Outcome Measurement Analysis

Outcome Measurement Analysis
Outcome measures are used to quantify a patient's status over an extended period of time. This helps
to assess the results of treatment and physiotherapy care as well as the quality there of.
Self–report measures are used clinically to screen for comorbidity or psychosocial behavioural risk
factors and so to quantify the patient's perception of his/her impairment, disability or pain and
functional limitations (Beattie & Maher, 1997).
As Beattie & Maher discussed (1997) the scope, the feasibility and measurement properties need to
be considered when chosing a self–rating measurement questionnaire.
Synnott et al. (2015) concluded that physiotherapists could not fully comprehend the cognitive,
psychological and social factors that influence people with low back pain, thus the stigmatisation of
patients with low back pain as demanding, attention–seeking and poorly motivated.
Psychosocial factors that have been described in having a substantial effect on chronicity, and
contributing to poorer recovery and prolonged disability in ... Show more content on
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Psychological factors are assessed by using various measures but an overlap between measures and
lack of clarity about the importance of these psychological factors are leading to unclear predictors
of pain and associated outcomes. In a study done by Campbell et al. (2013) significant overlap of
psychological measures in low back pain was shown with the largest overarching construct in pain–
related emotional distress. Measures was either directly (eg anxiety, depression), indirectly through
the persons' current experience of pain (eg. kinesiophobia, catastrophizing, emotional reaction).
person's self–view in relation to their pain (eg. pain self–efficacy) and the number of other
symptoms (Cambell et al, 2013). The predominant factor common to these psychological measures
is the patient's overall level of pain–related emotional distress that is
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The Link Between Anxiety And Depression
Research
Topic: "Anxiety and depression are often linked, experts say, as dealing with long–term anxiety can
lead to depression, or one may feel anxious about their battle with depression."
In order to talk about the "link" between Anxiety and Depression, there is a word that must be
discussed: comorbidity. According one paper, "Comorbidity may imply either the co–occurrence of
two or more disorders in an individual at a given time, or the manifestation of multiple disorders
during the lifetime of the individual." (Seligman and Ollendick, pg. 125) Two disorders may be
comorbid when there is symptom overlap; "when one underlying construct is split into two separate
disorders"; when disorders share risks, or "when one disorder causes or increases the risk of
developing the second disorder." (S and o, pg. 125) People with comorbid disorders are, "typically
more severely impaired than children with either disorder alone." (1) However, there has only been a
limited amount of research done on individuals with comorbid disorders, as comorbidity often
serves to exclude people from entry. This paper with specifically discuss and expand upon the
comorbidity between anxiety and depression.
Anxiety and depression are highly comorbid disorders. In a study done about the relationship
between anxiety and depression, researchers found a group of 106 children who struggled with
DSM–III diagnosed anxiety disorder. Of those 106 children, 28% were found to have a comorbid
depressive disorder.

Person Centred Care MDT
This essay will discuss the concept of person centred care, why ser–vice users are at the centre of
any decisions made. The importance of this when developing a plan of care to an individual with
dementia within a community care setting with limited mobility. What the structure of the mutli
disciplinary is when involved in delivering a package of care and how the different roles involved
contribute to the positive outcomes
Principles of care as stated by the Royal College of Nursing (2013) outlines guidelines what service
users should expect from the nurs–ing profession, whether you are a nurse, health care assistant,
community nurse, a service user, family member. You are given the information of what to expect
when you are in contact ... Show more content on Helpwriting.net ...
These stages are forming, storming, norming and performing.
Person centred care was first used in relation to people with demen–tia by a Professor called Tim
Kitwood who founded the Bradford de–mentia Group in the 1980's. His aim was to steer away from
the medical diagnosis of dementia and to help those living with the ill–ness to live and be treated as
an individual. To acknowledge that these people did have a voice even though in the medical eyes
they were slowly losing their own mind. He wrote about the Enriched Model (1997) which detailed
opportunities to maximise the well being of a person suffering from dementia whilst enhancing their
daily living of the other elements that affect the person. For example people suffering from dementia
have many challenges to deal with. They have the gradual memory loss but also lose the interaction
with others, communication becomes repetitive and in the past, how to eat, drink, co ordination,
coping with mood changes, general daily living skills become more difficult to complete along with
depression.
Buijssen 2005 suggests that depression is a main factor with dementia due to lots of feelings of
helplessness and anxiety which can cause the service user to have challenging out bursts. To enable
a person to remain in their home safely and independently other people will be involved. This
depends on how advanced the dementia is, otherwise the service

My First Episode Of Anxiety
Doc, as you review my Medical Record there are few things that you will not find there and that I
will share with you in this email. First, I was diagnosed with anxiety back in 2003 vice 2011 as I
previously stated. Since 2003 I have only experienced three episodes of anxiety. Back in 2003, I had
my first episode of anxiety and I decided to visit my Doc and asked him to refer me to Psychiatry
clinic just to make sure that I was not suffering from PTSD due to my last recent OIF Deployment.
In 2003, the Psychiatrist diagnosed me with anxiety and offered me to put me on pills for anxiety. I
cannot remember the name of the medication she wanted to put me on, but I told her "no medication
for Jose Colon". Then, 8 years later in 2011, I had another anxiety episode, which it was triggered
by finding out that I had developed Tinnitus. The funniest thing is that back then, I did not know I
had Tinnitus until I had to answer a series of questions about Tinnitus during my PHA. Needless to
say, I asked the Doc to refer me to the ENT Clinic to make sure that I was given a good diagnosis.
After a series of tests performed by the Otolaryngologist, he diagnosed me with Tinnitus and as a
result of this terrible news I developed insomnia. Having developed insomnia triggered my anxiety
since every night that I tried to get some sleep I would stay up all night listening to the ringing and
buzzing noises coming out of my ears. It was difficult to accept the new me and make the new

The Impact Of Gatekeeping On Health Care Systems Essay
Gatekeeping is a concept that is often applied to health care systems. This disquisition will discuss
in depth the role of gatekeeping in health care systems. The key aspects discussed will be
gatekeeping and, how it operates in the New Zealand (NZ) health system. Along side that another
key aspect that will be explored is the absence of gatekeeping systems in countries such as, the
United States of America (USA). And, how this effects the primary and specialist care sectors of the
health care system in that country. In addition to gatekeeping systems, this disquisition will also
comprehensively compare and contrast a few of the repercussions of having a gatekeeping system as
well as the repercussions that arise from the absence of one. Gatekeeping can be defined as, the
ability of a primary health care professional to authorize or restrict the access of a patient to
specialists, hospitals and other such medical facilities that require primary care physician (PCP)
referral (Bodenheimer and Grumbach, 2009). Thus, a patient can only gain access to secondary or
tertiary care if they have initially been referred by their PCP. The purpose of gatekeeping in a health
care system is to control the number of laboratory tests, therapist as well as specialist referrals
(Malcolm, 2004). Gatekeeping occurs predominantly in the primary care sector of the health care
system and, the gatekeepers generally tend to be the primary care physicians or qualified nurse
practitioners (Cummings,

