Leanne Wells, Chief Executive Officer, Consumers Health Forum of Australia, gave the Ian Webster Health for All Oration to the annual forum of the Centre for Primary Health Care and Equity on 13 August 2015.
Engines of Success for U.S. Health Reform?
Eric B. Larson, MD, MPHVice President for Research, Group Health Executive Director, Group Health Research Institute
Two major trends dominate healthcare in the United States. Chronic Illness is on the rise, meaning American's are having more difficulty than ever attaining mental and physical wellness. Providers are facing an unfriendly business of medicine environment requiring them to solve complex management problems while maintaining a high level of clinical excellence. The payment goal posts have moved requiring providers to understand and measure the value they provide to patients, not just the services they complete or perform. As providers struggle to understand the meaning of value in medicine and what outcomes qualify, consumers continually turn to alternative medicine and wellness initiatives to maintain their health.
Engines of Success for U.S. Health Reform?
Eric B. Larson, MD, MPHVice President for Research, Group Health Executive Director, Group Health Research Institute
Two major trends dominate healthcare in the United States. Chronic Illness is on the rise, meaning American's are having more difficulty than ever attaining mental and physical wellness. Providers are facing an unfriendly business of medicine environment requiring them to solve complex management problems while maintaining a high level of clinical excellence. The payment goal posts have moved requiring providers to understand and measure the value they provide to patients, not just the services they complete or perform. As providers struggle to understand the meaning of value in medicine and what outcomes qualify, consumers continually turn to alternative medicine and wellness initiatives to maintain their health.
Presentation - The Future of Home HealthC Sam Smith
"Instead of it being described as home healthcare, in a few years the services performed by home health care agencies will simply be known as "modern healthcare".
-Dr. Steve Landers, VNA Health Group, New Jersey
This presentation is intended to serve as an introduction to the long-term care industry, including the scope, purpose and organizational structure of a typical long-term care facility.
While applicable for everyone, this like all of our presentations is specifically designed for caregivers in a long-term care environment.
From Patients to ePatients Driving a new paradigm for online clinical collabo...ddbennett
CareTech eHealth Innovation Series
From Patients to ePatients Driving a new paradigm for online clinical collaboration and health management
David Bennett, SVP, Interactive Solutions
StayWell Custom Communications
Anthony Chipelo, Director, Portal Strategies
CareTech Solutions
The Paradigm Shift from Healthcare to Population HealthPractical Playbook
The Practical Playbook
National Meeting 2016
www.practicalplaybook.org
Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.
The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include:
Session presentations and materials
Poster session content
Photos from the National Meeting
The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting.
The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).
What thanksgiving means for patients and providers?Jessica Parker
Thanksgiving is a federal holiday in the United States, celebrated on the fourth Thursday of November celebrating the harvest and other blessings of the past year. The word thanksgiving means giving of thanks to God, especially in a religious ceremony.
Guidance for commissioners of services for people with medically unexplained ...JCP MH
This guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.
MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.
This guide aims to: describe MUS and the associated outcomes: outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and highlight the importance of commissioning comprehensive MUS services.
From the Customer Experience Trend tracker this presentation is the one used for the webinar addresed by Qaalfa Dibeehi, Kalina Janevska and Colin Shaw: A well
Presentation - The Future of Home HealthC Sam Smith
"Instead of it being described as home healthcare, in a few years the services performed by home health care agencies will simply be known as "modern healthcare".
-Dr. Steve Landers, VNA Health Group, New Jersey
This presentation is intended to serve as an introduction to the long-term care industry, including the scope, purpose and organizational structure of a typical long-term care facility.
While applicable for everyone, this like all of our presentations is specifically designed for caregivers in a long-term care environment.
From Patients to ePatients Driving a new paradigm for online clinical collabo...ddbennett
CareTech eHealth Innovation Series
From Patients to ePatients Driving a new paradigm for online clinical collaboration and health management
David Bennett, SVP, Interactive Solutions
StayWell Custom Communications
Anthony Chipelo, Director, Portal Strategies
CareTech Solutions
The Paradigm Shift from Healthcare to Population HealthPractical Playbook
The Practical Playbook
National Meeting 2016
www.practicalplaybook.org
Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.
The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include:
Session presentations and materials
Poster session content
Photos from the National Meeting
The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting.
The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).
What thanksgiving means for patients and providers?Jessica Parker
Thanksgiving is a federal holiday in the United States, celebrated on the fourth Thursday of November celebrating the harvest and other blessings of the past year. The word thanksgiving means giving of thanks to God, especially in a religious ceremony.
