Chapter 1 History & Trends of Health Care

1. Chapter 1History & Trends ofHealth Care

2. Health Care of the Past

3. Why is it important to understand the history of health care?

4. Health Care of the Past • Patients of the past were passive, dependent • Health care provider was the guiding force, unquestioned • Health care providers were well respected - Ancient Egyptians, Greeks, Chinese who practiced surgery, were herbalist or “witch doctors” enjoyed stature within the community • Many learned the art of healing from family

5. Ancient Times • In primitive times, common belief was that disease & illness were caused by evil spirits and demons. • Treatment was aimed at eliminating the evil spirits • Many ancient treatments were actually harmful • As civilizations developed, changes occurred as people began to study the human body and make observations about how the body functions

6. Ancient Times • Religion played an important role in health care - believed illness/disease were punishment from the gods -exploring the human body was limited b/c most religions did not allow dissection of the body (animals were frequently used to learn)

7. Ancient Times • Ancient Egyptians were the first people to record health records • Knowledge limited to the few educated because many could not read or write • Most records recorded on stone & created by priests, who also acted as physicians

8. Ancient Times • Ancient Chinese had a strong belief in the need to cure the spirit and nourish the body - this treatment remains important today - Chinese herbal medicine, acupuncture, and massage are still commonly used

9. Ancient Times • Hippocrates was known as the “Father of Medicine” • Ancient Greek physician • One of most important physicians • Helped establish that disease is caused by natural causes, not supernatural spirits & demons • Author of code of conduct for physicians, known as the “Hippocratic Oath” - still used (adapted)

10. Rod of Asclepius Greek symbol associated with medicine & healing - founded in ancient Greece - in Greek mythology, Asclepius was believed to be the son of Apollo & the god of healing - Symbol consists of a staff entwined by a single serpent Caduceus Symbol Often mistaken as the medical symbol, but it is actually the symbol for commerce

11. Ancient Times • Romans realized some diseases were connected to filth, contaminated water, & poor sanitation - began development of sanitary systems by building sewers to carry away waste & deliver clean water - drained swamps & marshes to reduce incidence of malaria - created laws to keep streets clean & eliminate garbage

12. Ancient Times • The first hospitals were established in ancient Rome • Although changes occurred, treatment was still limited • Average person had poor hygiene, drank contaminated water, & had unsanitary living conditions • Diseases such as typhoid, cholera, malaria, dysentery, leprosy, and smallpox infected many individuals - usually fatal because cause of the diseases had not been discovered - average life span was 20 to 35 years

13. Dark Ages 400–800 AD • Study of medicine fell after the fall of the Roman Empire • Individuals again lived in unsanitary conditions • Epidemics of smallpox, dysentery, typhus, & plague were rampant Epidemics- An outbreak of a contagious disease that spreads rapidly and extensively by infection and affects many individuals in an area or a population at the same time. Plagues:any widespread and usually highly contagious disease with a high fatality rate (many caused by rodents-human bitten by flea of rat) • Monks and priests stressed prayer to treat illness and disease

14. Middles Ages 800-1400 AD • Renewed interest in the medical practices of the Romans & Greeks • Monks obtained & translated the writings of the Greek & Roman physicians, and recorded the knowledge in handwritten books • Medical universities were created • Arabs began requiring physicians to pass exams & obtain licenses • In the 1300’s, a major epidemic of bubonic plague killed almost 75 percent of the population of Europe & Asia • Many infants died shortly after birth & many children didn’t live into adulthood

15. Renaissance1350–1650 AD • “rebirth of the science of medicine” • Major source of new info about the human body was a result of accepting & allowing human dissection - physicians could now view body organs & see the connection between different systems in the body - artists, such as Michelangelo & Leonardo da Vinci, were able to draw the body accurately • Development of the printing press resulted in the publication of medical books