Psychological Measure
Psychological Measure Evelyn Calderon, Charlene Pallas, Jasmine Perkins–Troutman, Ashley
Stringer–Franco PSY/475 Psychological Tests and Measurements September 17, 2012 Glenn
Leighbody Psychological Measure Team B examines the aspects of psychological tests and
measurements by focusing on the Beck Depression Inventory. Examining the two articles over the
Beck Depression Inventory aids Team B in deciding services, servers, and backgrounds of the
measure. The psychological testing that has developed and progressed and is used in a wide variety
of settings by a wide variety of individuals is called the Beck Depression Inventory. Testing aids in
serving professionals in figuring out sickness or deficiency and lending a hand in making ... Show
more content on Helpwriting.net ...
The BDI contains factor analysis because the BDI interprets as one syndrome composed of three
factors: negative self–attitudes, performance impairment, and bodily disturbance. The BDI test for
reliability, following established standards for psychological tests and contains internal consistency.
The BDI is valid and reliable and higher scores relate to educational attainment (Fundukian &
Wilson, 2008). Breast Cancer and Breast Disease In the Kuopio Breast Cancer Study, 115 women
with breast cancer symptoms participated in an in–depth interview and completed standardized
questionnaires. Study variables were retrieved before completing diagnostic procedures. BDI
evaluated the depression of study participants. Eskelinen and Ollonen (2011) reported, "Clinical
examinations and biopsies discovered breast cancer in 34 patients, 53 patients with benign breast
disease, and 28 healthy individuals. Healthy women exhibited less sadness (BDI mean score, 0.27)
than women with breast cancer (BDI mean score, 0.56) and women with benign breast disease (BDI
mean score, 0.49). Healthy women were less pessimistic (BDI mean score, 0.15) than patients in the
breast cancer group (BDI mean score, 0.44) and the benign breast disease (BD mean score, 0.42)"
(para. 3). The group of healthy women contained less self–accusation than the breast cancer group
and breast benign disease group. The group of healthy women reported less work inhibition and
weight loss than the

Case Study Patient Referral
Patient Referral Case Study The referral of a patient to care outside of your practice is an importance
decision for a primary care manager (PCM) in the care of their beneficiaries. The referral decision
must include not only whether that patient would be best since by a specialist, but by which
specialist (Kinchen, Cooper et al. 2004) the beneficiary would best benefit. In order to ensure the
best care from the specialist effective patient information must be exchanged between care providers
in a timely manner. Health Information Exchange (HIE), which is also known as "Summary of
Care", is an objective that is required for eligible professionals (EPs), eligible hospitals and critical
access hospitals (CAHs) that are taking part of the Electronic Health Record (EHR) Incentive
Program from 2015 until 2017 under Meaningful Use Stage 2 (MU2). The objective contains one
required measure for participation in the program. The measure is: certified EHR technology
(CEHRT) must be used to create a summary of care record which is to be used transmit care
information between entities involved in the care of the patient referred (Services 2016). The items
that must be included in the Summary of Care documents, provided the referring provider knows the
information, are shown in Table 1 (Mostashari 2012, Services 2016). Currently the standard format
that has been adopted for Summary of Care documents follows Consolidated Clinical Document
Architecture (C–CDA) guidelines.

Postpartum Depression On The Mother And Parenting
For this research paper, I decided to focus on postpartum depression. While being a listening ear, I
was introduced to the reality that not every mother has the attachment to her child that almost every
movie in Hollywood portrays. After hearing the story and not sure if it was a real thing, I began to
search the web for information, stories, and news coverage related to the rarely–discussed category
of depressed known as Postpartum Depression (PPD). I wanted to find solid proof that this was an
actual diagnosis and what the long–term effects would be, as well as what was being done to reduce
the amount of women that suffer from this. This research should allow me to better understand the
causes and effects of postpartum depression on the ... Show more content on Helpwriting.net ...
Problems such as breastfeeding, marital or relationship issues, feeling inadequate, and not having
the social support can all add to the stress factors that could potentially lead and contribute to
postpartum depression (Postpartum Depression, 357). Primary Care Physicians are ultimately more
likely to make the diagnosis of PPD over their obstetrician since they usually have a more solid
foundation and trust built up after being seen there more frequently. A test is given to women around
eight to twelve weeks postpartum in order to determine the likelihood of postpartum depression and
overall health of the mother (Postpartum Depression, 358–359). Another scholarly journal I found
was Disorganized attachment in early childhood: Meta–analysis of precursors, concomitants, and
sequelae by Marinus H van Ijzendoorn, Carlo Schuengel, and Marian J. Bakermans–Kranenburg
published by Cambridge University. The journal describes how a mother's postpartum depression
affects the mental development of the child as well as their own attachment issues that can result in
educational delays as well as behavioral issues (Development and Psychopathology, 228). Children
develop attachments with anyone who gives them steady care, disregarding the quality of that care.
The effect on infants whose mother went through postpartum depression (PPD) can impact the
development and quality of life that child will have (Child Development, Feb 1993). A long–term
effect

Ethical Dilemma In The Social Work Case Study
The social work profession is rooted in a set of core values and principles which are applied as
standards in determining ethical judgements. This paper will explore an ethical dilemma and how
utilizing the ethical decision making model can offer different resolutions. Joseph (1983) discussed
how this ethical model "suggests a structure and a systematic process for inquiry into ethical issues
that emerge in clinical practice and its organizational contexts."
Dilemma in Context
Practice Setting
The dilemma transpired in an outpatient community mental health center in a rural area of the state
that accepted both children and adults for services. In this area, all mental health facilities prescribe
psychiatric medications due to physician ... Show more content on Helpwriting.net ...
Maria further explained that she recently moved back to this area as she felt she was a burdened to
her children and disrupted their marriages. During the consultation, Maria signed releases of
information (ROI) for one child and her current and past physician; additionally we set up for a
psychiatric evaluation for medication services per Maria's request. Over the succeeding month, our
agency conducted several home visits where concerns were noted over lack of food within the
home, complaints by Maria that her medication had been stolen, etc. After staffing the case, the team
decision was to contact Adult Protective Services (APS) for an evaluation. After the initial
evaluation, APS reported they would continue to monitor the case, but the agency was not prepared
to assume the case.
During the psychiatric evaluation, there was a review of current medication from Maria's primary
care physician (PCP). The psychiatric provider expressed concern over the quantity of pain
medication prescribed to Maria. Maria explained she experiences joint discomfort and utilizes the
medication for mobility reasons. Our agency offered alternative pain management options, Maria
declined. The psychiatric provider prescribed medication to assist with anxiety, but refused to
prescribe Xanax which is what Maria had originally been given by her PCP and explained the
reasoning behind the denial. Maria acknowledged understanding and accepted the other medication.