Guidance for commissioners of services for people with medically unexplained ...JCP MH
This guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.
MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.
This guide aims to: describe MUS and the associated outcomes: outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and highlight the importance of commissioning comprehensive MUS services.
From the Customer Experience Trend tracker this presentation is the one used for the webinar addresed by Qaalfa Dibeehi, Kalina Janevska and Colin Shaw: A well
2015 was a great year in the automotive industry. Dealers are connecting with consumers in ways that bring value and strengthen trust. The best is yet to come!
I had the honor of speaking to hundreds of dealers at the Massachusetts State Automobile Dealers Association's annual auto show in January. Our time together was spend discussing the type of leadership that today's automotive showroom requires.
Presentation of Leanne Wells, CEO, Consumers Health Forum of Australia, at the Health Care & Social Media Summit 2015 Plenary Session, "Who owns your Big Data?"
I recently had the privilege of speaking with an audience of hundreds of dealers at the Massachusetts State Automobile Dealers Association Annual Meeting. I've attached an amended version of the Keynote for those that have requested it.
Special thanks to Robert O’Koniewsk, ESQ; Scott Dube, President; and Chris Connolley Jr., Vice President for the invitation. I am incredibly grateful for the opportunity to represent Ethos Group!
Tim Marbut and I had the pleasure of speaking at the Next Level Leadership + F&I Summit 2015, hosted by Ethos Group and sponsored by the Massachusetts State Auto Dealers Association. This event focused on creating a vision and leading people in a way that maximizes the potential of the person, the group, and the business!
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discussion on Health Economics and Health Care in our country and abroad, and what resources are given by the private sectors and with the very scarce help from the DOH, national and local government, and from the support given by WHO.
Heritage Healthcare:-
Legacy healthcare refers to the traditional model of healthcare that has been in vogue for many years. It is characterized by a fee-for-service payment model, where healthcare providers are reimbursed for each service they provide to patients. This model has been a foundation of the US healthcare system for many years, but it has faced increasing criticism for its high costs and inefficiencies. In this essay, we'll explore the history, challenges, and possible solutions to legacy healthcare.
History of Legacy Healthcare
Legacy healthcare emerged in the United States in the early 20th century. At the time, health care was largely provided by individual physicians and hospitals, and patients paid for services out of pocket. However, with the rise of employer-sponsored health insurance during World War II, a new payment model emerged. This model was based on a fee-for-service system, where healthcare providers were reimbursed for each service they provided to patients. The system was designed to encourage healthcare providers to provide more services, with the assumption that more services would lead to better health outcomes.
Over the past few years, the fee-for-service model has become deeply ingrained in the US healthcare system. It has been the foundation of the Medicare and Medicaid programs, which provide healthcare for millions of Americans. However, as the cost of health care continues to rise, the limits of this model are becoming increasingly apparent.
Challenges of Legacy Healthcare
One of the main challenges of legacy healthcare is its high cost. The fee-for-service model incentivizes healthcare providers to provide more services, whether those services are truly needed or not. This has given rise to a phenomenon known as overuse, where patients receive more tests, procedures and treatments than they actually need. This not only increases the cost of health care but can also cause harm to patients. For example, unnecessary tests and procedures can expose patients to radiation and other risks.
Another challenge of legacy healthcare is its fragmentation. The fee-for-service model encourages healthcare providers to work independently of each other, rather than collaborating to provide coordinated care. This can lead to a lack of communication between healthcare providers, resulting in duplication of services and missed opportunities to meet the health needs of patients. Fragmentation also makes it difficult for patients to navigate the health care system, as they may need to see multiple providers for different health problems.
Finally, legacy health care is often criticized for its lack of focus on prevention and population health. The fee-for-service model incentivizes healthcare providers to treat serious illnesses and injuries instead of addressing the underlying causes of poor health. more details
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35NURSING ECONOMIC$/January-February 2011/Vol. 29/No. 1
T
HE WORLD OF ARISTOTLE AND
Ptolemy believed that Earth
was positioned at the cen-
ter of the universe. Thanks
to Galileo and Copernicus’s studies
in the 16th century, we know this
is not true and that the sun is the
center of our universe. Pers -
pectives of health care have
undergone similar, radical changes
in perception. For centuries we
had a hospital-centric view; an
illness-based model, where the majority of care was
provided in hospitals, when we were ill. In the last
few decades, that model has migrated to a more con-
tinuum of care view; a wellness/health maintenance
model, where emphasis of care is outside the hospital
in other venues such as outpatient, ambulatory/clin-
ic, and home care (see Figure 1).
