PCPM100 Perspectives on Health and Healthcare PDF

PCPM100 MODULE Introduction to the Health Care System PROFESSOR: Ivy T. Echano, RPh. MSPharm 01...

PCPM100 MODULE Introduction to the Health Care System PROFESSOR: Ivy T. Echano, RPh. MSPharm 01 PHILIPPINE STATISTICS AUTHORITY (PSA)  Provides access in determining the Philippine TOPIC OUTLINE population projection BARANGAY HEALTH CENTER I. HEALTHCARE SYSTEM IN THE  Health care facility structure that can provide PHILIPPINES primary care activities II. DISEASE, ILLNESS, AND SICKNESS QUESTIONS A. Disease 1. Why would Filipinos live longer and experience B. Illness lower rate of mortality at birth? C. Sickness This is because there would be innovations when it III. HEALTH VERSUS WELLNESS comes to the healthcare system. There would be A. Population Health changes to improve patient care. B. Public Health 2. Can you mention the leading NCDs in the C. Health life Expectancy Philippines? IV. DIMENSIONS OF WELLNESS a. Alzheimer’s Disease V. THE HEALTH CONTINUUM b. Cancer VI. MODELS OF HEALTHCARE c. Epilepsy A. Health Promotion in Context d. Osteoarthritis VII. INTEGRATED HEALTHCARE e. Osteoporosis f. Cerebrovascular Disease (Stroke) g. Chronic Obstructive Pulmonary Disease (COPD) HEALTHCARE SYSTEM IN THE PHILIPPINES h. Coronary Artery Disease (2017) THROWBACK i. Heat Stroke  WHO refers to the Filipino healthcare system as j. High Blood Pressure or Hypertension “fragmented” k. Obesity and Overweight  Out of 90 million people living in the Philippines, l. Diabetes many do not get access to basic care m. Depressive Disorders  My Filipinos face diseases such as Tuberculosis, n. Substance Abuse: Alcohol Dengue, Malaria, and HIV/AIDS o. Substance Abuse: Ecstasy o These diseases pair with protein-energy malnutrition and micronutrient deficiencies SOURCE: https://caro.doh.gov.ph/non- that are becoming increasingly common communicable-diseases/  The population is affected by a high prevalence of obesity along with heart disease 3. Recommended ratio of doctor and midwife to  Healthcare in the Philippines suffers from a shortage population of human medical resources, especially doctors For every 1,000 people, they are recommending at  Filipino families who can afford private health least one doctor. For midwife, it must be 1 facilities usually choose these as their primary option midwife:500 people  Only 30% of health professionals employed by the 4. Is Philippines one of the largest pharmaceutical government address the health needs of the market in ASEAN after Indonesia and Thailand? majority Yes! We have lots of pharmaceutical companies  More than 3.500 public health facilities were here in the Philippines. updated across the country 5. Which dominates the Philippine Pharmaceutical Market? Generics or Branded Drugs DOCTORS OF THE BARRIOS Generics is more common in the Philippine  To compensate for the inequality Pharmaceutical Market than Branded Drugs  To build nine cancer centers, eight 8 heart centers, 6. What has been considered as an important part of and seven transplant centers in regional medical pandemic response? centers The important part of pandemic response is  Included Public-Private Partnerships in a plan to technology since it helps us keep on track the modernize the government-owned hospitals and situation. provide more up to date medical supplies DEPARTMENT OF HEALTH (DOH)  Regulates medical care at national level  Principal health agency in the Philippines PHILHEALTH  Provides the national health insurance ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C | Batch 2025 1  MODULE 1: PERSPECTIVES ON HEALTH AND HEALTHCARE reduction in physical capacities and/or a reduced life expectancy (Twaddle, A.C.)  an organic phenomenon (physiological events) independent of subjective experience and social conventions  measurable by objective means  something professionally defined  undergo various tests and diagnosis ILNESS  personal, more of a patient factor  subjective  “Ay parang ang sama ng pakiramdam ko” Pic on the upper left corner  ikaw lang nakakaramdam non, pero di naman  individualized therapy apektado yung iba  more on private care  a subjectively interpreted undesirable state of health Pic on the lower right corner  consists of subjective feeling states (e.g., pain,  majority of the people go to healthcare facilities to weakness), perceptions of the adequacy of their be treated bodily functioning, and/or feelings of competence (Twaddle, A. C.)  the subjective feeling state of the individual often referred to as symptoms  can only be directly observed by the subject and indirectly accessed through the individual’s reports SICKNESS  societal  a social identity.  the poor health or the health problem(s) of an individual defined by others with reference to the social activity of that individual (Twaddle, A.C.)  a social phenomenon constituting a new set of rights and duties.  Twaddle conceives of sickness as ‘‘an event located Where do you go from here as a health care in society... defined by participation in the social professional? As a pharmacist? system” To dispense the right medication for the people  accessed by ‘‘measuring levels of performance with reference to expected social activities when these DISEASE, ILLNESS, AND SICKNESS levels fail to meet social standards  e.g. hypertension  apektado na ibang tao SEQUENCE: DISEASE 1. disease  a health problem that consists of a physiological 2. impairment malfunction that results in an actual or potential 3. disability 4. handicap 5. rehabilitation ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C | Batch 2025 2  MODULE 1: PERSPECTIVES ON HEALTH AND HEALTHCARE HEALTH VERSUS WELLNESS DISEASE SPECTRUM HEALTH  a complex phenomenon where it can be approached from many angles. HEALTH (based on the definition of WHO)  a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity." WHO, 1948 o more on dimensions  A resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. (WHO, 1986)  The more exposed you are, the more chances of o More on a positive concept becoming sick and less chances of being infected Table No 1. Health versus Wellness CHAIN OF AN INFECTIOUS DISEASE PROCESS HEALTH WELLNESS 1. Infectious agent 2. Source Active process through State of complete physical, 3. Means of exit which people become mental and social well-being 