Separation Anxiety in Children
Many parents are all too familiar with the cries of their child that seem to be impossible to calm and
the child that clings to their leg when they are about to leave. The terrible twos are not the only
dreaded stage of child development; this is what is commonly known as separation anxiety.
"Separation anxiety is a developmental stage during which the child experiences anxiety when
separated from the primary care giver " (McPherson, 2004). Separation anxiety varies widely from
child to child and most commonly occurs between the ages of eight months to two and a half. There
are several different causes of separation anxiety, ways to manage separation anxiety to make it
easier for both the child and the parent, and symptoms and warning ... Show more content on
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When the parent returns, he or she should focus on the positive aspects of the child's day to reassure
the child that everything was okay and remain consistent with the new routine. "Since young
children are directly affected by their parents' level of comfort, it is important for [the parents] to
feel at ease" (Brodkin, 2003).
Some symptoms and warning signs that may indicate that the child is experiencing more than just
separation anxiety are "A child who continued to be inconsolable in a new child care or other setting
for more than two weeks And has an ongoing change in behavior" (Please Don't Go), reluctance
and/or fear of sleeping alone, nightmares, refusal to go places without the parent, refusal to eat,
refusal to interact with individuals other than the parents or primary caregivers, "excessive distress
when separated from the primary caregiver, worry about losing or harm coming to the primary
caregiver, repeated physical complaints " (McPherson, 2004). If a child exhibits any of these
behaviors or a combination of the following behaviors, the parents or caregivers of the child should
seek medical attention immediately as well as psychological testing/counseling to discover whether
or not a deeper problem exists.
This stage of separation anxiety can be overwhelming for the primary caregiver. The parents can
feel gratified that their child is attached to them while feeling guilty at the same time

Patient Visit
The first patient is MMH, a 67 year old retired Caucasian married female. The patient visit was
conducted in the home, which was a uncluttered trailer located in Greenwood, IN. Her husband was
present during the exam. The purpose of the well visit was to determine medication compliance,
evaluate functional and mental status and perform a complete physical evaluation. The past medical
history (PMH) was positive for insulin dependent diabetes, cataracts, hyperlipidemia, hypertension
and Dupuytrens contracture of her right ring finger. She was being followed by her family
physician, a dialectologist and an orthopedic surgeon. All immunizations were current and she had a
colonoscopy in 2016. She had not had a dilated eye exam for two years, however. ... Show more
content on Helpwriting.net ...
But, in conducting such a comprehensive history and physical, there is significant sharing that
occurs. The patient often shares recent difficulties in their lives, like deaths of parents, spouses or
children. Tthat allows for the spiritual experience of listening to another person's sorrow and giving
positive feedback and communicating empathy. It is helpful to share grief and pain in order to lessen
it.
Think back over your recent clinical experiences and determine if and how spiritual care was
provided to your patients. If so, in what way was spiritual care provided. If spiritual care was not
provided, do you see any missed opportunities for this with patients over the last 3 workshops? In
my first week of clinical experience, during a well visit, a patient's wife shared that she was raising
her granddaughter. She expressed her frustration that she and her husband were both retired and
should be relaxing but instead they were raising a three year old girl. The mother had been killed in
a drive by shooting. As well as her frustration, she shared that she was shattered emotionally by her
daughter's death. Again, active listening and empathy was what I felt God wanted for this lady. She
was obviously heartbroken and I shared with her what a blessing it was that she was willing to take
on such a task after raising her own children. I relied on my own experiences of loss and grief to
realize that at times,

What Is Your Evaluation of the Effectiveness of the U.S....
Health Promotions: Primary, Secondary and Tertiary
Beth Fleming
Grand Canyon University April 03, 2014
For many years, health promotions and prevention has been the focus for healthcare providers,
especially nurses. Health promotion seeks to improve a person or population's health by teaching
about and helps people become more aware of risky behaviors associated with different diseases. It
encourages individuals to take preventative measures to prevent onset or worsening of a disease or
illness. It encourages a healthier lifestyle (Edelman & Mandle, 2010). The strategy is to help
people make health improvements or prevention before illness occurs.
Health promotion is ... Show more content on Helpwriting.net ...
Health programs are implemented to improve the health of the individual and the community.
Implementation is both strategy and intervention which includes health related programs, policies,
benefits, and environmental support. Multiple interventions should be used because this would be
more effective than one intervention alone. Nurses are more educated and more experienced today
so they can help provide guidance to patients, families and the community.
Primary prevention starts at a young age. Prevention needs to be started in the family. Obesity for
example needs to be addressed from childhood. Families need to be taught about nutritious meals
and healthy snacks. This needs to be incorporated at home, day cares and at school. Families are
essential when it comes to promoting the health of their children. They have a big influence over the
food and physical activity choices children are exposed to. Strong family engagement will help
ensure successful implementation ((Reynolds, Cotwright, Pohamas, Rosenberg & Chang,
2013). Primary prevention can begin at your family physician. They can provide information to
encourage and start a health regimen. Children can be given chores and not be allowed to sit and
play video games or watch television all day. Daily activity, good nutrition and encouragement from
parents can help to prevent childhood obesity. Childcare providers can get assistance from state and
government agencies to

The Causes And Effects Of Stress In College Students
College can be a stressful time during one's life. It's a time of growth and change. Most students
have moved away from home and are living on a university campus or on their own in an apartment.
During college, many students are learning to provide for themselves, learning how to cook, clean,
and maintain a healthy lifestyle. Not only are they asked to make these everyday life decisions, but
are also asked to make life changing decisions. As a college student, we are often asked to decide
what job we would like to have for the rest of our lives and work towards a degree in that area
within four years. While learning new things, and trying to decide what they want to do with the rest
of our lives, college students are also learning how much they can handle. On top of university
classes, most students are also working a part–time job, and maintaining the balance between work
and school can be a whole separate job.
College students handle a lot of daily stressors, but what if a student's stress is interfering with their
everyday life to the point where they feel like they can't keep up with their work load? According to
a definition found on anxiety.com, anxiety is a body's reaction to a stressful or dangerous situation.
It can be a sense of uneasiness or dread that you feel before an event. Some stress is normal, for
example, being stressed about a job interview or test, but for those suffering from an Anxiety
Disorder, it may feel as though their stress is debilitating.