But as we all know, this is still not where we need
to be to support the highest quality care at the right
cost. Despite a focus on moving care out of the hospi-
tals, one only needs to think about the process of
medication reconciliation between care venues to
realize the lack of seamless integration of care deliv-
ery and the challenges of supporting interoperability
across the continuum. Hence, here I am proposing the
patient centric view, where the patient actively partic-
ipates in his or her care and we look at delivering care
from a patient’s point of view. This allows us to break
down some of the barriers we have struggled with on
our journeys to promote higher quality care through
the use of health information technology (HIT). Now
we need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital. Considering a
patient-centric point of view when implementing and
optimizing the use of HIT provides new perspectives
on the meaning of “integrated” health care.
Patient-Centric Care
It might seem odd that a health care organization
needs to be reminded to involve the patient in his or
her care. After all, this approach would certainly be
supported from a patient’s perspective. And, of
course, the health care industry has compelling rea-
sons to incorporate a strong customer and service
focus in order to improve patient satisfaction and
impact patient loyalty. But as health care systems
Patient as Center of the Health Care Universe:
A Closer Look at Patient-Centered Care
JUDY MURPHY, RN, FACMI, FHIMSS, is Vice President-
Information Services, Aurora Health Care, Milwaukee, WI; a
HIMSS Board Member; Co-Chair of the Alliance for Nursing
Informatics; a member of the federal HIT Standards Committee;
and is a Nursing Economic$ Editorial Board Member. Comments
and suggestions can be sent to [email protected]
EXECUTIVE SUMMARY
We need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital.
Considering a patient-centric point of view when
implementing and optimizing the use of health infor-
mation technology (HIT) provides new perspect.
35NURSING ECONOMIC$/January-February 2011/Vol. 29/No. 1
T
HE WORLD OF ARISTOTLE AND
Ptolemy believed that Earth
was positioned at the cen-
ter of the universe. Thanks
to Galileo and Copernicus’s studies
in the 16th century, we know this
is not true and that the sun is the
center of our universe. Pers -
pectives of health care have
undergone similar, radical changes
in perception. For centuries we
had a hospital-centric view; an
illness-based model, where the majority of care was
provided in hospitals, when we were ill. In the last
few decades, that model has migrated to a more con-
tinuum of care view; a wellness/health maintenance
model, where emphasis of care is outside the hospital
in other venues such as outpatient, ambulatory/clin-
ic, and home care (see Figure 1).
But as we all know, this is still not where we need
to be to support the highest quality care at the right
cost. Despite a focus on moving care out of the hospi-
tals, one only needs to think about the process of
medication reconciliation between care venues to
realize the lack of seamless integration of care deliv-
ery and the challenges of supporting interoperability
across the continuum. Hence, here I am proposing the
patient centric view, where the patient actively partic-
ipates in his or her care and we look at delivering care
from a patient’s point of view. This allows us to break
down some of the barriers we have struggled with on
our journeys to promote higher quality care through
the use of health information technology (HIT). Now
we need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital. Considering a
patient-centric point of view when implementing and
optimizing the use of HIT provides new perspectives
on the meaning of “integrated” health care.
Patient-Centric Care
It might seem odd that a health care organization
needs to be reminded to involve the patient in his or
her care. After all, this approach would certainly be
supported from a patient’s perspective. And, of
course, the health care industry has compelling rea-
sons to incorporate a strong customer and service
focus in order to improve patient satisfaction and
impact patient loyalty. But as health care systems
Patient as Center of the Health Care Universe:
A Closer Look at Patient-Centered Care
JUDY MURPHY, RN, FACMI, FHIMSS, is Vice President-
Information Services, Aurora Health Care, Milwaukee, WI; a
HIMSS Board Member; Co-Chair of the Alliance for Nursing
Informatics; a member of the federal HIT Standards Committee;
and is a Nursing Economic$ Editorial Board Member. Comments
and suggestions can be sent to [email protected]
EXECUTIVE SUMMARY
We need to consider how the health care system
should revolve around the patient, rather than the
patient rotating around the hospital.
Considering a patient-centric point of view when
implementing and optimizing the use of health infor-
mation technology (HIT) provides new perspect ...
These slides were used as part of a talk for Sheffield Health Watch on the idea emerging from NHS England that the future direction of NHS reform will be the creation of Accountable Care Organisations (ACOs)
Similar to Health literacy and consumer-centred care: at the brink of change? (20)
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
the IUA Administrative Board and General Assembly meeting
Health literacy and consumer-centred care: at the brink of change?
1. Health literacy and consumer-centred
care: at the brink of change?
