HEALTH CARE SERVICES

DEFINITION:

Health services consist of medical professionals, organizations, and ancillary health care workers who provide medical care to those in need. Health services serve patients, families, communities and populations. These services are centered on making high quality health care accessible to all individuals.

COMPONENTS OF HEALTH CARE SERVICES:

DISEASE PREVENTION

Disease prevention is a specific, population based and individual based interventions for primordial, primary and secondary (early detection) prevention, aiming to minimize the burden of diseases and associated risk factors.

LEVELS OF DISEASE PREVENTION

• Primordial Prevention: Establish and maintain standards to minimize the hazards of health (eg. Formulation of policy and laws that governs the population and minimizing the risk factors in the society).
• Primary Prevention: Prevent and reduce risk factors that lead to disease or injury (eg. Vaccinations, maintaining normal body weight, balanced diet, healthy lifestyle etc)
• Secondary Prevention: Early diagnosis and treatment
• Tertiary Prevention: Prevent complications and Relapses through education, follow up and continuing care

Primordial Prevention:

• Primordial prevention consists of actions and measures that inhibit the emergence of risk factors in the form of environmental social, behavioral, economic conditions and living standards.
• It is prevention of emergence of risk factors in population or countries in which the disease has not yet appeared.
• The aim of primordial prevention is discouraging the person/ population from adopting harmful lifestyles
• Primordial prevention is achieved through individuals and mass health education and through policies, laws etc.

Primary Prevention:

• Primary prevention is the action prior to the onset or occurrence of disease which will prevent the possibility of disease from occurring
• It aims at providing intervention in the pre-pathogenesis phase of the disease process
• Primary prevention can be achieved through measures like health promotion and specific protection

PRIMARY PREVENTION METHODS

HEALTH EDUCATION:

Health education is a strategy to provide learning experience  for the development of individual, group, institutional, community and uses systematic strategies to improve health knowledge, attitudes, skills and behavior. The purpose of health education is to positively influence the health behavior of the target Population and  aids to improve the living and working conditions that influence their health

ENVIRONMENTAL MODIFICATION:

This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe environment that can lead to disease or injury. This is done by providing access to improved drinking-water sources in developing countries to prevent water borne Infections. Providing access to improved sanitation and good hygiene behaviors that would help break the chain of fecal-oral pathogen contamination of water, yielding benefits to health and  well-being.

NUTRITIONAL INTERVENTION:

Nutritional intervention are planned Nutrition programs intended to positively change a nutrition related behavior, risk factor, environmental condition or aspect of health status for an individual, family, target groups or the community. The various Nutritional intervention include food fortification, supplementation, and behavioral and regulatory interventions which have a greater impact on nutrition outcomes

LIFESTYLE CHANGES:

Lifestyle modification play a significant role in disease Prevention. Lifestyle changes like Physical activity & exercise, cessation of smoking & tobacco consumption, eating a high-fibre & low-fat diet, controlling body weight, and learning to cope with stress can reduce the risk of cardiovascular disease, cancer, and premature mortality.

IMMUNIZATION:

Immunization is the most important and cost effective strategies for the prevention of childhood Infections and disabilities and it is a basic need for all children. Immunizations provides protection from serious diseases and also prevent the spread of those Infections. Immunizations have helped in preventing epidemics and also in eradicating certain Infectious diseases like small pox, polio etc.

CHEMOPROPHYLAXIS: 

Chemoprophylaxis is the administration of drug to prevent the development of a disease. The common examples of chemoprophylaxis like, fluoridated water to prevent dental caries; statins to prevent cardiovascular and coronary heart disease; trimethoprim-sulfamethoxazole for Pneumocystis pneumonia prophylaxis in AIDS patients with CD4 cell counts under 200; oral hormone contraception to prevent undesired pregnancies; and folic acid use in women of child bearing age to reduce risks of birth defects, especially in those desiring to be pregnant.