The Social Security Act
A. Is Shirley Caretaker disabled within the meaning of the Social Security Act in that she meets the
requirements of the disabling listing for 12.04 affective disorders in 20 C.F.R. Appendix 1 to
Subpart P of Part 404–Listing of impairments? With respect the answer is yes for the reasons stated
in the Argument section of this brief.
B. Is Shirley Caretaker disabled within the meaning of the Social Security Act in that she meets the
combined requirements of the listings for 1.01 and 1.02(a)(b) musculoskeletal and major
dysfunction of a joint (due to any cause) in 20 C.F.R. Appendix 1 to Subpart P of Part 404–Listing
of impairments? With respect the answer is yes for the reasons stated in the Argument section of this
brief.
C. The report of treating physicians of Ms. Caretaker have not been given the weight required by the
Social Security Act and implementing regulations as interpreted by opinions of the courts of the
United States.
Statement of the Facts
Shirley Caretaker is a 56 year–old widow who spent the last twenty–five (25) years working in the
health care field as a Certified Nurse's Assistant and Licensed Practical Nurse. Ms. Caretaker's job–
related knee pain was worsened by a work related accident, which also injured her hip and back. She
cannot sit or stand for more than 30 minutes at a time, or walk for more than 10 minutes. Pain in her
upper back radiates up her neck and through her fingers, which causes her arms and fingers to
periodically feel

Social Work Practice Essay
The Most Effective Practice for Young Adults Suffering from Depression and Anxiety in the
United States of America
Practice Problem
The topic I chose to study for the length of this course is the methods that are used to help young
adults who deal with depression and anxiety. I selected this topic for a couple of different reasons.
Primarily, I have some friends and family members who are currently or have in the past lived with
depression and/or anxiety. The different methods they have used to deal with depression and anxiety
have both helped and sometimes hindered their journey through these disorders. Secondly, I hope to
pursue a career in therapy and foresee myself often working with people, especially young adults,
who suffer from depression ... Show more content on Helpwriting.net ...
Studies have shown that this type of care brings about the best results. The use of multiple
perspectives and approaches helps bring about a more holistic method for people suffering from
depression and anxiety.
Implications
According to this systematic review of depression and anxiety, the effectiveness of collaborative
care is generally much more significant than usual care. Therefore, in the social work practice, this
is a type of care that should be considered to be implemented. However, much of social work seems
to already use collaborative care to a certain extent. As a social worker we often recommend
programs or other types of support groups that could together be considered collaborative care. To
improve on this framework, social workers should develop the
PRACTICE FOR DEPRESSION AND ANXIETY IN YOUNG ADULTS 6 communication between
professionals so that care is not duplicated and the client is best cared for. Following up with clients
where applicable would also be helpful. In general a more collaborative approach needs to be
implemented by the social work practice in regards to interventions for depression and

Common Occupations, Unemployment Level, And Hazards
Common occupations, unemployment level, and hazards from employment: The common
occupations are 21% production, 16% sales and related, 10% management, 9% construction and
extraction, 7% installation, maintenance and repair, 6% material moving occupations, 5% education,
training, and library occupations (para 6). The unemployment level is 7.5%. The majority of the
occupations in the area require great physical labor. Possible risks for this are injuries on the job,
strained muscles, or inhaled substances.
Access to transport; goods, services, grocery stores, and food prices: The town does not currently
provide pubic transportation. Most of the stores and services are within walking distance to able
bodied people, but to the ill ... Show more content on Helpwriting.net ...
23). The child neglect rate is 5.8% (pg. 23). There are no statistics on anima or malnourishment, but
the temporary assistance program rate is 1.2% and food stamp eligibility is 20.8% (pg. 23).
Utilization of programs: The food stamp usage is 20.8% in Smyth County (pg. 23). Temporary
assistance programs are being used by 1.2% of the region (pg.23).
Community lifestyle preventions: Saltville has several signs, posters, and even educational sessions
involving driving safety. The medical clinic in Saltville has pamphlets and teaching programs on
smoking preventions and substance abuse. Though from random survey I conducted 7/8 people
believe that substance abuse is a major problem. When asking several high school students what
they thought the biggest problem with their school was Jade Wyatt, senior at Northwood High
School, stated, "Drug use a big problem with our community, especially in our schools.", another
student Katelyn Blevins, 10th grader, responded "I would say drug use is a major problem that
seems to be constantly ignored in our school, but also health care access. You see so many people
that are sick, but they can't afford to visit the doctor due because they don't have the financial
ability". A student who wishes to remain anonymous reported the use of drugs in the bathrooms at
school, the usage include marijuana and vaping. The neighboring community of Chilhowie has a RU
program that helps with substance

Secondary And Tertiary Levels Of Care
Secondary and tertiary levels of care both provide more specialised, regionalised care for patients in
the health system, the lines between which are often blurred, but still present key distinctions.
Secondary care is specialised clinical care for problems more complex than those requiring primary
care. Secondary care has a finer scope of specialisation than primary care, with this narrowing of
specialisation continuing up the health care levels (Health Evidence Network, 2004). Secondary care
therefore includes physicians who operate in the scope of a specialty, such as general surgeons,
internists and neurologists (Bodenheimer & Grumbach, 2009). Secondary care is most commonly
provided in the context of a hospital setting, or a community office of the specialist. Whilst tertiary
care provides care for more complex illnesses as well, it instead focuses on subspecialties. Tertiary
care providers work at the apex of their specialties, servicing a far greater proportion of the
population compared to the other health care levels, as their services are so highly focused
(Bodenheimer & Grumbach, 2009). As tertiary care is the uppermost level of care in a typical
system, it is generally provided at a select number of hospitals or specialist tertiary centers.
Examples of tertiary care providers include cardiac surgeons; specialist burns units, and
immunologists, who may concentrate on rare illnesses (Bodenheimer & Grumbach, 2009).
Questions three and four: Describe how patients

An Analysis Of The National Institute Of Mental Health...
Stakeholders As noted in Diagram 1, many primary care physicians are referring new patients to
mental health clinics at alarming rates with the result being long wait times for the patient, as the
hospitals struggle to keep up with the referrals. The National Institute of Mental Health (NIMH), it
has noted that there are an approximately 57.7 million people per year between the ages of 18 and
older have a diagnosable mental health disorder (NIMA, 2016). Many people are subjected to
prolonged and unnecessary suffering due to the lack of expert clinicians available, as well as the
mismanagement of symptoms due to the stigma placed on these types of patients (Pizzo & Clark,
2012). This paper will show how the use of a flowchart may help ... Show more content on
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The OC is in charge of the records request, although this can be delegated to any of the front office
staff. The records are requested via fax or phone. The clinic manager placed this rule after referrals
were being lost. The thought was that by having one person ultimately responsible for the incoming
referrals and records, there would be decreased chances of the information being misplaced or being
incomplete. Once all patient records have been received the file is then given to the nurses to pull a
prescription drug monitoring (PDM) report on the patient. This report provides the clinicians'
information showing controlled substances that the patient has been prescribed, by whom, and dates
the medications were filled. This information can help identify "red flags" in a patient's prescription
history. The PDM shows the potential compliance by a patient to adhere to treatment rules by
showing if multiple providers have seen a patient and been prescribed narcotic medications. This
rule was put into place by the medical director. After all the patient information is gathered, it is
given to the medical director to review. A plan of care (POC) is given to the nurses from the medical
director after the records have been examined. After the POC has been received the nurses will then
communicate with the front office in scheduling the patient for the appropriate care. The rule for this
section was agreed upon by the medical

