding Seeing the patient as a person Promotion of patient independence Sensitivity Supporting the patient Assuming responsibility for intervention HEALTH CARE NEEDS OF A PATIENT Medical Care I care Mental Health Care Geriatric Care Dental Care Pharmaceutical Care Nursing Care Surgical Care

Chiro-practice Care Pediatric Care Maternal Care

Nutritional Care Eye Care

INTERACTIONS With patients and other health care providers COUNSEL CONSULT EDUCATION 4 R’s OF THE PHILOSOPHY OF PRACTICE Rules Relationship Roles Responsibilities PHARMACEUTICAL CARE -A responsible provision of therapy for the purpose of achieving definite outcomes that improve the patients quality of life Hepler and Strand -Applying knowledge to promote well- being of others -Requires responsiveness, sensitivity and commitment to others -Generalist practice that emphasizes health, prevention and care -A form of primary health care THE FOCUS -Patient–centeredness -Addressing both acute and chronic conditions -Emphasizing prevention -Implementing documentation systems that continuously record patient need and care provided -Being accessible to front–line first contact -Ensuring integration of care -Being accountable -Placing emphasis on ambulatory patient -Including education/health promotional intervention 5 FACTORS TO BE CONSIDERED IN PHARMACEUTICAL CARE PRACTICE A general understanding of how people feel about being ill, the seriousness of the disease(patient’s susceptibility to other factors) DENIAL–“Not me!” ANGER–“Why me?” DEPRESSION–“Yes, me!” BARGAINING–“Yes me, BUT….” ACCEPTANCE–“I’m ready” VITAL POINTS  Don’t assume patients had information from the doctor  Don’t assume patients understand all information given  Don’t assume patients have resources to comply

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Don’t assume patients don’t care or are stupid Don’t assume patients will comply if they understand Don’t assume others will monitor of follow– up Don’t assume patients will voluntarily seek help or information if there are problems

WHAT A PHARMACIST CAN DO? Patients on medications experience a lot of “drug misadventures”– adverse effects, drug interactions, errors in the use of medication and non–compliance MINIMIZE WASTE and MAXIMIZE BENEFITS of medical treatments OLD PARADIGM Emphasis on acute patient care Emphasis on treating illness Responsible for individual patients All providers are essentially similar Success achieved by increasing market share of in-patient admissions Goal is to fill beds Hospitals, physicians, and health plans are separate NEW PARADIGM Emphasis on the continuum of care Emphasis on maintaining and promoting wellness Accountable for the health of define populations Differentiation based on ability to add value Success achieved by increasing the number of covered lives and keeping people well Goal is to provide care at the most appropriate level Integrated health delivery system THE ROLE OF THE NEW PHARMACIST Has evolved from being product–oriented to a patient–oriented professional Extremely healthy for both patient and pharmacist Dispensers of therapy and drug effect interpretations as well as drugs In the future, pharmacy services must be evaluated on patient outcome rather than the number of prescriptions dispensed It must evolved towards interpretation and patient consultation, related to the use of medication technologies