The Ian Webster Health for All Oration to the
annual forum of the Centre for Primary Health
Care and Equity
Leanne Wells, Chief Executive Officer, Consumers
Health Forum of Australia
Thank you for the opportunity to give the Ian Webster Health for
All Oration.
It is an honour to give this talk in recognition of an individual
like Emeritus Professor Ian Webster and his commitment to
‘health for all’.
What his work and that of this Centre demonstrates is the
fundamental importance of robust knowledge and debate giving
rise to good public health policy to shape better lives in
Australia.
Right now we are at a crossroads in health where we need the
sort of leadership Ian Webster and many of his contemporaries
has shown over many decades.
We are at a point of flux in health policy decision-making where
we need fresh thinking to tackle the paradox of these times:
…..contemporary health care’s enormous potential to preserve
and extend life at a time of avoidable disparity in health
outcomes.
2. We are at a point where we need to rejuvenate health policy
thinking.
When you think about it, apart from Medicare’s introduction,
there’s really only three or so other real game changers that
have been introduced by the Commonwealth over the last three
decades that have really boosted the primary health care
system and made a difference for consumers – at least that
part of it that the Commonwealth leads or invests in.
That’s one per decade on average.
The first is the advent of divisions of general practice –
Australia’s version of the regional ‘meso’ organisation.
Even though we have seen some changes and medico-politics
as divisions have moved to Medicare Locals and then to PHNs,
the essential construct of a regionally based, clinically and
community led organisation to respond to local need and
support a connected system remains intact.
The second is the Enhanced Primary Health care items. While
we might reserve judgement on how successful they have
been, they did, for the first time, provide public subsidies for
team care arrangements and allied health service provision….
…..they recognised through our public health insurance
scheme the growth in chronic disease and the need for
multidisciplinary team care arrangements.
And the third is the reforms to primary care psychiatry – the
Better Access and Better Outcome in Mental Health Care –
which have been attributed by independent evaluation to have
changed the mental health landscape.
Arguably the Indigenous Chronic Care Package is a fourth.
3. Critically, all have had bipartisan support which perhaps
explains their success and longevity.
But in the face of the consensus spearheaded by Barbara
Starfield’s seminal work that tells us that the globe’s highest
performing health systems have strong primary health care
sectors, we’ve been stalled for too long.
We face too many challenges to remain so.
We need a modern, fit-for-purpose health system that serves
our needs now, not as they were thirty or so years ago when
Medicare was first designed.
And that means primary health care access for all including the
most vulnerable and disadvantaged in our society.
A perfect storm?
Ironically the ill-fated GP co-payment was the shot in the arm
that health policy needed.
It reinforced for all of us that good policy stems from the basic
question: what problem are we trying to solve?
There’s no doubt it jolted all the health players into renewed,
vigorous debate about our aspirations for our health care
system.
We’ve had almost a decade of inquiry and review through the
forums such as the National Health and Hospital Reform
Commission and Nicola Roxon’s Expert Reference Group.
All produced extensive reports steeped in equally extensive
consultation.
4. Now we’ve got the new Minister’s ‘Healthier Medicare’ which
includes a review of the Medicare Benefits Schedule to
consider how services can be aligned with contemporary
clinical evidence and improve health outcomes for patients
And we’ve got a Primary Health Care Advisory Group - of
which I am a member – looking at how to provide better care
for people with complex and chronic conditions,
Looking at innovative care and funding models,
Ways to better recognise and treat mental health conditions,
And how we can achieve greater connection between primary
health and hospital care.
In other words, how to design a better system for these
consumers and those who care for them.
5.
6. Consultations in all states and territories and regions are
underway now on the Discussion Paper released by the Group.
There are several avenues for input and consumer focus
groups and a dossier of the patient experience of primary
health care will also feed in to the case for change.
The cynics might well say ‘here we go again’.
The cynics might also say ‘this is all about GPs: what they do
and how they are paid’.
Well, to a large part, it has to be. We’d all agree that fee-for-
service funding does not serve the management of complex,
chronic disease at all well.
But that doesn’t mean that it is the only place we put the spot
light.
We need systems thinking. We need to take a holistic approach
look and analyse what works and doesn’t work about primary
health care in Australia…
…we need to focus on the way that its constituent parts
interrelate, how the system works over time and how it fits
within the context of even large systems.
A framework I particularly like that promotes system thinking is
the ten building blocks of high performing primary care.
7.
8. Its whole premise is how to gear the system to be more patient
centred – how to reach those quadruple aims of health reform:
better health,
improved patient experience,
more affordable costs, and
a motivated sustainable workforce.