Essay Improving Health in the Primary Care Setting
Improving Health in the Primary Care Setting "I order to improve health in the primary care setting
you need to work collaboratively with others" Throughout the discussion I will analyze the above
statement highlighting the professional issues raised, involving the nurse working in the primary
care setting. Within this I will distinguish exactly what primary care is and the relation to the
importance of collaboration in this particular setting. Leading onto how we/nurses collaborate in
primary care. I will also investigate what a clients roll is in the promotion of the populations health.
Included within this are recent policies applicable to this setting. To conclude I will critical analyze
... Show more content on Helpwriting.net ...
There is then the opportunity to provide individuals with advice and support to promote prevention.
The jobs have also evolved within primary care creating a very diverse client group and needs, this
is mainly due to "Hospital stays being shorter so patients are being discharged into the community
requiring more acute technical care than previously" Parham(2003). Where acute care within the
community is concerned these are such incidents as palliative care within the home. Due to the
recognition of the importance of primary care, primary groups were created in 1999, this was post
implementation of the White paper: The new NHS modern and dependable (Department of
Health,1997). The purpose of these groups were to improve the health of the local population they
covered and to address the health inequalities and also develop primary care and community health
services (Banks–Smith 2001). Then the PCG'S created and encouraged primary care to break into
PCT'S (Primary Care Trusts) this now means that each trust manages their own services. There are
many professions involved in the primary care sector. Here are some examples:– Â· District Nurses
Â· Health Visitors Â· School Nurses Â· Practice Nurses Â· Specialist Practitioners Â· General
Practitioners Â· Community Psychiatric Nurses Â· Voluntary

Importance Of Pursuing A Career In Education
2. What was your primary motivation for choosing this career option/program/scholarship?
I have always appreciated the biological sciences, and am fascinated by the complexities of the
human body. Pursuing a career in medicine would be especially rewarding because I am genuinely
interested in healthcare, and I acknowledge that our society is experiencing a significant shortage of
primary care physicians. My various healthcare–related experiences have introduced me to the
health disparities that exist in our society, and I am committed to addressing the healthcare needs of
medically underserved populations. Medicine is intrinsically rewarding, and I would feel a true
sense of pride in being able to have a long–lasting impact on the lives of patients through healthcare
services. Building a lifelong doctor–patient relationship is at the heart of medicine; as a rural
primary care physician, I would have the opportunity to establish these relationships with medically
underserved populations and help promote a healthy lifestyle through health education and
preventive healthcare measures (e.g., annual physical, vaccinations, screenings, etc.). Growth of
these relationships and providing compassionate, patient–centered care is what makes the profession
personally rewarding.
3. What personal attributes do you possess which will benefit you in this career/program?
I aspire to pursue medicine, and my experiences with healthcare have made me realize the
importance of providing

Teamwork Essay Examples
As a child, I learned teamwork is an essential part of our everyday activities. It is an aspect that has
becomes even more crucial to me in the adult world. To work alongside others with respect and
understanding leads to trust and wellness. When I began my college journey I was drawn to the
teamwork demonstrated at the rock wall on campus. Here I acquired the skills needed to belay rock
climbers. As a belayer you first need to explain to your climber that you have the skills and
qualifications for them to trust you, a quality you need to demonstrate in seconds to minutes. Once
trust is earned, it is the belayer's responsibility to be respectful, encouraging, and understanding to
the ability of the climber. The goal is to keep the climber calm and unscathed while they reach their
goal. As you work with ... Show more content on Helpwriting.net ...
These experiences taught me how to work alongside other guides to keep our participants fed, safe,
and on the right path. As a guide, I had participants who looked up to, and trusted me. I was not only
in charge of helping the freshman engage and bond, but to work with the other guides from start to
finish in planning and executing a seamless trip. As the Wilderness First Responder, I had the added
responsibility of making sure everyone stayed safe and healthy, and to respond quickly to any injury.
Thankfully the most pressing concern I had was a bee sting. I addressed my participant and asked if
she had ever been stung before and if she was allergic. When she answered she had never been stung
before and was unaware of an allergy, I had to start thinking about my next move. I learned that
thinking ahead and brainstorming actions I would take is essential. The participant didn't end up
having a life threating reaction, but that day she taught me that preventative care as well as being
proactive with potential treatments is

Theories Of Anxiety
.Psychoanalytic Theories Psychoanalytic theories of anxiety began with Freud and have not
developed a great deal since his time. Freud had two theories of anxiety (1917, 1926 respectively),
in both of which he saw anxiety as an everyday phenomenon and as away of explaining neuroses,
Everyday anxiety is realistic anxiety which refers to real objects; this has often been referred to as
fear rather than anxiety. Neurotic anxiety can take the form of being free–floating, phobic, or
involved in a panic attack. In the first formulation, Freud regarded anxiety as being a transformed
libido, the transformation coming about through repression. So, if a person is prevented or thwarted
from carrying out some instinctive (sexually driven) act through repression, ... Show more content
on Helpwriting.net ...
In this theory, anxiety is a signal from the ego about real (ie existing) or potential danger. The
unpleasantness of a threat causes anxiety which in turn leads to repression as a way of getting the
person out of danger. Behavioral Theories According to this anxiety is a conditional response to
specific environmental stimuli. According to social learning model, a person may develop anxiety
response by initiating the anxiety in the environment. For example a child with anxious parents
might also develop anxiety symptoms. Existential theories According to this the central concept is
that person experiences feelings of living in a purposeless universe. Anxiety is their response to the
perceived void in existence and meaning. Such existence concerns may have increased since the
development of nuclear weapons and bioterrorism. Autonomic Nervous System Stimulation of the
autonomic nervous system causes certain symptoms like cardiovascular, muscular and respiratory
symptoms. The autonomic nervous system of some patients with anxiety disorder, especially with
panic disorder, show increased sympathetic tone, adapt slowly to repeated stimuli and respond
excessively to moderate stimuli.

Cultural Influences Have Large Scale Impacts On Personal...
Cultural influences have large–scale impacts on personal decisions. You may decide to go out to a
social event that you are not particularly interested in just because you're expected to. In the medical
education setting, cultural influences play an active role in decision making. During a medical
student's primary education, they often are forced to rely on mentors and staff to guide them through
the grueling process. Many decisions are made, what to specialize in? Do I go into private practice?
With these important decisions at hand, the influence mentors have on students could not be more
impactful. Individuals trust practitioners with their lives, but is community health the determining
factor for medical students when deciding the field of medicine to practice? Should it be? I have
decided to conduct my research on why primary care seems to be looked down upon in the medical
school culture, and the impact declining numbers of primary care physicians has on the community.
I've also researched the Affordable Care Act's impact on public health, and how this may increase
the demand for primary care doctors even more so. This act is notable due to its political nature, and
educating oneself on the effects of policies could impact political and voting stances. It is interesting
to investigate why primary care is discouraged in medical school even though the field plays a
sizable role in public health. For this trend to change, it is necessary to examine the cultural forces

