BHAGATH MS
RAJEEV BISWAS
1. Introduction to Community Medicine 1. Community medicine  Community medicine is a branch of medicine that is concerned with the health of the members of a community, municipality, or region.  The emphasis in community medicine is - on the early diagnosis of disease - the recognition of environmental and occupational hazards to good health
- the prevention of disease in the community
2. Research methods : Steps 1. Formulating the topics
4. Data analysis
2. Sampling
5. Interpreting the findings
3. Questionnaire
6. Writing a report
2. Community Physiology 3. The stages of the family life cycle are : - Independence - Coupling or marriage - Parenting: Babies through adolescents - Launching adult children - Retirement or senior years
3. Community Etiology 4. Pathogen: - Pathogenic viruses
- Protozoa
- Pathogenic bacteria
- Multicellular parasites
- Fungi
- Prions
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5. Risk Factors for Cancer (4 risk factors ‘don’t miss any single point’) (A) Genetic Risk Factors - Genetic risk factors relate to genes inherited from your parents . - Hereditary factors that increase risk are more likely to be found in families that have: Family members diagnosed with cancer at a younger age than usual for the cancer Three or more generations diagnosed with similar cancers Three or more cancer on the same side of the family Family members diagnosed with two or more different kinds of cancer.
(B) Behavioral Risk Factors a. Tobacco b. Alcohol c. Poor diet
(C) Biological Risk Factors a. Old : Growing older The most important risk factor for cancer is growing older. b. Viruses & Bacteria c. Certain hormones
(D) Environmental Risk Factors a. Sunlight
b. Certain chemical and other substances
- UV radiation
- Fibers, fine particles & dust
- Ionizing radiation
- Pesticides
- Solvents
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4. Community Diagnosis 6. Community diagnosis: the process (or ) Steps to conducting a community diagnosis Step 1 :: Define the Community (Establish the What, Where & Who) Step 2 :: Learn more about the What, Where & Who Step 3 :: Identify Resources in your Community Step 4 :: Analyze & Learn from data you’ve collected Step 5 :: Develop an action plan Step 6 :: Share what you’ve learned
5. General Doctor in Community 7. General Medicine Practice - A general medicine practice is a medical practice that provides a broad spectrum of basic care to patients with both acute and chronic conditions. - In many regions of the world, a general practitioner acts as the primary physician for a patient,
providing referrals as necessary if a patient develops medical issues that the practitioner does not feel comfortable for handling.
- The scope of a general medicine practice is broad - The physicians who work for the practice may have specialized in family medicine or internal medicine, and they can often care for patients in all stages, from infancy to old age.
- At general medicine practice, patients can receive routine physicals, annual exams, sports
physicals, and treatment for an array of basic conditions, ranging from strep throat to asthma.
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8. General Practitioner A general practitioner is a medical doctor who provides comprehensive general care to patients, rather than focusing on specific organ system , family of conditions, or type of medical issues.
MCQ:: What does general practitioner give to patients ? A general practitioner or GP is a medical practitioner who provides primary care & specializes in family medicine. General practitioner treats acute and chronic illnesses and provides preventive care & health education for all ages & both sexes.
LONG QUESTION:: Goals of the Family Care Initiative: a) CHOICE :: Give people better choice about the service and supports available to meet their needs. b) ACCESS :: Improve people’s access to services c) QUALITY :: Improve the overall quantity of the long term care system by focusing on achieving people’s health & social outcomes. d) COT-EFFECTIVENESS :: Create a cost- effective long- term care system for the future. ( low cost,
high effect)
6. Community health care system 9. Definition & goal of Community health care system - Health care system are designed to meet the health care needs of target populations. - There are a wide variety of health care system around the world. - Efforts made by Governments, trade unions, charities, religious, or other coordinated bodies to
deliver planned care services targeted to the populations they serve - Goals :: -- improving performance (WHO,2000). -- are good health, -- responsiveness to the expectations of the population, and -- fair financial contribution.
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7. Health Education & Promotion 10. Health Education The World Health Organization defined Health Education as “comprising of consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge and developing life skills which are conductive to individual and community health”.
11. Health Promotion ‘ the process of enabling people to increase control over their health and it’s determinants, and thereby improve their health’
8. Community Prevention Medicine 12. Three tier prevention (What is the meaning of this three prevention) 1. PRIMARY PREVENTION
- avoids the development of a disease. - most population- based health promotion activities are primary preventive measures. 2. SECONDARY PREVENTION - activities are aimed at early disease detection, thereby increasing opportunities for intervention to prevent progression of the disease and emergence of symptoms. 3. TERTIARY PREVENTION - reduces the negative impact of an already established disease by restoring function and reducing disease related complications.
