THE HEALTHCARE ENVIRONMENT.pdf

THE HEALTHCARE ENVIRONMENT (Prepared by: Roberto B. Tagalog Jr., RRT) HEALTH - is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. - the state of being free from illness or injury. - the condi;on of being sound in body, min...

THE HEALTHCARE ENVIRONMENT (Prepared by: Roberto B. Tagalog Jr., RRT) HEALTH - is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. - the state of being free from illness or injury. - the condi;on of being sound in body, mind, or spirit - the general condi;on or state of the body or mind with reference to soundness and vigor - a condi;on in which someone or something is thriving or doing well. CARE - the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something. - feeling concern or interest; being polite - the process of protecting someone or something and providing what that person or thing needs. ENVIRONMENT - the surroundings or condi;ons in which a person, animal, or plant lives or operates - the natural world, as a whole or in a par;cular geographical area, especially as affected by human ac;vity - the circumstances, objects, or condi;on by which one is surrounded - the sum total of all surroundings of a living organism, including natural forces and other living things, which provide condi;ons for development and growth as well as of danger and damage HEALTH CARE - efforts to maintain, restore, or promote someone's physical, mental, or emotional well- being especially when performed by trained and licensed professionals - the organized provision of medical care to individuals or a community. - is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury - the act of taking preventive or necessary medical procedures to improve a person’s well- being. - an organized way of medical care concerned with the maintenance of the health of the whole body. - It is delivered by the healthcare providers or professionals in various fields includes a pharmacy, nursing, medicine, dentistry, psychology, physicians etc. Healthcare is mainly influenced by the social, economic conditions & health policies of the place and varies across different countries, individuals, groups etc. Types of Healthcare Every individual has required different care depending upon their health problem like some require normal care and some require extra special care. So on the basis of patient condition healthcare divides into various types. Following types of healthcare are explained below: 1. Primary Healthcare: Primary health care mainly focuses on health equity producing social policy beyond the traditional healthcare system. Its main aim is to provide local care to a patient because professionals related to primary care are normal generalists, deals with a broad range of psychological, physical and social problems etc. rather than specialists in any particular disease area. 2. Secondary Healthcare: This healthcare is provided by the medical specialists and other health professionals who do not have direct contact with a patient like urologists, dermatologists, cardiologists etc. 3. Tertiary Healthcare: This type of healthcare is known as specialized consultative healthcare usually for inpatients and on referral from primary and secondary healthcare for advanced medical investigation and treatment. Following examples of tertiary care services are plastic surgery, burn treatment, cardiac surgery, cancer management, neurosurgery, complex medical and surgical interventions etc. Health Care Environment - Is the healthful atmosphere and milieu at a healthcare setting in which a patient is undergoing treatment Hospital Hospitals are health care institutions that have an organized medical and other professional staff, and inpatient facilities, and deliver services 24 hours per day, 7 days per week. (WHO – World Health Organization) Hospitals need to be organized around people‟s needs, working closely with other health and social care services and contributing to strengthening primary health care (PHC) and public health services, to substantially contribute to Universal Health Coverage (UHC). An institution that is built, staffed, and equipped for the diagnosis of disease; for treatment, both medical and surgical, of the sick and the injured; and for their housing during this process. The modern hospital also often serves as a center for investigation and for teaching. A hospital is a facility supplying specialized staff and equipment to meet the health care needs of the surrounding population. Hospital funding is provided by a variety of sources, including for-profit and non-profit health care organizations, health insurance companies, religious orders, and charities. Some hospitals have the unique ability to allow both “inpatients” and “outpatients”. Depending upon a patient’s need after their diagnosis, treatment, surgery, or therapy, they may be required to stay overnight for further observation or recovery. Hospitals that do not have overnight patients are usually referred to as “clinics.” Historical Outline of Hospital Ancient Time - Culture and religion were linked into medicine. - Temples of Saturn, and later of Asclepius, were recognized as healing centers. 