4. Mode of transmission aware of, and make and not merely the absence 5. Means of entry choices toward a more of disease 6. Susceptible host successful existence A practical way of A state of being achieving health Goes a step further, Main aspects are mental, emphasizing the mental, physical, and social well physical, social as well as being occupational, intellectual, and emotional well being More related to More related to Western complementary and Medicine alternative medicine Focuses on mindfulness Considers mental well- and mind training as well, being, free from stress or 5 MODES OF TRANSMISSION in addition to general other mental diseases 1. Contact spread mental health 2. Vector Spread 3. Vehicular Spread Ultimate goal that can be 4. Droplet spread achieved if a person is Results in health 5. Airborne Spread healthy and free from disease How do stakeholders influence the triads concepts of health malady? POPULATION HEALTH  refers to the health of the population  measured by health status indicators, and as influenced by social, economic, and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development, health services, and gender and culture PUBLIC HEALTH  the science and art of preventing disease, health surveillance, prolonging life, and promoting health through the organized efforts of society 3 Ps of Public Health 1. Prevention of disease ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C | Batch 2025 3  MODULE 1: PERSPECTIVES ON HEALTH AND HEALTHCARE 2. Promotion of health o behavioral 3. Prolonging of Life o physical environment o health systems HEALTH LIFE EXPECTANCY  the average number of years that a newborn can BIOPHYSICAL expect to live in "full health"—in other words, not  includes physical risk factors for disease and hampered by disabling illnesses or injuries. illnesses such as the age of the person, their genetics, and the presence of any anatomical structure abnormalities. SOCIO-CULTURAL  includes social forces such as socioeconomic status, and support systems  the cultural aspect includes things like the beliefs, DIMESIONS OF WELLNESS practices, and values of the client as based on their  Health and wellness are often used interchangeably culture. to mean the dynamic, ever-changing process of  SOCIAL HEALTH trying to achieve one’s individual potential in each of o refers to the ability to have satisfying several interrelated dimensions. interpersonal relationships, to interactions  there are three additional dimensions on top of the with others, the ability to adapt to various well-known six dimensions of health such as social situations and daily behaviors. financial, academic or educational and occupational DIFFERENT DIMENSIONS OF WELLNESS PSYCHOLOGICAL AND EMOTIONAL  Physical  includes the client's ability to adapt with and cope  Emotional with changes, including those related to illness and  Academic disease, the client's level of cognition, and their  Social willingness and motivation to participate in health  Occupational and wellness activities  Spiritual  EMOTIONAL HEALTH  Environmental o refers to the feeling component  Financial o to express emotions when appropriate and  Intellectual to control expressing emotions either when it is inappropriate to do so or in an appropriate manner. o Feelings of self-esteem, self-confidence, self-efficacy, trust, love and many other emotional reactions and responses are all part of emotional health BEHAVIORAL  the client's choices in terms of their behaviors and life style choices  For example, a good exercise regimen, adequate nutrition and the avoidance of harmful substances are examples of some of the components of the behavioral dimension of health and wellness PHYSICAL ENVIRONMENT  includes factors and forces in the external environment that positively or negatively impact on clients' health  For example, clean air and clean drinking water in the environment facilitate health; and air pollution  Additional yung may mga heart, original yung may and contaminated drinking water negatively impact star on the health of those who are exposed to it in the  dimension models of health that will be highly environment. beneficial to nurses as well as pharmacists and others  Environmental health who will give and provide care for clients, families, o refers to appreciation of nature and populations and communities: external environment and the role o biophysical individuals play in preserving, protecting o socio-cultural and improving environmental conditions o psychological and emotional ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C | Batch 2025 4  MODULE 1: PERSPECTIVES ON HEALTH AND HEALTHCARE  At this time of your life, it is even very common for HEALTH SYSTEMS your emotions to shift suddenly from moment to  includes the clients' availability, accessibility, and moment affordability of health care and health-related  emotional shifts are normal that can help you resources and services that meet their health related maintain a healthful balance in life. needs NOTE: So the figure below (adopted from John W. Travis) shows that To achieve overall wellness, a person must be healthy your health can be measured on a sliding scale, with many in nine interconnected dimensions of wellness: physical, degrees of health and wellness emotional, intellectual, spiritual, social, environmental, occupational, financial, and cultural. SPITRITUAL HEALTH  refers to the ability to understand and express one’s purpose in life  to feel a part of a greater spectrum of existence  to experience love, joy, pain, sorrow, peace, contentment and wonder over life’s experiences  to care about and respect all living things.  This dimension reflects the client’s connectedness to their God/or their higher power. INTELLECTUAL HEALTH  reflects the client's level of cognition and their abilities to solve health care problems, including an adequate level of health literacy in order for the Left side: client to understand, and consent to, procedures,  indicates that people on this side usually do not take alternatives, and treatments relating to their health responsibility for maintaining their own health care concerns.  