And it makes it clear that active engagement of patients is a
common thread through all building blocks, whether it be
enrolment in a health care home; consumer peer workers as
part of the health care team; or data-driven improvement that
includes measures of patients’ experience.
So granted, the current PHCAG process is about GP financing.
It needs to be - but not exclusively.
But the other certainty is that, without doubt, it will be a lost
opportunity if any future primary health care strategy lacks solid
investment in health literacy, self-management and patient
activation programs so that consumers can take their rightful
place as partners in care – as the directors of their care.
That patients should be partners in care…
that we should have primary health care policy and system that
gives people greater control of their health and care so that
services will have to adapt and reform around their needs and
aspirations should not negotiable.
Consumer health literacy and empowerment is not the soft
underbelly. It is not the optional extra.
Patient participation, health literacy and empowerment must be
a main theme in the PHCAG report and the government’s
response.
9. How can we guard against it getting forgotten by policy
makers?
We need to keep bringing it back to system thinking and what’s
in the best interests of consumers: their equity of access, their
experience of care and their health outcomes.
That needs to be our compass.
10.
11. So back to ‘Healthier Medicare’ and our current medico-political
climate.
It seems to me that this time around – after over a decade of
reviews and reports - we have somewhat a perfect storm.
We have factors aligning where previously they didn’t.
There are the looming big shifts and wicked problems of which
we are all too well aware:
Mounting evidence that focusing the health system on the
patient improves outcomes, is more effective, more cost
efficient and more satisfying for both patient and clinician
Growth in the prevalence of chronic disease often
requiring less acute medical care but more coordinated care,
not necessarily involving the doctor, opening the way, and
demand for, more individualised packages of care
Modern information technology shifting the system from
care arrangements based on one-size-fits-all to individually-
tailored solutions
Personal health care monitoring systems that enable
individuals to check their own health status…these
consumer-centred devices have the potential to
revolutionise routine checks and treatment of chronic and
aged care, contributing to the rise of self- managed care
Growth in consumerism and the informed patient
12. Trends towards choice, control and self-directed
approaches to human service delivery, spearheaded by the
NDIS
Consumers facing a fragmented, complex and increasingly
unaffordable healthcare system
And, not least, the ballooning cost of health care to
individuals and governments
To put these costs and their drivers into sharper relief:
o Around 50% of Australians have at least one chronic
condition, and 20% have two or more
o The cost of chronic disease to Medicare has more than
doubled from about $10 billion to almost $20 billion over
the past decade
o Risk factors for chronic conditions such as obesity are
already at high levels and increasing
o There is a potentially preventable hospitalisation for
chronic disease every 2 minutes – now isn’t that an
astounding statistic?
o Nearly a quarter of people who visit an emergency
department felt their care could have been provided by a
GP.
We’ve known about these drivers for a while.
What are the main differences this time around? What are the
factors contributing to our perfect storm?
13. We’ve got central agencies (PM&C, Treasury and Finance)
giving unprecedented focus to primary health care as a key
solution to arresting the spending trajectories foreshadowed by
the most recent Intergenerational Report.
We got First Leaders recognising that primary health care is the
main game in a statement after their most recent retreat.
We’ve got a Health Minister who is on record as wanting to act.
We’ve also got a consumer sector that is rapidly growing in
maturity and positioning itself to be a serious policy actor.
We’ve got a clinical community – notably GPs – recognising the
case for change and actively canvassing new ways in which
they should work and be funded. The RACGP’s Vision for
Health paper has been out for comment for some time.
In all of this, the case for the empowered consumer is
compelling.
Several commentators and researchers agree that as the need
for efficiency and deriving better value from the healthcare
dollar grows, the key is to get patients with chronic illnesses to
manage more of their own care
That’s why I want to focus today on the role health literacy and
consumer-centred care are playing - and will increasingly play -
as a pivotal influence in the way health care transforms in the
next decade and beyond.
What do Australian health consumers want?
But first, let’s get back to basics. Let’s frame this discussion by
thinking about what Australian health consumers want.
14. What fundamental needs and wants underpin consumer
activism today? What experiences of healthcare do they value
and rate highly?
Any other industry setting out to invest in research and
development efforts to redesign itself and its services would
start with this fundamental question about their market….
….so should health policy makers and administrators.
After conducting extensive market research, NAB Health
recently formulated a set of design principles to underpin what
they call a future health “ecosystem”.
15.
16. NAB’s design principles included:
Make life easier and more convenient for me
Let me take ownership and empower me
Include and respect me in the relationship
Keep me informed
Enable transparent access to my information
Give me the best care you can
Reduce my costs
By any standards, these sound like a pretty good set of wants
to me – a good litmus test for any new policy.