16. 16th, 17th, and 18th Centuries • William Harvey described circulation of blood • Gabriel Fallopius described tympanic membrane & fallopian tubes • Bartolomeo Eustachio identified the tube between the ear and throat • Anton van Leeuwenhoek invented the microscope - allowed physicians to see smaller organisms • Apothecaries made, prescribed, & sold medications - many meds made from plants & herbs • Jenner developed a vaccine to prevent smallpox • Average life span increased to 40 to 50 years

17. 19th Century • Also known as the Industrial Revolution • Major progress in medicine occurred because of the development of machines & ready access to books • Rene’ Laennec invented the stethoscope • Formal training for nurses began • Florence Nightingale established sanitary nursing care units for injured soldiers • Major developments in infection control • Women became active participants in medical care - Elizabeth Blackwell: first female physician in US - Clara Barton founded the American Red Cross • Average life span increased to 40-65 years • Treatment for disease more specific b/c causes identified

18. 20th Century • Showed the most rapid growth in health care • New machines, such as X-rays • Meds, including insulin for diabetes, antibiotics to fight infections, & vaccines to prevent diseases were identified • Francis Crick & James Watson described the structure of DNA & how it carries genetic information • Health care plans started to help pay for medical costs • First open-heart surgery • Computers used in every aspect of health care • Average life span increased to age 60–80 (some live to 100)

19. 21st Century • The potential for major advances in health care are unlimited • Advances in genetic research • Research with embryonic stem cells & development of cloned cells could lead to treatments that will cure many diseases • Major threats to healthcare exist - Bioterrorism, New viruses, Pandemics • Health care has become a global concern & countries are working together to promote good health in all individuals- organizations such as the World Health Organization (WHO) are constantly monitoring health problems throughout the world & taking steps to prevent pandemics

20. Health Care of the Present Many of the past diseases are now preventable by: • Vaccinations • Improved methods of cleanliness & sanitation • New technological advances Focus of Health Care has now shifted from prevention of contagious diseases to diseases of lifestyle: • Cancer, Drug Abuse, Heart Disease, Obesity Although some communicable diseases remain a primary focus: • AIDS, TB, Flu

21. The “Patient” of Today • Takes on more responsibility for his or her own care • Obtains second opinions • Shops for the lowest health care costs • Seeks alternative and complementary providers

22. Trends in Health Care

23. Health care has seen many changes during the past several decades, and many additional changes will occur in the years to come. An awareness of such changes and trends is important for any health care worker.

24. Cost Containment • Trying to control the rising cost of health care and achieving the maximum benefit for every dollar spent • Reasons for high health care costs: - Technological advances - Aging population - Health-related lawsuits • Because these expenses must be paid, a major concern is that health care costs could rise to levels that could prevent providing service to all people

25. Methods of Cost Containment • Diagnostic related groups (DRGs) • Combination of services • Outpatient services • Mass / Bulk purchasing • Early intervention & preventive services • Energy conservation

26. Diagnostic related groups (DRGs): • Predetermined payment of structure for health care services established by the federal government • Attempt to control costs for government insurance plans such as Medicaid & Medicare • Patients with certain diagnoses who are admitted to hospitals are classified in one payment group. A limit is placed on the cost of care, & the agency receives this set amount. • If cost of care is less, agency keeps extra $$$ / If cost of care is more, agency accepts the loss • Encourages the agency to provide care within expense limit allowed

27. Combination of Services: • Health care agencies join together or share specific services so care can be provided to a larger number of people at a decreased cost per person • Examples: - Clinics & Labs shared by different agencies - Health Maintenance Organizations (HMOs) - Preferred Provider Organizations (PPOs)

28. Outpatient Services: • Patients receive care without being admitted to hospitals or other care facilities • Reducing the length of hospital stay or need for a hospital admission lowers the cost of health care • Surgery, radiographs, diagnostic testing, & many other procedures that once required admission to a hospital are now done on an outpatient basis • Less expensive home care or transfer to a skilled-care facility can be used for patients who require additional assistance

29. Mass or Bulk Purchasing: • Buying equipment & supplies in larger quantities at reduced prices • Can be done by: • Combining purchases of different departments within an agency • Combining purchases of several different agencies • Computerized inventory can be used to determine when supplies are needed to and to provide overstocks & waste