resulting to human malady: ill, disease, sick. Right Side OCCUPATIONAL HEALTH  People on the right side of the continuum usually  includes the client's ability to balance their work life exhibit a high degree of responsibility, discipline and with their personal and social lives and associated positive direction in life. roles and responsibilities  They accept responsibility for maintaining their own health FINANCIAL HEALTH Neutral Point  describes the state of a person's personal financial  A person with a balanced life is said to have a high situation. Its dimensions include savings, retirement degree of wellness, an overall state of well-being, or planning, and the income spent on fixed or non- total health. discretionary expenses  It usually arises from your way of living each day  Those who are financially well are fully aware of their that includes decision making and behaviors current financial state. They set long-and short-term practiced that are based on sound health knowledge goals regarding finances that will allow them to and healthful attitudes reach their personal goals and achieve self-defined  Achieving wellness requires an ongoing, lifelong financial success commitment to physical, mental/emotional and social health ACADEMIC WELNESS SIGNS  encompasses all things school, time, and graduation.  refer to the objectivity of disease (measurable or It includes satisfaction in your program, what health provider can observe) performance in classes, relationships with SYMPTOMS instructors, and progress toward graduation.  refer to the subjectivity of the disease (something felt  Academic wellness can give you a sense of drive and by patient) purpose MODELS OF HEALTH CARE THE HEALTH CONTINUUM  Approaches to health care may have change over  Health is dynamic. time in response to the changes in the types of  Being healthy does not mean that you will never get disease affecting or prevalent in your own sick or that you will be guaranteed a position on the community. basketball team. MODELS OF HEALTH CARE:  Instead, we have to strive to be the best you can be 1. Biomedical Model of Health at any given time and circumstances 2. Social Model of Health 3. Biopsychosocial Model 4. Salutogenic Model of Health ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C | Batch 2025 5  MODULE 1: PERSPECTIVES ON HEALTH AND HEALTHCARE 5. Health Education Model o action taken to improve health via medical 6. Health Promotion in Context treatment, hospitalizations, prescriptions, surgery, etc. ADVANTAGES AND DISADVANTAGES OF BIOMEDICAL MODEL ADVANTAGES OF BIOMEDICAL MODEL  it creates advances in technology and research - many common problems can be effectively treated  extends life expectancy  improves quality of life DISADVANTAGES OF BIOMEDICAL MODEL  relies on professional health workers and technology BIOMEDICAL OR MEDICAL MODEL OF HEALTH can be expensive  Focus on diagnosis and cure  does not promote good health/narrow view  Care in hospital, doctor’s office, nursing home of health  Drugs, surgery rehabilitation  not every condition can be treated  Physicians control most treatment  not always affordable  Little focus on prevention or community based care  focuses on the physical and biological aspects of SOCIAL MODEL OF HEALTH diseases.  A medical model of care attended by doctors or other health professionals in association with diagnosis, cure and treatment of disease  used by physicians and other health care cadres to diagnose diseases in modern westernized societies  In an extreme form, the "medical model" views the body as a machine, to be fixed when broken. It emphasizes: o risk behavior (for example smoking, diet, and exercise) o clinical risk factors (blood pressure, blood sugar, cholesterol levels) o genetics o behavioral change and o patient education  The reasons for the illness are not the center for biomedical model.  attempts to address the broader influences on  The medical model locates the causes of diseases in health (social, cultural, environmental, or economic the individual (behavior, genes). Usually, an factors) rather than disease and injury. individual’s economic and social environments are  A community approach focusing more on policies, not considered while a diagnosis is made. education and health promotion  Most epidemiological and medical studies and  arisen as criticism of the biomedical model and practice seek to identify individual risk factors for a limitations of individualist therapeutic approaches disease according to the biomedical model. Also  seeks to move beyond individual behavior and to clinical practice is organized according this principle. understand health and illness in terms of the When broader features of society  research or clinical work is conducted according to  a community approach to prevent diseases and this model, health problems are looked upon as illnesses. For example, it looks at how society, culture biological processes. The cause of a disease can be and environment affect our everyday health for example germs, viruses, toxoids or accidents. and well-being, including factors such as social Thus, smokers have a higher risk of several diseases, class, poverty, low income housing, diet, pollution for example plasma cholesterol or blood pressure is and income. associated with cardiovascular diseases, and  brings us closed to SDH approach by stating that reckless driving causes road accidents. health is ultimately determined by position within the social structure. That is: society determines ASPECTS OF BIOMEDICAL APPROACH health in many ways 1. Diagnosis  emphasizes that almost all major diseases are o identification of the disease or multi-causal. illness through physician’s observation of o This means that they are primarily symptoms or through diagnostic tests determined by a network of interacting 2. Intervention exposures that increase or decrease the risk for the disease. ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C | Batch 2025 6  MODULE 1: PERSPECTIVES ON HEALTH AND HEALTHCARE o A typical example is the case programs, smoking cessation are just few to mention for cardiovascular disease and type II possible activities of health psychologists in diabetes; these conditions are the result of collaboration with other health professionals social, economic, and political forces. When  research often focuses on prevention and health problems are looked upon as social intervention programs designed to promote processes, factors such as poverty and healthier lifestyles (e.g., exercise and nutrition wealth, types of housing in which people programs) live, sanitary systems and access to clean  “We suffer when our interpersonal bonds are water are directly linked to health and sundered and we feel solace when they are diseases. reestablished” (Engel, 1997) FIVE KEY PRINCIPLES SALUTOGENIC MODEL OF HEALTH  Addresses the broader determinants of health  Developed by sociologist Aaron Antonovsky such as gender, ethnicity, socioeconomic state,  focuses how and why we stay well location and physical environment influence the  This model increases understanding of the behavioral aspect and become the focus of health relationship between stressors, coping and health promotion strategies  It focuses on how and why people stay well.  Reduce social inequities  Antonovsky (1987) describes the substantive  Empower individuals and communities structure of the sense of coherence as comprising with knowledge, skills and confidence to make three components: positive decisions about their health and participate o Comprehensibility in healthy behavior. o Manageability  Access to health care is significant factor o Meaningfulness contributing to health status.  It rejects the current tendency to hold individuals o Social factors that can impact on access to responsible for the fate of their health health care include cultural and language  It recognizes that optimal functioning requires social barriers, economic and geographical stability, rewarding occupations and freedom from factors and education level. anxiety, stress and persecution  Inter-Sectorial collaboration  The salutogenic model stresses health as a balance: ‘an ecological process, within and without the BIOPSYCHOSOCIAL MODEL OF HEALTH individual’ (Fulder, 1998). SALUTOGENESIS VERSUS PATHOGENESIS PATHOGENESIS SALUTOGENESIS What causes disease? What causes health? About avoiding problems About reaching potential Reactive (absence Proactive (presence health) disease) Against pain or loss For gain or growth Prepares one to live Discover how to live fully HEALTH EDUCATION MODEL OR MODELS OF HEALTH PROMOTION  The kinds of health promotion programs  Developed by psychiatrist George Engel in 1977, and that students and schools implement reflect the recognizes that many factors affect health. health education models on which they are based.  It views health as a scientific construct and a social  There are three main categories in which health phenomenon education model can be broadly placed:  It pays “explicit attention to humanness” (Engel, o Behavioral Change Model 1997). o Self-empowerment Model  It views health and illness behaviors as products of o Collective Action Model biological characteristics (such as genes), behavioral factors (such as lifestyle, stress, and health beliefs), BEHAVIORAL CHANGE MODEL and social conditions (such as cultural influences,  preventive approach family relationships, and social support).  focuses on lifestyle behaviors that impact on health.  Developing treatment protocols to increase adherence to medical treatments, weight loss ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C | Batch 2025 7  MODULE 1: PERSPECTIVES ON HEALTH AND HEALTHCARE  It seeks to persuade individuals to adopt healthy  Helps people to know where, when, why, and how lifestyle behaviors, to use preventive health services, to seek help. and to take responsibility for their own health.  Encourages independence.  It promotes a 'medicalized' view of health that may  Uses critical thinking and critical action in relation be characterized by a tendency to 'blame the to oneself. victim'.  Uses the action competence process for the  The behavioral change model is based on the belief individual, recognizing determinants that may that providing people with information will change be beyond their control. their beliefs, attitudes, and behaviors.  Fosters resilience and empowerment at a personal  This model has been shown to be ineffective in many level. cases because it ignores the factors in the social  Enhances self-awareness. environment that affect health, including social,  Focuses largely on the individual. economic, cultural, and political factors.  Gives opportunities to celebrate individuality. CHARACTERISTICS OF BEHAVIORAL CHANGE MODEL  Focuses on health professionals' perceptions of COLLECTIVE ACTION MODEL health needs  determined largely by factors that operate o suggests that 'experts' know best. outside the control of individuals.  Transmits knowledge  This model encompasses ideas of o increases people's knowledge of the factors community empowerment, which requires people that improve and enhance health. individually and collectively to acquire the  Educates 'about' health. knowledge, understanding, skills, and commitment  Uses health campaigns. to improve the societal structures that have such a  Uses the transmission approach to teaching powerful influence on people's health status. o the learners are largely passive.  It engages people in critical thinking in order to  Often reflects 'healthism' improve their understanding of the factors affecting o Healthism is a set of assumptions, based on individual and community well-being. It also the belief that health is solely an individual engages them in critical action that can responsibility, that embrace a conception contribute to positive change at a collective level. of the body as a machine that must  Given the importance of determinants of health, the be maintained and kept in tune in a similar use of a collective action model is more likely to way to a car or motorbike achieve healthy outcomes, both for individuals and  May have a 'moralistic' tone. for groups within society.  Emphasizes disease and other medical problems so CHARACTERISTICS OF COLLECTIVE ACTION MODEL tends to be negative and deficit-focused.  Encourages democratic processes and  Focuses on risks rather than on protective participation 'by all for all'. or preventive factors and takes a 'band-aid'  Takes a student-centered/constructivist approach to approach. teaching and learning.  Tends not to reflect the socio-ecological perspective.  Takes determinants of health into consideration.  Does not take into account determinants of health or  Emphasizes empowerment for all participants. consider who is responsible for health.  