How Healthcare Has Changed Since Its First Trial And Error...
Over many years, the ideas of healthcare have been heavily debated in the United States. From early
years dating back to the nineteenth century, people have been involved in some form of health
insurance. They would have this "insurance" in case of some form of accident, so that they would
not have many losses of income. According to Sultz and Young, "As early as the 19th century, some
Americans carried insurance against sickness through an employer, fraternal order, guild, trade
union, or commercial insurance company (2014)". Healthcare has greatly changed since its first trial
and error days. There have been new policies and pieces of legislation that have been passed in
efforts to try and have all Americans covered with some form of health insurance. However, the
newest form of healthcare out on the market is the idea of Concierge medicine.
Concierge medicine may also be known as Retainer medicine. It is a service that a physician would
provide private direct primary care for an out–of–pocket monthly service fee. This private and direct
form of health care would allow the patient direct and unlimited access to their doctor at the snap of
their fingers. The services that would be provided would be regular primary care visits potentially at
home, EKGs, biopsies, etc. However, the main perks of having a concierge doctor would be the
personal benefits that one would experience. Some of these benefits would include having the
doctor's personal cell phone number or email with

A Single System Research Design
A single system research design (SSRD) allows for the practitioner to study an individual, family or
program. Single system research design is convenient, brief and cost efficient for the practitioner(s);
SSRD interventions can be tested and assist in identifying their effectiveness on the patient (Royse,
et al., 2010). SSRD has a risk of bias, from both the practitioner and the patient and the information
gathered is not for generalizability, because it is only observing an individual. SSRD has little
external validity, but allows the practitioner to observe in individual's response to the intervention
and monitor a trend for subsequent studies (Royse, et al., 2010). The patient involved in this
research study is a 40 year–old Latina female. Her primary care physician referred her to behavioral
health, when she demonstrated physical symptoms of fatigue, sleeplessness and numbness in her
arm, inability to concentrate and feelings of sadness. Once, all medical illnesses were ruled out, the
physician, working at an integrative care clinic, referred the patient to the LCSW on staff. In her
first session the patient stated that she has demonstrating these symptoms for a month or so. She
states that she did not know what is happening to her but she knew she had to see her doctor.The
patient described that she has been living in Arlington for about 16 years. She is originally from
Mexico and is married with four children. She states that lately she has been having some issues
with

Operation Of Health Care System
OPERATION OF HEALTH CARE SYSTEM
The medical system in Cuba is a national priority, it provides care to every citizens. It is primary
care based, which means that team of doctors and nurses are in every part of the country and are
responsible for the health of a geographically defined population of 800–1800 people. Most of the
frequent visitors and people with chronic diseases, usually they spent half the day consulting people
in office and other half for the home visit. They are expected to be available for the patients in their
community 24 – 7 for any urgent cases. Some of the doctors in these settings are residents in the
second of their two–year FM residency, and they include those from other countries whose
governments permit ... Show more content on Helpwriting.net ...
Health care system is structured on two levels.
Level 1: Primary health care
Family doctor unit
Polyclinics (includes dental care)
Specialty institution
Mother's home
Grandparents home
Community mental health clinic
Level 2: Secondary health care
Inpatient hospital
Inpatient nursing homecare
One of the key differences between the US health system and Cuba health system is that Cuba
focuses on preventing diseases rather than treating the diseases. And everyone will be having family
physician and nurses. For the Cuba health system there are no private hospitals, all hospitals and
clinics are controlled by the government and people are given access to the system without any cost.
Every patient are visited by the family physician at home once in a year, one with chronic disease
will be visited frequently. If it is necessary patients are referred for specialty evaluation, but after the
evaluation they will come back to the community team for ongoing treatment.
This prevention orientation structure has produced positive result for the Cuba. Vaccination rates in
Cuba is the highest in world. The infant mortality rate fallen from 80 per 1000 live births to 5 per
1000, lower than US.
PRINCIPLE OF THE HEALTH SYSTEM
The principle that govern the public health system in Cuba are:
The public and social nature of the medicine
Access to services at no cost
Preventive

Depression And Anxiety Among College Students Essay
Introduction Anxiety and Depression disorders are two of the most common mental disorders in the
United States (Falsafi, 2016). It appears that the two disorders are widespread amongst college
students and most cannot manage the high demands and stress (Falsafi, 2016). Therefore, they feel
more prone to depression and anxiety (Falsafi, 2016). According to the authors Miller & Chung,
mental health amongst college students in the United States is a growing public health concern and
educators are concerned about the low academic performance of college students and how it
influences their mental health (Miller, & Chung, 2009). Research indicates that university students
suffer with low grades and poor academic performances, while trying to manage depression and
anxiety (Falsafi, 2016). With the consistence of higher drop out rates, it is imperative that colleges
and universities create programs that assist students with managing their depression and anxiety to
help them through their education. Literature Review This section will offer background information
of several aspects of Depression and Anxiety among college students and an overview of the
problematic nature of these two conditions on the academic performance. Anxiety According to the
Anxiety and Depression Association of America, Anxiety is the number one presenting concern
among college students followed by depression (ADAA, 2016). The Diagnostic and Statistical
Manual of Mental Disorders (DSM–IV–TR,

Problems With Gatekeeping
Gatekeeping is a system that controls general access to various operations or activities. The problem
with gatekeeping having the counselor to determine if the behavior in question is problematic or an
impairment (Erford, 2014). This causes the gatekeeper to have some sort of accountability for the
evaluation outcomes when regarding a student's suitability for professional practice. In turn, the
gatekeeping issue can bring forth dilemmas in which the gatekeeper must be able to differentiate
between what is acceptable and what is not while still maintaining a healthy developmental process
for the individual. Though it is important to understand and implement guidelines to these
problematic behaviors or impairment, there is a lack of set procedures that allows the counselor to
proper hand the situation with an impaired student causing many counselors to be hesitant to address
the issue (American Counseling Association, 2014). The responsibility that is bestowed on the
counselor, educators, and supervisors requires competent professional knowledge and ... Show more
content on Helpwriting.net ...
However, it is mentioned that there are difficulties in preventing those who are not competent in
which many are overlooked. The reason for that is because there is a larger adjunct–to–faculty ratio
or fewer tenured faculty members that allows a higher rate of gateslippers. This can cause issues
down the lines for hundreds and thousands of students because it prevents one from progressing and
graduating. Also, the faculty are more concerned about the possible legal issues, poor evaluations, or
being pressured from the program to prevent the problem students (Erford, 2014). Still, this is a
complication that programs need to formalize that procedure that will reduce the number of

Diagnosis And Management Of Depressive Disorder Essay
According to Arroll et al (2010), "80% of the population visits their family physicians each year,
family physicians are in an excellent position to improve the diagnosis and management of
depressive disorder. In the absence of systematic screening, family physicians miss at least 50% of
cases of major depression (348)." This is evidence that a systematic screening is needed for
screening of patients that have a family physician for major depression. There are several types of
questionnaires used for screening of depression. One of the screening tools used to identify
severities of depression is called the Patient Health Questionnaire 9 otherwise called the PHQ–9.
According to Hinz et al (2016), "the PHQ–9 is a screening instrument with 9 items, developed to
measure depression. For each item the patients are asked to assess how much they were bothered by
the symptoms over the last two weeks. There are four answer options: not at all (0), several days (1),
more than half of the days (2), and nearly every day (3). The sum score (0 to 27) indicates the
degree of depression, with score of ≥5, ≥10, and ≥15 represents mild, moderate, and severe levels of
depression (2–3)." This screening tool can be valuable within the primary care setting to identify
those patients who may be suffering from depressive symptoms. Depression is defined by the
National Institute of Mental Health (2016) as, "Depression (major depressive disorder or clinical
depression) is a common but serious