230 BC - King Ashoka established a chain of hospitals in Hindustan (230 BC) 100 BC - Romans established hospitals (valetudinaria) for treatment of inured soldiers 331 AD - Roman Emperor Constantine I (Constantine the Great) established the modern concept of hospital - The Christian tradition emphasized the close relationship of the sufferer to the members of the community 370 AD - St. Basil the Great established religious foundation in Cappadocia that included a hospital, an isolation unit for those suffering from leprosy 6th Century - St. Benedict of Nursia at Montecassino, founded a hospital where the care of the sick was placed above and before every other Christian duty - Religion continued to be the dominant influence in the establishment of hospitals during the Middle Ages 11th Century - Pestilence and disease killed crusaders 1099 - Hospitallers of the Order of St. John established a hospital that can cater 2000 patients in the Holy Land – later known as St. John Ambulance 12th Century - Arab hospitals in Baghdad and Damascus and in Cordoba in Spain admitted patients regardless of religious belief, race or social order. 1145 - Hospital of the Holy Ghost was founded at Montpellier France – became one of the most important centers in Europe for Training Doctors - The middle Ages also saw the beginnings of support for hospital-like institution by secular authorities 1540 - Henry VIII stopped building hospitals in England - Voluntary Hospitals were established 1524 - First Hospital in North America (Hospital de Jesus Nazareno) was built in Mexico City by Hernan Cortes 1751 - First incorporated hospital in America was the Pennsylvania Hospital in Philadelphia which obtained a charter from the crown in 1751 - Spanish government and missionaries established hospitals in the Philippines. The first hospital was erected by the Spaniards in Cebu during 1565. It was later transferred to Manila for the purpose of treating sick and wounded military personnel. - Early hospitals in the Philippines were established by – Franciscans, Brotherhood of the Misericordia, Brotherhood of San Juan de Dios, and the Dominicans - San Lazaro hospital was established in 1578 Classification of Hospitals in the Philippines DOH Administrative Order No. 2012 – 0012 Subject: Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Institution Types of Hospitals 1. Public Hospitals - A public hospital or government hospital is a hospital which is owned by a government and receives government funding. This type of hospital provides medical care free of charge, the cost of which is covered by the funding the hospital receives. 2. Private Hospitals - A private hospital is a hospital owned by a for-profit company or a non- profit organisation and privately funded through payment for medical services by patients themselves, by insurers, or by foreign embassies. 3. District - The district hospital is the central health care facility within its geographical region. District hospitals have a large capacity for intensive care and long-term care. Specialized centers for surgery, plastic surgery, obstetrics, and laboratories will also be available. 4. Specialized - There are various types of specialized hospitals such as, trauma centers, rehabilitation hospitals, children‟s hospitals, geriatric hospitals, psychiatric hospitals. In addition, there are specialty specific hospitals for cardiology, oncology, orthopedics, etc. These specialty hospitals are typically part of a large hospital or hospital network. They are often located on the hospital campus or nearby. 5. Teaching – A teaching hospital combines assistance to patients with teaching to medical students and nurses and often is linked to a medical school or nursing school. Some hospitals are affiliated with a university, college, medical school, or nursing school and offer health care to patients while teaching medical students, physicians, surgeons, and nurses. Teaching hospitals are unique in that they employ physician residents who are in training and work hand in hand with local medical schools. The physician residents are overseen by chief medical residents as well as department chairs of the various medical specialties. 6. Clinic - Clinics generally provide outpatient care only and are smaller than a typical hospital. Clinics are usually operated by a government health agency or a partnership of private physicians and/or surgeons. There are many departments that can be found within a hospital or clinic, including trauma centers, burn centers, emergency departments, surgery, wound care, or urgent care. There may be outpatient departments such has psychiatric health, physical therapy, dentistry, and rehabilitation. Also, specialized units of equipment, physicians and nurses will support the various departments with expertise or functionality in cardiology, obstetrics and gynecology, oncology, intensive care, neurology, pathology, and radiology. Functions of Hospitals 1. Patient care - Inpatient, outpatient and day patient, Emergency and elective, Rehabilitation 2. Teaching - Vocational, Undergraduate, Postgraduate, Continuing education 3. Research - Basic research, Clinical research, Health services research, Educational research 4. Health system support - Source for referrals, Professional leadership, Base for outreach activities, Management of primary care 5. Employment - Inside hospital - Health professionals, other health care workers; Outside hospital - Suppliers, Transport services 6. Societal - State legitimacy, Political symbol, Provider of social care, Base for medical power, Civic pride Mental Health Facility Psychiatric hospitals, also known as mental hospitals, mental health units, mental asylums or simply asylums, are hospitals or wards specializing in the treatment of serious mental disorders, such as clinical depression, schizophrenia, and bipolar disorder. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialize only in short- term or outpatient therapy for low-risk patients. Others may specialize in the temporary or permanent care of residents who, as a result of a psychological disorder, require routine assistance, treatment, or a specialized and controlled environment. Patients are often admitted on a voluntary basis, but people whom psychiatrists believe may pose a significant danger to themselves or others may be subject to involuntary commitment. Psychiatric hospitals may also be referred to as psychiatric wards (or "psych" wards) when they are a subunit of a regular hospital. Long Term/ Residential Care Facility At some point, support from family, friends, and local programs may not be enough. People who require help full-time might move to a residential facility that provides many or all of the long-term care services they need. Facility-based long-term care services include: board and care homes, assisted living facilities, nursing homes, and continuing care retirement communities. Some facilities have only housing and housekeeping, but many also provide personal care and medical services. Many facilities offer special programs for people with Alzheimer's disease and other types of dementia. 1. Board and Care Homes - Board and care homes, also called residential care facilities or group homes, are small private facilities, usually with 20 or fewer residents. Rooms may be private or shared. Residents receive personal care and meals and have staff available around the clock. Nursing and medical care usually are not provided on site. 2. Assisted Living - Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. Assisted living facilities range in size from as few as 25 residents to 120 or more. Typically, a few "levels of care" are offered, with residents paying more for higher levels of care. Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and social and recreational activities. Exact arrangements vary from state to state. 3. Nursing Homes - Nursing homes, also called skilled nursing facilities, provide a wide range of health and personal care services. Their services focus on medical care more than most assisted living facilities. These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, are also available. Some people stay at a nursing home for a short time after being in the hospital. After they recover, they go home. However, most nursing home residents live there permanently because they have on-going physical or mental conditions that require constant care and supervision. 4. Continuing Care Retirement Communities - Continuing care retirement communities (CCRCs), also called life care communities, offer different levels of service in one location. Many of them offer independent housing (houses or apartments), assisted living, and skilled nursing care all on one campus. Healthcare services and recreation programs are also provided. In a CCRC, where you live depends on the level of service you need. People who can no longer live independently move to the assisted living facility or sometimes receive home care in their independent living unit. If necessary, they can enter the CCRC's nursing home. Hospice -Hospice is specialized type of care for those facing a life-limiting illness. -Hospice care addresses the patient‟s physical, emotional, social and spiritual needs. It also helps the patient‟s family caregivers. It takes place in the patient‟s home or in a home-like setting. It concentrates on managing a patient‟s pain and other symptoms so that the patient may live as comfortable as possible and make the most of the time that remains. - It is founded on a belief that the quality of life to be as important as length of life Hospice care is a type of care and philosophy of care that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient's pain and symptoms, and attending to their emotional and spiritual needs. In Western society, the concept of hospice has been evolving in Europe since the 11th century. Then, and for centuries thereafter in Roman Catholic tradition, hospices were places of hospitality for the sick, wounded, or dying, as well as those for travelers and pilgrims. The modern concept of hospice includes palliative care for the incurably ill given in such institutions as hospitals or nursing homes, but also care provided to those who would rather spend their last months and days of life in their own homes. The first modern hospice care was created by Cicely Saunders in 1967. Hospice is NOT a place. Hospice services can be provided to a person with limited life expectancy and his/her family, wherever they live. This means a patient living in a nursing facility or long-term care facility and his/her family can receive specialized visits/contacts from physicians, nurses, aides, chaplains, social workers, and volunteers, in addition to other care and services provided by the nursing facility. The hospice and the nursing home will have a written agreement in place for the hospice to serve residents of the facility. Out-patient/Ambulatory Care Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis,observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals. Ambulatory care can be a misleading term, as it actually encompasses a wide range of care and services. By definition, ambulatory care is any same-day medical procedure performed in an outpatient setting. This refers to any medical service that is not performed in a hospital or facility that requires admission. We can further divide ambulatory care into four smaller sub- categories to better help you understand all that ambulatory care encompasses: 1. Wellness - This is normally what you think of when you imagine going to the doctor. Ambulatory wellness services are mostly for prevention and basic medical care. They include doctor‟s clinics, such as primary care, as well as counselling centers for mental health and weight loss. 2. Diagnosis - Diagnostic services can be provided on their own, or as part of a wellness or treatment program. They include X-Rays, lab and blood tests, MRIs and screening for various cancers and illnesses. 