And they tell us that if Australia is to advance health there will
need to be quite fundamental changes.
There are, by our standards, radical changes happening or
being proposed in countries like the UK and US, yet little real
sign of serious debate about such changes here in Australia.
Health literacy and consumer-centred care are concepts where
Australia, despite a lot of talk has, with some exceptions,
shown little progress in systematically advancing.
This is at least partly due to the way the combination of
Medicare and fee for service funding regimes has stifled better
practices in this area.
But the growing knowledge of what makes an effective
consumer-clinician relationship and the revolution in information
and technology now makes it more pressing than ever for us to
exploit the benefits of health literacy, the activated patient and
consumer-centred care in the way programs and services are
designed and delivered.
We are an informed group here today but let me just briefly
cover what I mean by these two terms.
17. Health literacy is the ability to obtain, understand and
use healthcare information …
….to make appropriate health decisions and follow instructions
for treatment.
In a broader sense health literacy is also where the individual is
exposed to those influences which promote wellness, help
them understand their medical treatment and elements of a
healthy lifestyle.
A national report on health literacy agreed by Health Ministers
last year states that the complexity of the health system is
challenging for everyone and contributes to poor quality and
unsafe care.
Low health literacy also hits the bottom line with the report
saying it may be associated with 3 to 5 per cent extra cost to
the health system.
It goes on to say about only 40 per cent of adults have a level
of individual health literacy needed to meet the complex
demands of everyday life.
That means only 40 per cent of adults can follow health
messages and will be able to make right choices based on a
thorough understanding of those choices.
18. The literacy deficit: why empowerment matters?
So, what to do about this troubling literacy deficit?
The national statement suggests three ways to improve health
literacy.
Supporting effective partnerships between consumers,
healthcare providers and managers is one of these.
Consumers themselves have long recognised the benefit of
empowerment to their experiences of care and to setting and
achieving their health care goals in partnership with their
clinicians.
Yes clinicians will say that, of course, they are focused on
the patient in front of them.
But too often it is the system which triumphs over the
individual’s needs.
The consumer and patient is subject to the system rather
than vice-versa.
Patients want and need professionals who see them as more
than just the ‘vessel’ of a disease to be cured, or a problem
to be solved. Patients want to be recognised for who they
are: unique individuals with their own unique lives.
That might sound an obvious point.
But CHF has found that the biggest drivers of complaints and
dissatisfaction with the health system is almost always that
consumers feel they aren’t being respected as individuals,
and partners, in their own health care decision-making.
19. Our message to the policy makers and health workforce is
for them to take a patient-centred approach to setting policy
and providing care: not disease-centred, not system-centred,
but patient-centred.
So, if that’s the case what do we need the system to reflect:
Clinicians’ education and continuing professional
development that promotes patients as partners in care
Consumers involved in health care research
Self management programs embedded in primary
care
Consumer participation recognised in national safety
and quality standards and associated accreditation
Consumer participation in the governance and values
of health organisations
Models of care where, as Janne said, there’s a team of
professionals looking after the consumer, sharing
information and contributing to a common care plan
Care in place – by that I mean but we need to move
away from thinking that hospitals or clinics are the only
care settings.
Health professions should be prepared to meet the
consumer where it’s convenient for the consumer.
For primary care, this might mean expanding services in
pharmacies, having better after-hours services, making
better use of telemedicine, coming into consumers’
homes and offices or in-reaching to supported
accommodation and crisis homelessness services
20. clinicians open to working across the traditional
clinical boundaries. The future for specialists may be
beyond the hospital’s four walls.
Recent work by the UK think tank, the King’s Fund,
contemplates new ways of working for hospital
physicians whereby they work much more closely with
their primary and community care colleagues in non-
hospital settings as advisers.
So it’s all these things like this that add up to what I would
say is a consumer-centred system.
And let’s be frank, it’s not money that is not necessarily the big
barrier here. It is that much more challenging hurdle: human
behaviour.
So much of the benefits that come with a consumer – focused
system are much less to do with cost than with changing the
way we do things.
Time for alternative approaches
So given the largely clinician-directed nature of our health
system, don’t we need to consider alternative approaches?
I think it starts with culture change and challenging the
prevailing orthodoxy.
There are highly talented health care thinkers who are pointing
towards a brave new world of consumer-centred, individualised
health care that lies within our reach right now.
21.
22. Eric Topol, the medical innovator and cardiologist recently
published a book entitled The Patient Will See You Now:.. The
Future of Medicine is in Your Hands.