Globalization Healthcare
Health Care Name: Institution: Healthcare ( (or human services) is the finding, treatment, and
avoidance of malady, disease, harm, and other physical and mental weaknesses in individuals.
Access to health awareness shifts crosswise over nations, gatherings, and people impacted by social
and monetary conditions and, in addition, the wellbeing strategies set up. Nations and wards have
distinctive policies and plans in connection with the individual and populace based social insurance
objectives inside their social orders. Medicinal services frameworks are associations made to meet
the wellbeing needs of target masses. Their definite setup fluctuates in the middle of national and
subnational elements. In a few nations ... Show more content on Helpwriting.net ...
The International Classification of Primary Care abbreviated as (ICPC) is an institutionalized device
for understanding and examining data on medications in essential care by the explanation of the
patient visit. Normal interminable diseases treated in essential consideration may incorporate, for
instance: hypertension, diabetes, asthma, COPD, misery and uneasiness, back pains, joint
inflammation or thyroid brokenness. Essential care additionally incorporates numerous fundamental
maternal and kid human services administrations, for example, family arranging administrations and
inoculations. In the United States, the 2013 National Health Interview Survey found that skin issue
(42.7%), osteoarthritis and joint issue (33.6%), back issues (23.9%), issue of lipid digestion system
(22.4%), and upper respiratory tract ailment (22.1%, barring asthma) were the most well–known
purposes behind getting to a doctor. In connection of worldwide populace maturing, with expanding
quantities of more seasoned grown–ups at more danger of endless non–transferrable infections,
quickly expanding interest for essential consideration administrations is normal in both created and
creating nations. The World Health Organization qualities the procurement of crucial essential care
as a basic part of a comprehensive

Who Is A Doctor?
I have always wanted to become a doctor. It 's been a great journey for me so far and I have been
gratified by all the experiences I have encountered. When I was younger, I had a cousin who was
diagnosed with Down 's Syndrome. I rattled the blue toy in front of my aunt's son and watched as he
sluggishly stared at my hand. The baby's symptoms were hard to miss: weak muscles, flat head and
nose bridge, short neck, slanted eyes, and abnormally low outer ears. My aunt was trying to cope
with the situation while devastation, guilt, frustration, and grief weighed her down. During this time,
I was attending my second year in high school and learned as much about genes and genetic
diseases as a high school biology course would let me. Even so, I held on to what little knowledge I
had of genetics and gave much thought to the baby I shared genes with who suffered from an extra
chromosome. In the course of time, the investment I made in understanding my baby cousin's illness
nurtured my interest in human health and grew into a passion for the field of medicine.
Six years later, I was honored to receive a diploma from the University of Istanbul Cerrahpasa
Medical School as a trophy for my eager interest. Not long after graduation, I was working as a
general practitioner in a poorer socioeconomic area where I encountered the challenges of serving
those who faced the social problems of health in poverty. During my stay, I regularly encountered
people who had problems brought on by

Review of Literature
Health promotion is defined by Edelman as the "Intervention designed to improve health, such as
providing adequate nutrition, a healthy environment, and ongoing health education". Health
promotion programs create behavioral changes that can lead to healthy behaviors by creating a
positive and pleasant atmosphere (Camann). They also lower the overall healthcare costs by
preventing the incidence of diseases, hospital stays as well as complications (Potter). Currently 20%
of the population suffers from a chronic or acute illness, these people account for 80% of our health
care costs (Potter). With an added emphasis on early health promotion at the primary care level we
can lower these rates to less than 20%. With health promotion at the ... Show more content on
Helpwriting.net ...
These observations show where the greatest amount of health promotion is needed, as well as what
aspects the patient will be compliant with.
Nursing responsibilities are ever evolving and will continue to do so as more issues begin to develop
and become discovered to treat and prevent. While nurse practitioners are meant to provide health
promotion, health protection, disease prevention, anticipatory guidance, counseling, palliative and
end of life care (Thomas). According to J. Thomas, health promotions are not always accomplished
by Nurse Practitioners in the primary care setting. This can be due to the time consumption and
impracticality of the situations. Research has found that only 60% of the time nurse practitioners are
bringing up preventative services (Thomas). Nurse practitioners have a great capacity to perform
health promotion as they are there to treat, educate, and prevent illnesses from occurring.
The use of health promotion is the same throughout all levels of care but the implementation differs
through the different levels. For instance, in primary care health promotion is given to prevent
illnesses from occurring or to care for a patient. Secondary health care implements health promotion
by giving information, running tests/procedures to treat an illness whereas tertiary care's health
promotion is given to help maintain or bring one's health status to the most optimal level possible.
Within the three levels of health care, the prevention methods do

Hardest Day Of My Life
22nd September 2015, the hardest day of my life as I received the news that I could not pass my step
2 CK examination! The only failure of my life and at this stage! It was even harder, as I was in the
United States and had no one to support. Therefore, I planned to give up, leave a wonderful clinical
opportunity, prepone my flight and go back! Which I did, except for going back! While riding in the
subway for airport, I witnessed an incident of seizures in 7 to 8 years old boy, which refreshed my
objectives.
My path–to–medicine started as a result of suffering of one of my close friend, when there was no
one there to understand reason of his silence. Nonetheless, topic of sexual harassment and
victimization is a taboo in the underserved areas of developing countries. The only person who
could understand his silence was the primary care physician, practicing in the neighborhood. That
particular incident diverted my attention towards Medicine. Medicine in my life has never been for
me – medicine in my life is a commitment that I made to myself 21 years ago for alleviating the
suffering of others – thus anything that exclusively does not belong to, I cannot give up!
However, I knew that being among those 20% of applicants who could not pass Step 2 CK on the
first attempt has increased my journey of road–to–medicine. Yet, the Winston Churchill said
"success is not final, failure is not fatal; it is courage to continue that counts". Hence, that incident of
subway took me to