Educates 'for' health.  ∙May imply 'victim blaming'.  Uses a social action or action competence process to work with others. SELF EMPOWERMENT MODEL  Uses a whole community/school  This approach (also known as the self-actualization development approach. model) seeks to develop the individual's ability to  Views teachers and students as social agents. control their own health status as far as possible  Uses critical thinking and critical action in relation to within their environment. the individual, others, and society.  focuses on enhancing an individual's sense of  Takes a holistic approach personal identity and self-worth and on the o Is based on authentic needs. development of 'life skills', including decision-making  Fosters resilience at wider community and and problem-solving skills, societal levels  so that the individual will be willing and able to take o not just at an individual level. control of their own life. People are encouraged to engage in critical thinking and critical action at an HEALTH PROMOTION IN CONTEXT individual level.  The "reflective-analytical context model” recognizes  This model, while often successful for individuals, is that health issues have multi-factual causes and not targeted at population groups and is unlikely to impacts. affect social norms.  the focus of the health problem can be attended to CHARACTERISTICS OF SELF-EMPOWERMENT MODEL individually, as a group, within an organization or on  Develops a sense of identity. a community or societal level  Promotes reflection in relation to others and society.  Combining micro-, meso-, and macro levels creates  Encourages people to reflect and change their views reflection on the connection between social  Clarifies values. structures and their effect on everyday life ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C | Batch 2025 8  MODULE 1: PERSPECTIVES ON HEALTH AND HEALTHCARE  Different perspectives of a specific health problem The Ottawa Charter for Health Promotion (WHO, 1986) necessitate reflection on the causes of the health  provided much of the impetus for the change to problem in focus, and thereby contribute to a focus using a socio-ecological approach for health on which dimensions of a problem could be selected education and health promotion for further investigation.  This charter recognized that major health gains were linked not so much to advances in medical knowledge as to increases in wages and living standards and to public health initiatives accompanied by policy changes at government and community levels  identifies nine broad prerequisites for health: o peace o education o food o shelter o income o a stable ecosystem o sustainable resources o social justice o equity.  It advocates "a socio-ecological approach to improve health in which people and their environments are considered to be inextricably MEDICATION NON-ADHERENCE linked.  In relation to health promotion, the Ottawa Charter determined that five key strategies were needed to LEVEL enhance public health: Risk Factors Interventions o creation of supportive environments o development of personal skills o strengthening of community action o building of healthy public policies Poor SES o reorientation of health services Depression, low education literacy Educational / Cognitive INTEGRATED HEALTH CARE Cognitive dysfunction interventions Costs of medication  When Shortell and others developed the notion of an Patient Counseling / Behavioral Higher Comorbidity "organized delivery system," they began by Interventions Living alone, complex Psychological / Affective characterizing an ideal health system as one that: regiment, side effects Interventions o focuses on meeting the community's health Poor knowledge, lack of motivation needs; matches service capacity to meet Health beliefs / attitudes the community's needs; o coordinates and integrates care across the continuum; has information systems to link Trust in the healthcare consumers, providers, and payers across Learning healthcare to use the continuum of care provider Micro effective patient-centered Communication style communication methods and o provides information on costs, quality, Quality of the patient outcomes and consumer satisfaction to behavioral management provider relationship multiple stakeholders - consumers, Time available for employees, staff, payers, community consultation groups and external review bodies Specialty care / case o uses financial incentives and organizational management Continuity of care kill mix of structure to align governance, Meso Treatment team skill mix health care team management, physicians and other Drug success, Competencies of the health providers to achieve objectives dispensing of drugs care team Center case satisfaction o is able to continuously improve the care it with clinic provides; is willing and able to work with Access of clinic others to ensure objectives are met (Shortell et al. 1996). Insurance Coverage Increase reimbursement of Macro Regulation regarding drugs reimbursement of drugs Public Health coverage for all THE IDEAL SYSTEM Continent / country inhabitants  Shortell et al. (1993, 1994) originally described organized delivery systems (ODSs) as "networks of organizations that provide or arrange to provide a coordinated continuum of services to a ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C | Batch 2025 9  MODULE 1: PERSPECTIVES ON HEALTH AND HEALTHCARE defined population and who are willing to be held CLINICAL INTEGRATION clinically and fiscally accountable for the outcomes  reflects an umbrella concept including the notion of and the health status of the population being served." continuity of care, coordination of care, disease  Organized delivery systems typically embrace all management, good communication among levels of care - primary, secondary, tertiary, caregivers, smooth transfer of information and restorative/ rehabilitative and long-term. records, elimination of duplicate testing and  The key characteristics of an organized delivery procedures and, in general, making sure things system are the organization's breadth, depth and don't fall between the cracks geographic dispersion.  