3. Treatment - These include same-day surgery centers, substance abuse clinics, chemotherapy and other forms of therapy. 4. Rehabilitation - Rehabilitation includes post-operative therapies, occupational and physical therapy and rehabilitation for drug and alcohol abuse. In addition to these procedures and services, ambulatory care encompasses newer forms of healthcare, such as telemedicine. Telemedicine allows doctors and nurses to “see” and interact with patients via email, phone and video- chatting. Amelia Roberts, BSN RN, uses telemedicine to assess her patients. Ambulatory care, while outside of a hospital, employs almost all of the same healthcare professionals as inpatient care. Doctors, registered nurses, physical therapists, physical therapy assistants, surgical techs, medical lab techs and medical administration staff can all be found in various ambulatory care settings. Preventive Health Care Preventive healthcare (alternately preventive medicine, preventative healthcare/medicine, or prophylaxis) consists of measures taken for disease prevention, as opposed to disease treatment. Just as health comprises a variety of physical and mental states, so do disease and disability, which are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices. Health, disease, and disability are dynamic processes which begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention. Level Definition Any measure aimed at helping future parents provide their upcoming child with adequate attention, as well as secure physical and affective Primal and environments from conception to first birthday (i.e., over the child's primordial primal period of life prevention Primordial prevention refers to measures designed to avoid the development of risk factors in the first place, early in life. Methods to avoid occurrence of disease either through eliminating Primary prevention disease agents or increasing resistance to disease. Examples include immunization against disease, maintaining a healthy diet and exercise regimen, and avoiding smoking. Methods to detect and address an existing disease prior to the Secondary appearance of symptoms. Examples include treatment of Prevention hypertension (a risk factor for many cardiovascular diseases), cancer screenings. Methods to reduce the harm of symptomatic disease, such as Tertiary prevention disability or death, through rehabilitation and treatment. Examples include surgical procedures that halt the spread or progression of disease. Quaternary Methods to mitigate or avoid results of unnecessary or excessive prevention interventions in the health system Home Health Care Home health care is a wide range of health care services that can be given in patient‟s home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as the care received in a hospital or skilled nursing facility (SNF). Examples of skilled home health services include: -Wound care for pressure sores or a surgical wound -Patient and caregiver education -Intravenous or nutrition therapy -Injections -Monitoring serious illness and unstable health status In general, the goal of home health care is to treat an illness or injury. Where possible, home health care helps the patient: -Get better -Regain their independence -Become as self-sufficient as possible -Home health care may also help patients maintain their current condition or level of function and slow decline Doctor‟s orders are needed to start care. Once the doctor refers the patient for home health services, the home health agency will schedule an appointment and come to the patient‟s home to talk to about the needs and ask them some questions about their health. The home health agency staff will also talk to the doctor about the care and keep the doctor updated about the progress. It’s important that home health staff see the patient as often as the doctor ordered. Examples of what the home health staff should do: -Check what the patient is eating and drinking. -Check the blood pressure, temperature, heart rate, and breathing. -Check that the patient is taking his or her prescription and other drugs and any treatments correctly. -Ask if the patient is having pain. -Check the patient safety in their home. -Teach them about the care so they can take care of themselves. -Coordinate the care. This means health staffs must communicate regularly with the patient, the doctor, and anyone else who gives the patient care. Telemedicine Telemedicine is the remote delivery of healthcare services, such as health assessments or consultations, over the telecommunications infrastructure. It allows healthcare providers to evaluate, diagnose and treat patients without the need for an in-person visit. History of Telemedicine The development of modern telemedicine began with the invention of the telecommunications infrastructure, including the telephone and telegraph. Early on, telemedicine technology was adopted for use in military situations during the Civil War, such as ordering medical supplies or medical consultations. Casualty and injury lists were also delivered via telegraph. The first example of an electronic medical record transfer occurred in 1948 in Pennsylvania, when radiology images were sent 24 miles between two townships via telephone line. A few years later, Canadian radiologists built on that early application of telemedicine technology and created a teleradiology system for use in and around Montreal. In 1959, clinicians at the University of Nebraska transmitted neurological examinations across campus to medical students using two-way interactive television.  