SPECIFIC NUTRITION PROGRAMS:

Specific Nutrition Program have helped to provide proper nutrition to the children and women. The implementation of these programs, together with public health and primary care services, offers an approach to ensure more equitable health care for the population

The Specific Nutrition supplementation programs in India are:

1.  Integrated Child Development Services Scheme (ICDS);
2. Mid-day meal Programs (MDM);
3. Special Nutrition Programs (SNP);
4. Wheat Based Nutrition Programs (WNP);
5. Applied Nutrition Programs (ANP);
6. Balwadi Nutrition Programs (BNP);
7. National Nutritional Anaemia Prophylaxis Program (NNAPP);
8. National Program for Prevention of Blindness due to Vitamin A Deficiency; and
9. National Goiter Control Program (NGCP).

PREVENTION OF OCCUPATIONAL HEALTH HAZARDS:

Occupational health deals with all aspects of health and safety in the workplace and has a strong focus on primary prevention of hazards. The health of the workers has several determinants, including risk factors at the workplace leading to cancers, accidents, musculoskeletal diseases, respiratory diseases, hearing loss, circulatory diseases, stress-related disorders and communicable diseases.

Employment and working conditions in the formal or informal environment has been improved with Occupational Health and Safety Administration (OHSA),  that includes workplace policies for working hours, salary, concerning maternity leave, health promotion and protection provisions, etc.

FOOD & DRUG SAFETY:

The Food and Drug Administration (FDA) is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation's food supply, cosmetics, and products that emit radiation. It also protects the rights and safety of patients in clinical trials of new medical products and monitors the promotional activities of drug and device manufacturers.

SECONDARY PREVENTION

• It is the action taken at its incipient stage to prevent the progress of the disease and its complications
• Secondary prevention aims at arresting the disease process and restore health by providing adequate treatment before irreversible pathological changes occurs and prevents the communicability of the disease
• The interventions done are early diagnosis and treatment. The earlier the disease is diagnosed and treated better is the prognosis.

TERTIARY PREVENTION

• It is the action taken after the disease process has advanced beyond its early stages
• It is the measure taken to limit the disability or impairment caused by the disease and aims to promote patient’s to adjust with the irremediable conditions
• The interventions done in tertiary prevention are disability limitation and rehabilitation.

HEALTH PROMOTION

• Health promotion is the process of empowering people to increase control over their health and its determinants through health literacy efforts and multi-sectoral action to increase healthy behaviors.
• This process includes activities for the community at large or for populations at increased risk of negative health outcomes
• Health promotion usually addresses behavioral risk factors such as tobacco use, obesity, diet and healthy inactivity, as well as the areas of mental health, injury prevention, drug abuse control, alcohol control, health behavior related to HIV and sexual health.

COMPONENTS OF HEALTH PROMOTION

• Policies and interventions to address tobacco, alcohol, physical activity and diet
• Dietary and nutritional intervention should also appropriately tackle malnutrition, defined as a condition that arises from eating a diet in which certain nutrients are lacking, in excess (too high in intake), or in the wrong proportions
• Inter-sectoral policies and health services interventions to address mental health and substances abuse
• Strategies to promote sexual and reproductive health, including through health education and increased access to sexual and reproductive health and family planning services
• Strategies to tackle domestic violence, including public awareness campaigns; treatment and protection of victims and linkage with law enforcement and social services.

PRIMARY CARE

• Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern (‘the undifferentiated’ patient) not limited by problem origin (biological, behavioral or social), organ system or diagnosis.

CHARACTERISTICS OF PRIMARY CARE

• Patient/family centered care, self-reliance and participation
• Community engagement and participation
• Health workers collaborating in inter disciplinary teams
• Proactive prevention focus
• Integration and coordination of services
• Accessibility
• Better management of chronic conditions
• Localized set of choices
• Sustainability
• Multi-sector alignment and involvement

PRIMARY CARE SPECIALISTS

• Family Care
• Internal Medicine
• Pediatric care
• Obstetric & gynecology care
• Geriatric care