30. Early Intervention& Preventive Services: • Providing care before acute or chronic disease occurs • Preventing illness is always more cost effective than treating illness • Methods used: - Patient education - Immunizations - Regular physical exams - Incentives for participation -Easy access to preventive care

31. Energy Conservation: • Monitoring the use of energy to control costs & conserve resources • Major expenses for health care facilities include electricity, water, & gas • Most perform energy audits to determine how resources are being used & calculate ways to save • Methods used for energy conservation: - Energy efficient lightbulbs - Sensors to turn lights & faucets on / off - Thermopane windows - Recycling

32. Cost Containment - Summary • The quality of health care should not be lowered simply to control costs • Agency for Health Care Policy (AHCPR) researches the quality of health care delivery & identifies standards of treatment that should be provided • Everyone must work together to help control cost: - Healthcare workers must make every effort to provide quality care while avoiding waste - Health care consumers must assume responsibility by being informed of options for health care & following preventive measures to avoid or limit illness & disease

33. Home Health Care • Rapidly growing field • DRGs & shorter hospital stays have created a need for providing care in the home • Current trends show a return to practices of the past when home care was the usual method of treatment • All aspects of health care can be involved • Another form of cost containment because it is usually less expensive to provide

34. Geriatric Care • Care for the elderly • Will continue to grow due to - large number of individuals experiencing longer life spans because of advances in health care - “Baby boom” generation is now reaching geriatric age • Many different facilities involved in providing care: - Adult day care centers, retirement communities, assisted/independent living facilities, long-term care facilities

35. Omnibus Budget Reconciliation Act • OBRA • Established in 1987, requires states to establish training & competency evaluation programs for nursing & geriatric aides • All assistants working in a long-term care facility or home health care is now required under federal law to obtain certification/registration by completing a mandatory: - state-approved training program - pass a written exam - pass a competency skills exam

36. Omnibus Budget Reconciliation Act • OBRA also requires: - continuing education - periodic evaluation of performance - retraining and/or testing if a nursing assistant doesn’t work in a health care facility for more than 2 years • Each state maintains a registry of qualified individuals • Minimum skills required are specified in the Nurses Aide Competency Evaluation Program (NACEP) developed by the National Council of State Boards of Nursing

37. Telemedicine • Involves the use of video, audio, & computer systems to provide medical and/or health care services • Examples: - EMTs at scene of accident/illness may transmit data to ER physician - Physician’s able to access lab results/medical records from hospital or vice versa - Robotic surgeries - Info sent to physician or nurse via telephone from home

38. Wellness • State of being in optimum health with a balanced relationship between physical, mental, & social health • People are more aware of need to maintain health & prevent disease to improve quality of life • More individuals recognizing the importance of exercise, good nutrition, weight control & healthy living habits • Led to establishment of wellness centers, weight control facilities, health food stores, nutrition services, stress reduction counseling, & habit cessation management

39. Wellness • Wellness is determined by the lifestyle choices made by an individual & involves many factors • Some of the factors & ways to promote wellness include: - Physical wellness - Emotional wellness - Social wellness - Mental & Intellectual wellness - Spiritual wellness (p 19)

40. Pandemics • An infectious disease that affects many people over a wide geographical area: a worldwide epidemic • Becoming an increasing concern due to society becoming more global – people can travel readily throughout the world & disease can spread more rapidly from individual to individual • The World Health Organization (WHO) has major concerns about influenza pandemics • Examples: H1N1 virus in 2009, HIV/AIDS in 1980 • Many governments creating pandemic influenza plans to protect populations - Education, Vaccine production, Antiviral drugs, Development of protective public health measures, & International cooperation

41. Drug-Resistant Bacteria • Of growing concern are the drug-resistant bacteria, or superbugs • Examples: - Methicillin-resistant Staphylococcus aureus (MRSA) - Vancomycin-resistant Enterococcus (VRE) • Believed to be caused by decades of unnecessary antibiotic use which caused genetic mutations of bacteria and resistance to commonly used antibiotics