In the early days of telemedicine, health professionals used the burgeoning technology as a way to reach patients living in rural areas. However, the technology quickly expanded into urban areas, especially those that suffered from health care shortages. In 1967, physicians at the University of Miami, School of Medicine and Miami's Fire Department transmitted electrocardiographic rhythms over existing voice radio channels from fire-rescue units to the city's Jackson Memorial Hospital. Types of Telemedicine Telemedicine can be classified into three main categories: remote patient monitoring, store- and-forward and interactive telemedicine. 1. Remote patient monitoring -- Also known as telemonitoring, remote patient monitoring allows patients with chronicbdiseases to be monitored in their homes through the use of mobile medical devices that collect data about blood sugarblevels, blood pressure or other vital signs. Remote caregivers can review the data instantly. 2. Store-and-forward -- Also known as asynchronous telemedicine, store-and-forward telemedicine allows providers to share patient information, such as lab results, with a physician at another location. 3. Interactive telemedicine -- Interactive telemedicine allows physicians and patients to communicate in real time. Such sessions can be conducted in the patient's home or in a nearby medical facility and include telephone conversations or the use of video conferencing software that complies with Health Insurance Portability and Accounting Act regulations. Telemedicine vs. Telehealth Telemedicine is a subset of telehealth, which includes both remote clinical service delivery and nonclinical elements of the healthcare system. Telehealth refers to a broader spectrum of remote healthcare services than telemedicine and does not necessarily involve clinical services. It includes nonclinical services such as continuing medical education, provider training and administrative meetings. In contrast, telemedicine refers specifically to the use of medical information exchanged for the purpose of improving a patient's health. It pertains to the use of electronic communications to provide clinical services without requiring a patient to come in to a doctor's office. Technology such as video conferencing and transmission of still images are considered part of both telemedicine and telehealth. Advantages of Telemedicine - Convenience -- Patients do not have to take time away from work for an appointment. There is also no travel time or associated expenses, such as paying for gas or child care. - Increased access -- Patients in rural areas can obtain specialty services more easily. Similarly, patients who live in underserved areas have increased access to primary, dental and mental healthcare. - Reduced cancellations or no-shows -- Because of its convenience for patients, telemedicine can reduce the number of cancellations or no-shows. Providers can reach out prior to or at the appointment time if the patient forgot about the appointment. - Encourage healthy lifestyle choices -- Telemedicine allows providers to encourage their patients' healthy lifestyle choices, such as smoking cessation. Disadvantages of Telemedicine - Inability to prescribe medications -- Many states generally do not allow online prescribing (not to be confused with e-prescribing) without an established relationship between the physician and patient. A physical examination or evaluation may be required before a physician can write a prescription for a patient, but there are inconsistencies in state laws as to what constitutes a physical examination. - Technical training and equipment -- Providers need to be trained on how to use telemedicine equipment. There are also the associated costs of the equipment, such as integrated telemedicine carts and encounter management software, to consider. The startup cost of implementing telemedicine may be especially prohibitive to rural facilities. - Licensing issues -- Certain states may require providers who practice telemedicine across state lines have a valid license in the state where the patient is located. References/Sources: http://triotree.com/blog/healthcare-primary-secondary-and-tertiary-brief-description/ https://www.equotemd.com/blog/different-types-of-hospitals-and-hospital-medical- malpractice-insurance/ https://www.britannica.com/science/hospital#ref35528 https://www.scribd.com/doc/27565716/Types-of-Hospitals https://hfsrb.doh.gov.ph/images/Psychiatric_care/Issuance/ao2012-0012.pdf https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes https://moments.nhpco.org/what-hospice https://www.rasmussen.edu/degrees/nursing/blog/what-is-ambulatory-care/ https://www.medicare.gov/what-medicare-covers/home-health-care/home-health-care-what- is-it-what-to-expect.html https://searchhealthit.techtarget.com/definition/telemedicine https://philippines.knoji.com/20-facts-about-the-oldest-in-the-philippines/ https://searchhealthit.techtarget.com/definition/telemedicine