1. Family Care: Physicians work with both children and adults patients. They generally work in an outpatient setting, diagnosing and treating a variety of disease. They also perform physical, health screen conditions and provide general preventive care. Family physicians receive extensive training in order to treat most conditions and provide comprehensive health care for everyone, regardless of age.
2. Internal Medicine: Internal medicine is another specialty within the primary care family. Internal medicine physicians, also called internists, work with adult patients on many common diseases, such as diabetes, obesity or high blood pressure. They also provide health screenings and general preventive medicine. Some work in hospitals, while others work in clinics or doctor’s offices.
3. Pediatric care: Pediatricians are primary care doctors trained to diagnose and treat babies, children and adolescents. They specialize in providing care for diseases and injuries common to younger patients. They also handle vaccinations, Physicals and general preventive medicine. When caring for younger patients, pediatricians counsel parents on the growth and development of their children.
4. Obstetric & gynecology care: Gynecologists are physicians who diagnose, treat and care for the female reproductive organs for patients in adolescence through adulthood. Obstetricians are physicians who provide care before, during and after pregnancy. They also over see labor and delivery.
5. Geriatric care: Geriatricians are specially trained to care adults over the age of 60. They diagnose and treat an array of disease and injuries common among of adults, including injuries related to falls and memory issues. They also assist with medication management, as older patients tend to have more prescriptions for chronic and acute conditions.

DIAGNOSIS: 

The act or process of Identifying or determining the nature and cause of a disease or Injury through evaluation of patient history, Physical Examination and review of Laboratory data.

IMPORTANCE OF DIAGNOSIS

• To know the outcome of disease
• For management of disease
• To ascertain whether the disease is curable
• To decide the line of treatment
• To prescribe medicines
• To select the potent medicine in advanced diseases
• To evaluate the effectiveness of treatment
• To identify the symptoms
• To prevent the spread of infection

TYPES OF DIAGNOSIS

• Clinical Diagnosis: A diagnosis made on the basis of medical signs and patient reported symptoms, rather than diagnosis tests.
• Laboratory Diagnosis: A diagnosis based significantly on laboratory reports or test results
• Radiology diagnosis: A diagnosis based primarily on the results from medical imaging studies. Magnetic resonating imaging (MRI) are common radiological diagnoses
• Principal Diagnosis: The single medical diagnosis that is most relevant to the patients chief complaint or need for treatment
• Differential Diagnosis: A process of identifying all of the possible diagnoses that could be connected to the signs, symptoms and lab findings and the ruling out diagnosis until the final determination.

TREATMENT

• The word treatment, therapy or care are synonymous and tends to imply a broad idea of everything done to protect or improve someone’s health.

TYPES OF TREATMENT

Three principal types of treatment are

• Curative: To cure a patient of an illness
• Palliative: To relieve symptoms from an illness
• Preventive: To avoid the onset of an illness

LEVELS OF TREATMENT/CARE

• Emergency Care: Handles medical emergencies and is a first point of contact or intake of less serious problems, which can be referred to other levels of care as appropriate.
• Intensive /Critical Care: It is care for extremely ill or injured patients. It thus requires high resource intensity, knowledge and skill as well as quick decision making.
• Ambulatory Care: Care is provided on outpatient basis. Typically patients can walk into and out of the clinic under their own power (hence ambulatory) usually on the same day.
• Home Care: This care is provided at home, including care from providers (such as physician, nurses and home health aides) making house calls, care from caregivers such as family members and patient self care
• Primary Care: Primary care is meant to be main kind of care in general, and ideally a medical home that unifies care across referred providers
• Secondary Care: Secondary care is care provided by medical specialists and other health professionals who generally do not have first contact with patients.
• Tertiary Care: Tertiary care is specialized consultative care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as tertiary referral hospital.
• Follow up care: Follow up care is additional care during or after convalescence. After care is generally synonymous with follow-up care.
• End of life care: End of life care is care near the end of one’s life
• Palliative Care: Palliative care as “ an inter-disciplinary approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual.
• Hospice care: Hospice care is palliative care very near the end of life when cure is very unlikely. Its main goal is comfort, both physical and mental.