Organized delivery systems do not require common ownership - what ties the organization together is the HOW WIL PATIENTS KNOW WHEN AN INTEGRATED clinical and fiscal accountability to a defined HEALTHCARE SYSTEM EXISTS? population When they: DEFINITIONS AND MODELS OF INTEGRATED  do not have to repeat their health history for HEALTHCARE each provider encounter  focus on the coordination of health services across  ∙do not have to undergo the same test multiple the continuum of care, as well as the collaboration times for different providers are not the medium for among providers and provider organizations in the informing their physician that they have been delivery of health services. hospitalized or undergone diagnostic or treatment  Two methods of integration have been identified: procedures; been prescribed drugs by another o horizontal integration physician; not filled a previous prescription; or been  which involves the affiliation referred to a health agency for follow-up care of organizations that provide a  do not have to wait at one level of care because similar level of care under one of incapacity at another level of care management umbrella  have 24-hour access to a primary care provider ∙ o vertical integration have easy-to-understand information about quality  which involves affiliation of of care and clinical outcomes in order to make organizations providing different informed choices about providers and treatment levels of care under one options management umbrella (Conrad  can make an appointment for a visit to a clinician, and Shortell 1996; Integrated a diagnostic test or a treatment with one phone call Delivery Systems 1997)  have a wide choice of primary care providers who are able to give them the time they need TYPES OF INTEGRATION  with chronic disease, are routinely contacted to As identified by Shortell, types of integration are as follows: have tests that identify problems before they occur; 1. Functional integration provided with education about their disease 2. Physician Integration process; and provided with in-home assistance and 3. Clinical Integration training in self-care to maximize their autonomy FUNCTIONAL INTEGRATION  refers to the extent to which key support functions and activities (such as financial management, human resources, strategic planning, information management, marketing and quality improvement) are coordinated across operating units so as to add the greatest value to the system.  integration involves shared or common policies and practices for each of these functions, but does not mean mere centralization or standardization of REFERENCES these activities. NOTES FROM THE DISCUSSION BY:Ivy T. Echano, RPh. MSc. PHYSICIAN INTEGRATION SOURCES: Centro Escolar University – Manila Power Point Presentation  the extent to which physicians are economically CEU LEAPS Learning Modules linked to a system, use its facilities and services and LECTURE TRANSCRIBED BY: actively participate in its planning, management and Ellyssa Gwyn P. Balestamon governance. Francesca Q. Alejandro  Key relationships include the development of a Ma. Chelrizze Jazzmine B. Juan Marietea Jacinth D. Caña common medical staff, shared credentialing, group practice activity and physicians serving on system BSP1C – SY. 2021 to 2022 boards and committees PLEASE ASK FOR OUR PERMISSION FIRST BEFORE SHARING ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C | Batch 2025 10 PCPM100 MODULE Introduction to the Health Care System PROFESSOR: Insert Name 02 MODULE 2: ACHIEVING OPTIMAL HEALTH Table No.3 Leading cases of death by country income group I. KEYWORDS ON ACHIEVING OPTIMAL HEALTH II. HEALTH INDICATORS A. Measurements of Health Outcomes III. VITAL STATISTICS A. Subtopic i. subsub IV. DETERMINANTS OF HEALTH V. HEALTH IMPACT ASSESSMENTS KEYWORDS ON ACHIEVING OPTIMAL HEALTH Nutrition Emotional Relationship Energy Health Equity Table No.1 Nationwide Cases Data HEALTH INDICATORS A characteristic of an individual, population or environment which is subject to measurement and can be used to describe one or more aspects of the health of an individual or population a measurable characteristic that describes the following: o The Health of Population ▪ life expectancy ▪ mortality ▪ disease prevalence or incidence o Determinants of Health ▪ risk factors ▪ health behaviors o Health care access o Cost o Quality o Use Table No.2 HALE In the context of monitoring and evaluation: o Quantitative metric ▪ Data measured on numerical scale o Performance ▪ Effectiveness & efficiency of operation of activity o Achievement ▪ Successful accomplishments of activity o Accountability ▪ Responsibility for the performance and achievement PRIORITY INDICATIONS RELATION TO 4 DOMAINS 1. Health status indicators o mortality by age, sex and cause, core morbidity and fertility indicators ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C 1  MODULE 2: ACHIEVING OPTIMAL HEALTH 2. Risk factors Table No.2.3 Morbidity o nutrition, environmental, behavioral, injuries and violence 3. Service coverage o reproductive, maternal, newborn, child and adolescent, immunization, HIV, TB, malaria, NTDs, NCDs, mental health and substance abuse 4. Health systems o health facility density and distribution, health workforce, health information, and quality and safety of care, health security capacity As mentioned in the 2018 Global Reference List of 100 Core Health Indicators, the process of selecting a global reference set of core health indicators is guided by the priority global monitoring requirements relating to health and health-related SDGs, universal health coverage and noncommunicable diseases among others health priorities. HEALTH STATUS Table No.2.4 Fertility Table No.2.1 Mortality by age and sex Table No.2.5 The Leading Causes of Mortality Table No.2.2 Mortality by cause ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C 2  MODULE 2: ACHIEVING OPTIMAL HEALTH Table No.2.6 The Leading Causes of Morbidity Table No.2.10 Noncommunicable diseases RISK FACTORS probability of an adverse outcome 3 variables associated with risk: o Exposure o Hazard – substance/object that causes sick o Vulnerability – condition Table No.2.7 Nutrition Table No.2.11 Injuries Practices SERVICE COVERAGE Table No.2.8 Infections Table No.2.12 Reproductive, maternal, newborn, child, and adolescent Table No.2.9 Environmental Risk Factors ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C 3  MODULE 2: ACHIEVING OPTIMAL HEALTH HEALTH