Health Care and Hygiene Lecture Notes (KPE162) - University of Toronto

Health Care and Hygiene Take Responsibility KPE162 Lecture 18 – March 21, 2023 for your Care Outline Health Care in Canada philosophies, regulation, funding Health Care Interventions preventive / periodic reactive / unscheduled Self-Examination Person...

Health Care and Hygiene Take Responsibility KPE162 Lecture 18 – March 21, 2023 for your Care Outline Health Care in Canada philosophies, regulation, funding Health Care Interventions preventive / periodic reactive / unscheduled Self-Examination Personal Hygiene livingwithmigraines.com Health Care in Canada Philosophies, Regulation, Funding Health Care in Canada Many different professions in health care differ in philosophy, education, skillsets, and scope of practice Regulated (or not) at the provincial level Funded in various ways Health Care Philosophies Evidence-based health care purports to advocate health interventions that have been shown to be effective (more than sham or placebo) using scientific methods Theory-based health care advocates health interventions based on inferences & assumptions (theories) that have not (yet) been validated (but have not necessarily been invalidated) “The absence of evidence is not evidence of absence” [attributed to multiple sources] Quackery / Charlatanism advocates invalidated interventions Regulation of Health Care Regulated Health Professions Act (ON 1991) specifies controlled acts - e.g. - Rx drugs, surgery, spinal manipulation, etc. Profession Acts for specific professions – scope of practice e.g. - The Medicine Act (ON 1991), The Kinesiology Act (ON 2007) Self-governing regulatory “Colleges” (e.g. - CPSO, CKO, etc.) set competency and practice standards complaint and disciplinary procedures Many unregulated disciplines, practices, labels, & acts e.g. - athletic therapy, osteopathic manual practice, “therapist”, Rx exercise Funding of Health Care Federal government transfers blocks of funds to provinces (FT’s) gives them some indirect control over regulation (e.g. - Canada Health Act 1989) Provincial / Territorial governments raise additional funds with their own taxes and some user fees Provinces / Territories implement and regulate health care decide what they will pay for using public money Direct User Fees pay for services not covered by public funding private (for-profit) insurance plans often used to cover these expenses Canadian “Medicare” Universal disease-care insurance – a bit different in each province / territory Pays physicians in most settings for most services (OHIP) de-listing of “cosmetic” or unnecessary codes fees-for-services vs. rostered care / health maintenance organizations (HMO) Pays for almost everything in public hospitals (hospital budgets) Pay little or nothing else i.e. - services not provided by MDs or in hospitals Health Care Interventions Roles and Types When You Should Visit a Health Care Professional When to Visit a Health Care Professional Reactive health care unscheduled / on demand visits with symptoms or signs of health disorder or pregnancy forbes.com Preventive health care scheduled / periodic visits evidence-based? aboutkidshealth.ca Lalonde Revisited Consider Lalonde’s 3x3 table of health interventions (Module 1) Ask these questions: Which of these are preventive or reactive “health care” interventions? How do these align with “cost effectiveness” of interventions? What are the implications of this?  Lalonde Revisted Primary Secondary Tertiary Macro Personal HC HC HC Micro HC HC HC Preventive Reactive Some Important Reasons to see a Physician possible signs of cancer (7 warning signs, skin ABCDs) fever persisting > 2 days sore throat with fever, no runny nose (rule out Strep throat) chest pain shortness of breath severe depression / suicidal thoughts Seven Warning Signals of Cancer Insel & Roth, Core Concepts in Health  These are NOT The ABCD’s of Skin Self-Examination desirable features of “moles” (nevi or lentigenes). They don’t mean a lesion is malignant, but they increase suspicion of cancer. Preventive Care / Periodic Health Examinations Practiced for many years with no evidence of cost-effectiveness Canadian Task Force on Periodic Health Examination (1974) since renamed Canadian Task Force on Preventive Health Care has published the world’s most authoritative evidence-based guidelines on this subject Recommended practitioners, content and frequency of PHE’s vary: should be dependent on a person’s risk factors (age, sex, past and family history, lifestyle, exposures, etc.) Some Unjustifiable Periodic Interventions “Annual” complete general assessment by physician (the “complete annual checkup”) Regular chiropractic “adjustment” (manipulation) Dental x-rays every 6 months “Routine” blood tests every year “Routine” chest x-rays Evidence-Based Prenatal PHE’s Checkups may be with physician, midwife, or nurse practitioner initial diagnosis at variable point in first 10 weeks 16 weeks gestation, every 4 weeks until 32, then biweekly, then weekly after 36 Monitor multiple outcome measures: weight gain, swelling, BP, protein in urine, nutrition, foetal developmental milestones, foetal heart rate, uterine growth, foetal position in late pregnancy Evidence-Based Infant Preventive Care APGAR at moment of birth – 10-point vitality score General assessment on day of birth also - thyroid status, antibiotic eye drops, Vit K injection Checkups @ 1,2,4,6,10,12,15,18,24 months immunizations monitor milestones of growth & development Evidence-Based Childhood Preventive Care Physician / Nurse Practitioner visits annual flu immunization (add COVID booster to the list?) checkups at 5, 10, 15 years: growth & developmental milestones immunizations issue education (e.g. – substance use, sex, seat belts) Dental visits first visit to establish rapport ~ 2 years yearly examination / occasional (?) fluoride treatments Evidence-Based Adult Preventive Care Women MD breast exam / Pap smear / CHL test bi-annually Exam & tests associated with OCs annually; BP every 5 years if not on OCs BMD once by age 20 Men every 5 years - BP CHL test bi-annually? (not yet validated by CTF) annual prostate exams > 50 Both annual flu (and COVID?) shots; other immunizations every 5-10 years annual dental examination / cleaning colo-rectal Ca screens > 50 (which tests depends on risk factors) blood work – hemoglobin, lipids once by age 20 Self-Examination and Hygiene Being Responsible for your Health Self Examinations skin - ABCDs breast – learn how from HCP testes - lumps vecteezy.com oral cavity – white spots, ulcers excreta – blood, mucous cincinattichildrens.org original source unknown Hygiene Integument frequency of bathing soaps, detergents, “moisturizers” hair and nails Oral care brushing vs. flossing, frequency fluoride toothpastes Anus Ears / Eyes Foreskins Summary and So What? What you should have learned today. Why it matters. Summary Health Care in Canada philosophies, regulation, funding Health Care Interventions preventive / periodic reactive / unscheduled Self-Examination Personal Hygiene livingwithmigraines.com So What? Take responsibility for your health care make it happen, don’t wait until it comes to you appropriate preventive care, especially immunizations appropriate reactive / problem-centred care Hygiene it prevents some infections, and should be common sense… keep it clean, but not too squeaky? Be responsible for your care