REHABILITATION

• Rehabilitation is a set of interventions needed when a person is experiencing or is likely to experience limitations in everyday I ij functioning due to ageing or a health condition, including chronic diseases or disorders, injuries or traumas. Examples of limitations in functioning include difficulties in thinking, seeing, hearing, communicating, moving around, having relationships or keeping a job. Rehabilitation enables individuals of all ages to maintain or return to their daily life activities, fulfil meaningful life roles and maximize their well-being.

INTERVENTIONS OF REHABILITATION

• Exercises to regain the ability to swallow or upper-limp retraining to regain coordination, dexterity and movement of an affected limb following a stroke
• Interventions that improve safety and independence at home and reduce the risk of falls for an older person, such as balance training or modifying their home environment.
• Early interventions to address developmental outcomes of a child with cerebral palsy, such as fitting as orthrosis, or providing training in sensory integration and self care, which in turn can improve participation in education, play and family and community activities.
• Interventions that optimize surgical outcomes after a hip fracture, including exercise prescription, provision of a walking aid and education about hip movements to avoid during the recovery process
• Cognitive behavioral therapy and interventions aiming to increase exercise for an individual with depression
• Interventions that support daily activities and community access for individuals with vision loss, such as providing strategies to complete personal care tasks and training in the use of white cane.

TYPES OF REHABILITATION

• Physical Rehabilitation: Therapists work with patients to restore movement, strength, stability and for functional ability and reduce pain via targeted exercise and a range of other treatment methods.
• Occupational Rehabilitation: This form of therapy focuses an individual’s ability to perform necessary daily activities. This may mean working to improve fine motor skills, restore balance, or assist patients in learning how to increase their functional ability via use of adaptive, equipment, among other potential treatment options.
• Speech Rehabilitation: This type of rehabilitation therapy is used to address difficulties with speech, communication and/or swallowing.
• Pulmonary Rehabilitation: This is used to aid patients who have breathing disorders or difficulties, this form of rehabilitation therapy works to help them decrease respiratory distress, maintain open airways and when necessary, learn how to use inhalers and supplemental oxyhgen properly.
• Cognitive Rehabilitation: It also commonly called cognitive behavior rehabilitation, this type of therapy works with patients to improve memory, thinking and reasoning skills.
• Vocational Rehabilitation: This form of therapy is geared towards preparing individuals to return, to work after an injury, illness or medical event.

CONTINUING CARE

• Continuing care services include assistance with dressing, eating and bathing, meal preparation, respite, wound care, medication administration and various health care support services.
• These services and supports may be provided in different settings including individuals homes, community-based services locations, such as adult day programs and residential care facilities which include designated supportive living and long-term care.

HOME CARE

• The Home care program provides personal and health care services for client of all ages living in their home or other private residential settings, such as suites in a seniors lodge or supportive daily living facility
• The Home care program helps people remain well, safe and independent in their home foa as long as possible
• Home care services are intended to supplement, not replace, the help and support received from family, friends and other community supports.
• Home care services provide care for a short-term basis if recovering from an accident, injury or illness or on a long-term basis due to disease, disability or aging.

SUPPORTIVE LIVING

• Supportive living is a type of continuing care accommodation, where people can remain as independent as possible in a home-like setting while they have access to services that meet their changing needs.
• Supportive living accommodations vary by size, appearance and the types of services offered and can include senior’s lodges, group homes for individuals with developmental disabilities and designated supportive living accommodations
• Each supportive living accommodation is different and it varies according to the need of persons.

LONG TERM CARE

• Long-term is a type of continuing care facility for people with complex medical needs who are unable to remain safely at home or in a supportive living accommodation.
• Long-term care is provided homes and auxiliary hospitals, both of which may be referred to as “long-term care facilities”.
• In long-term care, residents receive accommodation, meals, and access to 24 hour on-site professional nursing and personal care. Case management, professional nursing, rehabilitation therapy and other consultative services are provided on-site by facility staff.