Topol specialises in arresting conventional thought …
but he is no couch commentator. He was the first physician to
raise the alarm earlier this century about a new arthritis drug
associated with high rates of heart attacks.
It’s fair to say he probably raises the pulse of many
conventional doctors with his arresting book titles.
Recently he tweeted a table showing the contrast in culture and
practices between what he calls “Old Medicine” and “New
Medicine”.
So the Old Medicine is:
“Population-based”…
--- while the New Medicine is “individualised”.
The old is “One-off, doctor’s office”…
--- The new is real-time streaming, in the real world
Doctor-ordered data makes way for…
--- patient-generated data
Unshared doctor’s notes become …
… Our notes, patient-edited
Information owned by doctors and hospitals becomes…
23. --- information owned by rightful owner
And data goes from “limited”…
--- to “panoramic”.
We see in those contrasting terms a striking shift away from the
paternal doctor-passive patient stereotype to the two-way
relationship that involves a dialogue and information sharing
between clinician and consumer…
To the sort of health literacy and consumer-centred care that
Janne described.
And we see the same sort of principles emerging elsewhere,
this time in proposed new rules for the coming healthcare era
emerging in the US.
The Commonwealth Fund recently published this list proposed
by the Institute of Healthcare Improvement.
The Institute’s recipe for what they describe as a “radical
redesign of health care delivery” includes precepts such as:
Change the balance of power – to encourage patients and
families to take a leading role in their care
Standardise what makes sense and make it easy –
streamline processes and use technology to facilitate
team work so patients with complex conditions are not
asked to repeat tests and medical histories
Customise to the individual so services are designed to
meet needs of patients rather than the providers and payers
Collaborate and cooperate
24. Eliminate walls – encourage partnerships between health
care, social agencies et all to address social and economic
issues that impede good health
Assume abundance – to encourage cooperation that
makes the most of existing resources
Return the money – share savings between patients,
employers and communities to ensure affordable care and
to promote health or invest in other sectors like education
Move knowledge, not people – to deliver relevant
knowledge to patients and providers whenever and
wherever they need it.
So that list shows just how far moves towards individualised,
personal-tailored approaches to health are being proposed in
the US, albeit conveying the optimism of the USA, particularly
admirable given its history of a costly, highly inequitable health
system.
And in England, the health world there too is deeply embroiled
in debate about pressure for change to the NHS.
Giving people choice and control over their health and care and
shifting away from a system where decisions that impact most
on patients are still taken by clinicians, commissioners and
policy makers are seen as a key part of the solution.
Again, it is the individually-targeted approach that
is being proposed as a centrepiece for change according to
former (Labour) Health Secretary and leading commentator
Alan Milburn.
25. In a report titled ‘Powerful People’ by the Institute for Public
Policy Research in the UK, Milburn and collaborator Stephen
Dorrell have written in their foreword that the NHS needs to be
transformed and that money be “put directly in people’s hands
by accelerating the spread of personal health budgets”.
They say these payments should be an entitlement for all those
with long-term conditions by 2020.
They write about “devo-health” where power should be
devolved down to local areas and to frontline professionals so
that they are better able to redesign services around people’s
needs.
Consumer centred care seems reasonably subscribed to in the
UK, at least by lead commentators and clinicians.
Even so, Milburn and Dorrell’s commentary suggests that,
despite political emphasis on empowering patients,
empowerment remains at the margins rather than the centre of
the UK system.
Equally so, they say their agenda would require a profound
change to clinical and healthcare cultures.
Their report argues for giving citizens greater control over their
own health and care, so that services are redesigned around
their needs, “to improve health outcomes and to save money by
supporting people better to manage their conditions
themselves”.
I guess it’s that last point on costs which tends to focus the
mind on the idea that perhaps better care - a more responsive
system - can save costs, and/or generate more available cost-
effective care.
26. What’s happening in Australia?
So what’s happening in Australia in the way of patient-focused
systems?
Not nearly enough CHF would say.
But there’s promise on the horizon.
The NSW Clinical Excellence Commission’s “patient-based
care challenge” is one such examples.
Earlier this year the Commission’s Karen Luxford and co-author
Stephanie Newell published in the British Medical Journal about
this project.
The aim of the program introduced across NSW Health districts
was to make patient centred care more broadly recognised as
everyone’s responsibility from the executive through to
clinicians and staff.
Developed in collaboration with a patient advisory committee,
this project highlights the importance of engaging with patients
right through: at the bedside and in health service governance
and strategic decision making.