SYSTEM Table No.2.13 Tuberculosis Table No.2.16 Quality and safety of care Table No.2.17 Utilization and access Table No.2.14 Immunization Table No.2.15 Screening and preventing care, Mental Table No.2.17 Health information health, Substance abuse, and Essential health services Table No.2.18 Health security and Governance ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C 4  MODULE 2: ACHIEVING OPTIMAL HEALTH Table No.2.19 Health financing SURVEILLANCE from the French “sur” that means over and “veiller” that means to watch is the foundation of public health practice providing essential data to inform decision making and respond to health threats. Table No.2.21 Metrics vs. Health Indicator vs. Health System Performance Indicator Measure Type Description Examples Metric Information that is -Total Health quantifiable and is Expenditures reported as -Number of ER number; has value visits and many uses, but due to opioid cannot be poisoning compared Table No.2.20 Strategy Map of DOH Health indicator Puts metrics into -Cost of a Standard some kind of Hospital Stay context, usually -Proportion of using a ratio (per Physicians in Rural X) and designed to Areas ensure comparability (e.g., being risk-adjusted or standardized). Directionality may or may not exist. Health A health indicator -30-day surgical Performance that has a desired readmission rate Indicator direction (e.g., -hospitalizations lower is better) entirely attributable to alcohol MEASUREMENTS OF HEALTH OUTCOMES By its nature, epidemiology involves the measurement of health outcomes, including the occurrence of adverse clinical events, degree of therapeutic response achieved, and success in preventing or reducing morbidity and mortality. ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C 5  MODULE 2: ACHIEVING OPTIMAL HEALTH Table No.2.22 Health Outcomes Ranking of Southeast study of uses and drug effects in a defined Asian Countries population “Pharmakon” – Drug “Epi” – upon or among “Demos” – people or district “Logos” – study A. QUANTITATIVE MEASUREMENTS 1. Counts are the number of cases of a disease or other health phenomenon under study. For example, we may wish to quantify the number of documented cases of influenza in a defined geographic area at It usually takes 5 years to interpret this data. different times of the year. However, count data are of limited use epidemiologically since they represent Table No.2.23 Case Counts in Statistics numerator data only, and hence, are difficult to interpret without knowing the size of the source population. 2. Ratio is the expression of the relationship between two items. These items may be either related to or independent of each other. Mathematically, a ratio is expressed as X:Y. o For example, if 300 occurrences of subarachnoid hemorrhage are observed, with 200 cases occurring in females and the remaining 100 cases in male, what is the female-to-male ratio? 3. Proportion is the expression of the relationship of one part to the whole. A proportion is expressed as percent. Mathematically, a proportion is expressed as: x/y X k. o For example, in a classroom of 15 boys and 5 girls, the proportion of female students Table No.2.24 General Formula for Computing is__________. 4. Rate is the expression of the probability of occurrence of a particular event in a defined population during a specified period. o For example the annual death rate in the Philippines based on 2016 census data was 582,183 deaths/103.3 M persons in the population, what is the rate? a. Since the total population changes during the time interval, the estimated midinterval population is used. b. the estimated midinterval population is determined by adding the population at the beginning of the time interval to the population at the end of the time interval and dividing by two. Rates can be expressed in three forms: I. Crude rate R = Rating II. Adjusted rate K = Constant (multiple of tens) III. Specific rate EPIDEMIOLOGY 5. Index is used when the true denominator or population at risk cannot be determined. A related the study of distribution and determinants of denominator is used as a measure of the population health-related states or events in specified at risk. An index is then a pseudorate. Example is populations MMR. Though it is impossible to determine the figure the application of this study to the control of health where the true population at risk should be the problems number of pregnant women. The number of live births is chosen because it reflects the number of PHARMACOEPIDEMIOLOGY pregnant women. ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C 6  MODULE 2: ACHIEVING OPTIMAL HEALTH B. SPECIFIC MEASUREMENTS c. Attack rate is expressed as: 1. Natality rates measure the rate of birth. number of new cases of a specific a. Crude birth rate is expressed as: disease during a specific time o number of live births reported during a interval given time interval =______________________________ = _____________________________ Total population at risk during the estimated midinterval population same time interval b. Fertility rate is expressed as: Attack rate normally is expressed as a percentage. It is an o number of live births reported during a incidence rate that is calculated in an epidemic situation given time interval using a particular population observed for a limited period of = ____________________________ time. estimated number of women age 15-44 d. Secondary attack rate is expressed as: years at midinterval (number of new cases in a group) – (index case or cases during a 2. Morbidity rates measure the rate of illness specified time period) a. Incidence rate is expressed as: =______________________________ o number of new cases of a specific (number of susceptible individuals disease during a given time interval in the group) – (index case or cases) = __________________________________ estimated midinterval population at risk 3. Mortality rates measure the rate of death. a. Crude death rate is expressed as: A high incidence rate means a high occurrence of total number of deaths reported disease; a low incidence rate means a low during a given interval occurrence of disease. = _____________________________ 1. Because incidence rate is a measure of the rate at estimated midinterval population which healthy people develop disease during a