Generalized Anxiety Disorder Case Study
Mrs. Smith was a 54–year–old, married, heterosexual, White female living in Arizona, whose
primary language is English. Mrs. Smith was referred by her primary care physician, Dr. James Dell,
who requested a psychological evaluation to assess the emotional and psychological function of
Mrs. Smith due to her complaints of: headaches, stomachaches, and chest pain, along with
depression and anxiety symptoms.
Mrs. Smith's depression and anxiety symptoms appeared about 3 months ago when she changed
jobs. She also reported having trouble keeping details straight and felt that she was not as sharp as
she was. Mrs. Smith expressed that she had relational problems with her children and some marital
issues with her husband, who noted that his wife had ... Show more content on Helpwriting.net ...
Smith is struggling with anxiety that had significantly impacted her social and occupational
functioning. She also reported multiple symptoms including feeling fatigued, having difficulty
concentrating, irritability, and sleep disturbance which started over 6 months ago, which are all
indicative of 300.02 (F41.1) Generalized Anxiety Disorder. Additionally, somatic symptoms such as
Mrs. Smith's headaches, stomachaches, and chest pain, can be caused from anxiety. Mrs. Smith also
had symptoms that were aligned with 309.28 (F43.23) Adjustment Disorder, with mixed anxiety and
depressed mood, due to her new job. She changed jobs over three months ago, and had significant
impairment in her social and occupational functioning, with anxiety and depression being key
symptoms. In my clinical opinion, both diagnoses are fitting and appropriate for Mrs. Jane Smith.
However, I believe that more information is needed to solidify the diagnoses. This is due to a
possible rule out. Due to her hypothyroidism and the potential hormonal issues that may arise from
her hysterectomy, her anxiety and somatic symptoms of anxiety may be medically based and it is
recommended that she follow up with her doctor for a check–up.
Diagnostic

The Heath Care System Essay
There are two different ways that the heath care system is structured; the Dawson model, where the
primary, secondary and tertiary levels of care have a distinct line drawn between them and where
primary care is the first point of access with the health care system, or the other model, where
patients go directly to a specialist of their own choosing without referral from someone in the health
care field. The first model is the preferred model as it focuses on a coordinated primary health care
system where health care resources are divided equally amongst communities. (Bodenhemier and
Grumbach (2009)). Primary care is an essential part of a country's health system includes taking care
of health problems that occur ordinarily on a day–to–day basis (Bodenhemier and Grumbach
(2009)) and allows for the advancement of the community (Gillies (2003)). This type of care is
usually provided in ambulatory care settings (Bodenhemier and Grumbach (2009)) – community
based care that is provided outside of a hospital – and is provided mainly by general practitioners.
This may include treating issues such as the common cold or, in order to hinder these common
health issues, immunisations or screening tests to help identify a disease so precautionary actions
can be taken. It also provides support for those with illnesses that are not curable or those that are
long–term. This necessary health care is made accessible to the whole of a community where
affordability can be maintained by either,

Essay on Emergency Room Overutilization
Emergency room over utilization is one of the leading causes of today's ever increasing healthcare
costs. The majority of the patients seen in emergency rooms across the nation are Medicaid
recipients, for non–emergent reasons. The federal government initiated Medicaid Managed Care
programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare
costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is
'Yes' and 'No'.
Throughout the early 1980's and 1990's the Federal Medicaid program was challenged by rapidly
rising Medicaid program costs and an increasing number of uninsured population. One of the
primary reasons for the overall increase in healthcare costs is the ... Show more content on
Helpwriting.net ...
It was also hoped that the number of uninsured people would dramatically decrease by offering
Medicaid managed care coverage to low–income families and individuals that were not Medicaid
eligible. These services and coverage could be delivered through the Medicaid managed care
carriers and be covered by the cost savings.
States have chosen to two forms of Medicaid managed care to better deliver healthcare services
besides the traditional fee–for–service Medicaid programs; primary case management and
traditional health maintenance organizations. "In primary care case management, the state Medicaid
agency contracts with a primary gatekeeper entity (e.g., physician, clinic) that coordinates primary
and specialty care for Medicaid beneficiaries. For healthcare maintenance type programs, a State
Medicaid agency contracts with an existing healthcare maintenance organization, prepaid health
plan, or other institutional health care provider who, in addition to proving primary care services,
assumes insurance risk of providing covered services. Typically primary case management are paid
on a fee–for–service basis plus a monthly case management fee per enrollee, while health
maintenance organization plans are paid a capitation rate and are at full financial risk." (1)
Once implementation of the program began, enrolling and educating the Medicaid population was
one of the

Primary Care Gatekeeping
Gatekeeping is a core concept in a primary health care (Grumbach et al.,1998). One of the several
key aspects of gatekeeping is to guard patients that have direct access to specialised care
(Bodenheimer & Grumbach,2009). General practitioners and other primary care professionals are
signified to be gatekeepers (World Health Organisation,2000). Starfield.B (1992), Grumbach & Fry
(1993) and Bodenheimer & Grumbach (2009) points out responsibilities of primary care professions
(gatekeeper) first, they are to encounter the patient's health care (Starfield B.,1992) and proceed
ambulatory care (Grumbach and Fry,1993). A gatekeeper is the decision maker for opening the gates
to a further specialised field after proceeding fundamental primary care on a patient hence, patients
are not entitled to direct their own specialists. Also, their purposes are not just to take care of the
patient's wellbeing but giving extensive treatment if any is required (World Health Organisation,
2000) such as, minor illness which includes skin disorders, respiratory infection, headache and
common flu, also includes preventive care; vaccinations, immunization and prenatal care are some
of the common examples (Heinemann,1980). ... Show more content on Helpwriting.net ...
Regionalised model focuses on the primary care base, the majority of times General Practitioners
are in charge of the first contact with the patients. In New Zealand, GPs perform gatekeeping role in
the primary healthcare where patients are not able to enter specialities without a gatekeeper's referral
(GP) (Robin

Nurse Practitioner Essay
The Role of Nurse Practitioners in Reducing Healthcare Costs
In the United States, not every individual has the privilege of affording the necessary medical
attention. Socioeconomic status has an impact on the health outcomes of individuals, as a result,
many people who are uninsured go through their daily lives without assisting to a yearly physical or
a primary care visit when they feel ill. This leads to an increase in emergency room visits, which
increases healthcare costs. The increased healthcare expenses are greatly related to the decreased
availability of primary care services, and the excessive emergency room visits. This paper will
explore the benefits of allowing nurse practitioners to provide primary healthcare by delving into ...
Show more content on Helpwriting.net ...
This is partly due to the differences in pay for specialists and primary care physicians. With the
increased shortage of primary care professionals, advance practice registered nurses could assume
the responsibility and therefore aid in lowering healthcare costs
There are various ways that nurse practitioners can improve primary care while simultaneously
reducing healthcare costs. According to Naylor and Kurtzman (2010), "the average cost of a nurse
practitioner or physician assistant visit is 20–35 percent lower than the average cost of a physician
visit" (p. 895). This could result in approximate savings of 4.2 million to 8.4 million dollars between
the years 2010 and 2020 (Naylor & Kurtzman, 2010, p. 895). Nurse practitioners are able to provide
patient centered care geared towards the prevention and management of chronic diseases such as
diabetes and hypertension.
Economic Factors
In order for individuals to have access to medical services, they must have a method of payment,
whether it will be out of pocket, private insurance, employment based insurance, or government
financing. The access to care also depends on the availability of medical professionals and the
accessibility of resources (Bodenheimer & Grumback, 2012, p. 17). Even those who have the
privilege of having insurance might not seek care for minor issues due to various copays and out of
pocket payments.

Outcome Measurement Analysis

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