KINE 1020 LECTURE NOTES.pdf

health equality ↑ The Regionalized Model (UK and Canada) • Basil, a 60-year-old man living in a London suburb, is registered with Dr. Prime, a general practitioner in his neighborhood. Basil goes to Dr. Prime for most of his health problems, including hay fever, back spasms, and hypertension. On...

health equality ↑ The Regionalized Model (UK and Canada) • Basil, a 60-year-old man living in a London suburb, is registered with Dr. Prime, a general practitioner in his neighborhood. Basil goes to Dr. Prime for most of his health problems, including hay fever, back spasms, and hypertension. One day, he experiences numbness and weakness in his face and arm. By the time Dr. Prime examines him later that day, the symptoms have resolved. Suspecting that Basil has had a transient ischemic attack, Dr. Prime prescribes aspirin careand refers him to the neurologist at the local hospital, where a carotid artery sonogram reveals high-grade carotid stenosis. Dr. Prime and the neurologist agree that Basil should make an appointment at a London teaching hospital with a vascular surgeon specializing in head and neck surgery. The surgeon recommends that Basil undergo carotid endarterectomy on an elective basis to prevent a major stroke. Basil returns to Dr. Prime to discuss this recommendation and inquires whether the operation could be performed at a local hospital closer to home. Dr. Prime informs him that only a handful of London hospitals are equipped to perform this type of specialized operation. Basil schedules his operation in London and several months later has an uncomplicated carotid endarterectomy. Following the operation, he returns to Dr. Prime for his ongoing care. secondary https://basicmedicalkey.com/ This is the typical public funded medical model in Canada (evidence-based medicine) The Dispersed Model (USA): • Polly Seymour, a 55-year-old woman with private health insurance who lives in the United States, sees several different physicians for a variety of problems: a dermatologist for eczema, a gastroenterologist for recurrent heartburn, and an orthopedist for tendinitis in her shoulder. She may ask her gastroenterologist to treat a few general medical problems, such as borderline diabetes. On occasion, she has gone to the nearby hospital emergency department for treatment of urinary tract infections. One day, Polly feels a lump in her breast and consults a gynecologist. She is referred to a surgeon for biopsy, which indicates cancer. After discussing treatment options with Polly, the surgeon performs a lumpectomy and refers her to an oncologist and radiation therapy specialist for further therapy. She receives all these treatments at a local hospital, a short distance from her home. https://basicmedicalkey.com/ This is the typical full private medical model in the USA (evidence-based medicine) Advantages of Public versus Private Health Care Full Private Full Public Pro • Faster Care • More Options for Procedures • Can choose doctor • Better doctor-patient ratios • More privacy Pro • Everyone can get the SAME healthcare • Care is more affordable (non-profit) Con • Inequality • Not all will get health care • Refuse to treat complex cases (to increase profit) • Even with insurance, care may not be covered 100% • More Expensive • Profit may undermine patient interests (order more tests than needed for profit) Con • Longer Wait Times • Fewer Choices • Higher patient loads for healthcare workers First International Conference on Health Promotion held in Ottawa, Canada, in 1986 The Ottawa Charter for Health logo represents a circle with 3 wings. It incorporates five key action areas in Health Promotion (build healthy public policy, create supportive environments for health, strengthen community action for health, develop personal skills, and re-orient health services) and three basic Health Promotion/Public Health strategies (to enable, mediate, and advocate). https://www.who.int/publications/i/item/ottawa-charter-for-health-promotion • Advocate: Good health is a major resource for social, economic and personal development and an important dimension of quality of life. Political, economic, social, cultural, environmental, behavioural and biological factors can all favour health or be harmful to it. Health promotion action aims at making these conditions favourable through advocacy for health • Enable: Health promotion focuses on achieving equity in health. Health promotion action • aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential. This includes a secure foundation in a supportive environment, access to information, life skills and opportunities for making healthy choices. People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. This must apply equally to women and men. > responsible to help and mediate health promotion Mediate: Health in Canada cannot be ensured by the health sector alone. More importantly, health promotion demands coordinated action by all concerned: by governments, by health and other social and economic sectors, by non-governmental and voluntary organizations, by local authorities, by industry and by the media. People in all walks of life are involved as individuals, families and communities. Professional and social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health. https://academic.oup.com/heapro/article/26/suppl_2/ii187/580659 What Are We Spending Health Care $ On? Prevention versus Promotion?? 8 Health Promotion • Mental Health • Pregnancy • Injury • Infection • Child Health • Violence Anti Smoking Other Issues http://www.phac-aspc.gc.ca/dca-dea/injury/en/playgame-eng.php Some Examples on Disease Prevention Programs • $480 million - Anti-tobacco (2005) • $90 million - Diabetes Strategy (2005) • $5 million for renewal of ParticipACTION (2005) • $27.6 million - Healthy Living Projects (2005) • Children’s Fitness Tax Credit up to $500 (Jan 1, 2007) • $10.7 million - incorporating at least 20 min of daily physical activity in elementary children in Ontario (2005). • $27 million Mental Health (2011) • >$17.6 billion to support COVID-19 vaccine procurement, deployment, and administration (2020-21) * • $100 million over 3 years (2022-2024) for Mental Health because of covid-19* * https://budget.gc.ca/2022/report-rapport/chap6-en.html Traditional Evidence Based Medicine vs. Complementary/Alternative Medicine The Traditional Canadian Medical Model Prides itself on Evidence-Based Medicine • Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values. • The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. • “Evidence based practice (EBP) is the conscientious use of current best evidence in making decisions about patient care.” –Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000 – It includes the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients • Used to determine the “strength” or “weight” of the scientific evidence for a type of care (medicinal and non medicinal) – It focuses more on clinically effectiveness (efficacy)… – But not so much on cost effectiveness… Evidence Based Medicine (EBM) • EBM is the use of current “best evidence” in making decisions about the care of individual patients • Evidence comes from peer reviewed original published manuscripts/journals Only this is truly “evidence-based medicine” (and its still not perfect!) Problems associated with some medical advice What about the people that didn’t get better? Will they tell you about the people that didn’t get better? Was it the doctor that made them better or something else? Are we the same as mice? Only this is truly “evidence-based medicine” Evidence based recommendations Based on “quality of evidence” and thus study design • Level I: Evidence obtained from at least one properly designed randomized controlled trial and Meta-analysis. • Level II: Evidence obtained from welldesigned controlled trials but without randomization or well-designed cohort or Level III case-control studies and meta-analysis. • Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. Level I https://www.sciencedirect.com/science/article/abs/pii/S1360859211000751 Level II Looking backwards in time for differences in those with or without the disease Example level II evidence: In one published study, it was noted that when questioning women with existing heart disease it was found that they tended not to take estrogen after menopause as compared to women with no heart disease who tended to be more likely on estrogen therapy…. Looking groups that are different and then wait to see if there are differences in the disease occurrence Example level II evidence: in another published study, following women who were already on estrogen therapy it was noticed that they tended to have less heart disease risk as compared to women who did not take estrogen therapy. Example level I evidence: In another study, a randomized control trial was conducted on estrogen therapy and heart disease risk Example level I evidence (a Randomized Control Trial) Estrogen Example level I evidence (a Randomized Control Trial) Complementary and Alternative Medicine (CAM) • Defined as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional (Western) medicine • According to one recent report by the Fraser Institute in 2016, about 80% of all Canadians surveyed used some form of CAM in their lifetime (e.g. acupuncture, supplements, chiropractic, etc.) – Usage is on the rise https://www.fraserinstitute.org/studies/complementary-and-alternative-medicine-use-and-public-attitudes1997-2006-and-2016