b. Cause-specific death rate is expressed as: specific time period, it is a statement of probability. number of deaths assigned to a 2. Since incidence rates are affected by any factor that specific cause during a given time affects the development of a disease, they can be interval used to detect etiologic factors. = _____________________________ b. Prevalence rate is expressed as: estimated midinterval population o number of current cases (old: i.e., c. Maternal mortality rate is expressed as: people who contracted disease before number of deaths related to time period began and who still have pregnancy during a given interval the disease) and new cases of a = _____________________________ specified time period number of live births reported = ________________________________ during the same time interval estimated midinterval population at risk d. Case-fatality rate is expressed as: number of deaths assigned to a 1. Point prevalence refers to a specific time. For specific disease example, if on June 30, 2012, Neighborhood A has a = _____________________________ population of 1,600 individuals, and 29 of these number of cases of the disease individuals are infected with hepatitis B virus, what is the point prevalence? Case-fatality rate is frequently expressed percentage. It 2. Period prevalence refers to a given time interval predicts the risk of dying if the disease is contracted. Tetanus Since prevalence rate contains all known cases has a case-fatality rate of 30%-90%, depending on the age of in the numerator, it used primarily to measure the host, the length of the incubation period, and the type and the amount of illness in a community ad, thus, length of therapy. can be used to determine the health care needs of that community. e. Year of potential life lost (YPPL) are a Prevalence rates are influenced by both the quantitative measure of premature incidence of disease and by the duration of mortality. illness. 1) It reflects the mortality trends of younger age- For example, assume that neighborhood A has: groups by taking into account not only the cause o An average population of 1,600 of death but also the age at which it occurs. individuals between June 30 and 2) The CDC defines YPLL as the number of years of August 30, 2012 potential life lost by each death occurring before o 29 existing cases of hepatitis B virus age of 65. Some calculations use the remaining on June 30 life expectancy as the upper age limit. o 6 incident (new) cases of hepatitis B 3) The YPLL of a specific disease is calculated as virus between July 1 and August 30 follows: ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C 7  MODULE 2: ACHIEVING OPTIMAL HEALTH a) To determine the total number of deaths caused by a specific disease in a specific age-group, the age-specific rate for that specific disease is multiplied by the estimated population of the age-group. b) The total YPLL is the summation of all the YPLL for each age-group up to 65 years of age. 4) The YPLL can also be calculated for a specific risk factor (e.g., alcohol, tobacco) to determine the number of YPLL caused by that factor. a. Year of Life with Disability (YLD) It measures years of healthy life lost due to living in states of less than full health. b. Disability-Adjusted Life Year (DALY) It represents the total number of years lost to illness, disability, or DETERMINANTS OF HEALTH premature death within a given Many factors combine to affect the health of population. It allows for individuals and communities. Whether people are comparison of impact of a healthy or not, is determined by their circumstances program and/or diseases across and environment. To a large extent, factors such as population. where we live, the state of our environment, c. Quality-Adjusted Life Years (QALY) genetics, our income and education level, and our Gives us an idea of how many relationships with friends and family all have extra months or years of life of considerable impacts on health, whereas the more reasonable quality pa person commonly considered factors such as access and might gain as result of treatment. use of health care services often have less of an Ratings: negative values below impact. zero (worst possible health) to 1 The determinants of health include: (best possible health) o the social and economic environment o the physical environment VITAL STATISTICS o the person’s individual characteristics and refer to the registration or recording of vital events behaviors such as birth, deaths, fetal deaths, abortions, The context of people’s lives determines their health, marriages, and divorces. These vital events must be and so blaming individuals for having poor health or reported by law, and an analysis of these data crediting them for good health is inappropriate. provides the best information about the health of a Individuals are unlikely to be able to directly control population. National Statistics Office (NSO) now many of the determinants of health. These Philippine Statistics Authority (PSA) consolidated the determinants or things that make people healthy or data entered on standard forms from one not include the above factors, and many others: municipality to another and issues authenticated o Income and social status documents. ▪ higher income and social status are linked to better health. The Table No.3.1 Outcomes and Determinant Factors greater the gap between the richest and poorest people, the greater the differences in health. o Education ▪ low education levels are linked with o Physical Environment ▪ safe water and clean air, healthy workplaces, safe houses, communities, and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions ALEJANDRO. BALESTAMON. CAÑA. JUAN | BSP-1C 8  MODULE 2: ACHIEVING OPTIMAL HEALTH o Social support and networks o Housing ▪ greater support from families, o Transport friends and communities is linked o Waste to better health. Culture - customs o Energy and traditions, and the beliefs of o Water the family and community all o Industry affect health. o Urbanization o Genetics o Radiation ▪ inheritance plays a part in o Nutrition and Health determining lifespan, healthiness, and the likelihood of developing Table No.4.3 Health Impact Pyramid certain illnesses. Personal behavior and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health. o Health services ▪