The leadership challenge proposed 26 possible strategies
ranging from starting each board meeting with a story of patient
care, related by the patient or read by staff, and including
requirements that the board spend 25 per cent of meetings on
quality of care issues, regular board and executive visits to the
ward.
27. The strategy also embraced the mission “the patient at the
centre --- every patient, every time”, encouraged staff to view
patients, family and carers as care team members, and sought
to use patient feedback to drive change. That might include
getting patient family advisers to survey patients in waiting
rooms or work with junior medical staff to conduct a patient
shadowing project.
By October last year, after about two years, 13 districts had
adopted an average of 19 of the 26 strategies.
The authors say that as the project uptake was in the early
stages it was hard to judge whether it has been a success.
Whatever the final results, the important feature is that we are
seeing significant steps to promote the concept of consumer-
focused health care championed by an organisation whose
core business is to lead safety and quality improvement in a
public health system.
Like the Commission, Primary Health Networks, as regional
system stewards, are well placed to take up this mantle.
Health Minister Ley has said that patients will have the
opportunity to have their say, with community advisory
committees to advise PHN boards “from the patient
perspective”.
But success will depend on whether PHNs have got consumer
and patient perspectives as integral and on the same footing
as input from clinicians.
28. It will depend on PHN’s appetite for investing in patient
leaders as much as they invest in clinical leaders, and the
sophistication with which they involved patients and consumers
in all steps of the commissioning cycle.
And in that respect, we are seeing some hope-stirring
particularly in the directions being set by the Federal Health
Minister Sussan Ley.
The PHCAG Discussion Paper I mentioned earlier makes the
point that Medicare is failing to meet the challenge of chronic
care.
It says patients often experience a fragmented system,
uncoordinated care, difficulty finding the right care, low uptake
of eHealth and technology to overcome these barriers….
It acknowledges that patients feel disempowerment, frustration
and disengagement.
A heartening feature of the Paper is the acknowledgement of
the idea of the “patient as a partner in care”.
It recognises that patients have different levels of
understanding, skills and capacity to self-manage their
conditions.
Targeted education, training and motivational support, the
report says, has been shown to enable patients more
effectively to self-manage their health and wellbeing.
Furthermore, the report states “health workforce training ---
beginning at the undergraduate level --- must include the
principles of the patient as a partner in care”.
This is a central requirement, we believe, for the development
of health literacy and consumer-centred care.
29. As the report states, care co-ordinators could help patients
better understand their needs and make an assessment of their
self-management and self-advocacy.
The coordinators could support patient participation,
engagement and self-management and build health literacy,
either directly or in conjunction with practice nurses, community
nurses and Aboriginal and Torres Strait Islander health
practitioners.
Putting patients first: the ultimate disruptive innovation?
So in conclusion, right now, putting patients first is more an
aspiration than a systematic program of action.
We have promising sentiments in high level policy documents
and some promising practice but it is in pockets and not
widespread.
What should we be doing so that patients can climb the health
care ladder?
30.
31. We need broad changes in behaviour and culture including:
Acknowledgement and support by clinicians to treat the
patient as an individual with individual needs and not as
another passive recipient at the mercy of an uncoordinated
system
Educating the health work force to encourage informed and
engaged health consumers
Funding clinicians to give the time and attention to informing
and supporting patients to better manage their health
Shifting from a fee for service system to a system that
rewards wrap-around, team-based care rather than one-off
episodic services, particularly for those with chronic and
complex conditions
And not least, providing effective funding for the education
and training of health consumer representatives --- like
Janne Graham in the video --- to guide both patients and
health institutions towards more effective care
These suggested changes are pretty modest I would suggest,
given the perfect storm we are facing of rising costs and a
disempowering primary health system.
We remain hopeful that Australia takes up the opportunity to be
exemplars: to be leaders rather than followers of world’s best
practice in consumer participation and leadership in primary
health care.
Such an approach would exploit the growing evidence in
Australia and abroad of the value of having active consumer
involvement in both design and delivery of health services.
The Australian Commission on Safety and Quality in
Healthcare reminds us of the research that demonstrates that
patient-centred care improves the patient experience and
creates public value for services.
32. As Alan Milburn and several other commentators also remind
us, there is a straightforward moral case for empowering
people in health and care as well as an instrumental case.
Empowerment can produce better health outcomes, more
satisfied citizens and much needed financial savings.
Rather than being seen as a warm and fuzzy option, consumer
health literacy, empowerment and better self-management
should be central to a modern health system.
Patients have been described as the health system’s untapped
resource.
They have been described as powerful agents of change.
The empowered consumer could just well be the disruptive
innovator we have been looking for.