13. Communicable Disease Control in Hospitals (include aspects to infectious disease control) Preventing and reporting communicable disease Universal blood and body fluid precautions Needle-stick precaution Proper medical waste disposal
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9. Therapeutic Community Treatment Model
(v-imp chap)
14. What is Therapeutic Community (TC) ? - Therapeutic Community(TC) is a drug free environment in which people with addictive problems live together in an organized and a structured way in order to promote the change and make the possible a drug-free life in the outside society. - Therapeutic Community forms a miniature society in which residence and staff in the role of facilitators, full fill distinctive roles and adhere to clear rules all designed to promote the transitional process of the residence.
15. How TC can be apply to practice ? TC adapt to serve the particular needs of a number of ‘special populations’ including :: - adolescents - HIV positive & AIDS clients - Homeless men & women - Mother & children - Mentally ill chemical abusers - Methadone clients
MCQ:: What is the ideal size (range) ? 80 – 120 residents Therapeutic communities are not locked facilities but ´semi-closed’ environments where residents choose voluntarily to live a period of 3 to 24 months, & in some cases, longer. MCQ:: How many patients for how many staffs (ratio) ?
15 : 1 (patients : staff) [example: 150 patients for 10 staffs] average resident to staff ratio MCQ:: Typical gender breakdown on Ratio of male/female in Therapeutic Community is about ? (a) 1:1
(b) 2:1
(c) 3:1
(d) 1:3
(e) 6:1
(c). 3:1 The treatment process: therapy, education & training The elements of treatment at TC typically include substance abuse treatment, education, primary medical & dental care, vocational skills training. PAGE 6
MCQ:: Which one is the central component of the therapeutic application? ďƒ Work
16. Which kind of staffs comes under TC models? - Example:: nurses, physicians, lawyers, case workers, counsellors who must be integrated though therapeutic community- grounded training.
17. When considering way to ensure a well functional TC? (Who is responsible for TC?) factors to be considered include : (1) optimal governance and management structures (2) adequacy and reliability of on- going operational funding (3) intake and referral system (4) transition planning for residents who complete the program.
10. Community Based Rehabilitation MCQ :: Key component of CBR ? ďƒ Information exchange All sectors should support CBR by sharing information with the community, collaborating with each other, & strengthening the specific services they provide to people with disabilities
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11. Primary Health Care 18. How did WHO act towards primary health care? The world Health Organization championed primary health care (PHC) even before 1978, when it adopted the approach as central to the achievement of the goal of “Health for All”.
19. What is the primary health care? “Primary Health Care is essential health care based on practical, scientifically sound & socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation & at a cost that the community & country can afford to maintain. It forms an integral part of the country’s health system. It is the first level of contact of individuals, the family, and community with the national health system bringing health care as possible to where people live and work, and constitutes the first element of a continuing health care process.
> Primary Health Care starts with a person’s first contact with the health system. > PHC may include service like: health promotion, disease prevention, screening tests & examinations, rehabilitation therapy, nutritional & psychological counseling. > Variety of professionals, including nurses, pharmacists, dieticians, counselors, rehabilitation therapists & social workers--- in addition to physicians--- provide primary care.
20. How to Build Primary Health Care- Based Health System -
A PHC based health system is composed of a core set of functional & structural elements that guarantee universal coverage & access to services that are acceptable to the population and that are equity-enhancing.
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It provides comprehensive, integrated, & appropriate care over time, emphasizes health promotion & prevention, & assures first contact care.
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21. What are the benefits of PHC- Based Health System? Health system based on PHC are thought to be able to improve equity because the PHC approach is less costly to individuals & more cost-effective to society when compared to specialty- oriented care.
12. Home Health Care Read Home health care is that component of a continuum of comprehensive health care whereby health services are provided to individuals and families in their places of residence for the purpose of promoting, maintaining, or restoring health, or of maximizing the level of independence, while minimizing illness. Services appropriate to the needs of the individual patient and family are planned, coordinated, and made available by providers organized for the delivery of home care through the use of employed staff, contractual arrangements, or a combination of the two patterns.
22. Why do needs increase nowadays to home health care? Reasons for this development are: (i) the more effective, efficient & appropriate provision of care to individuals in need for such services in the place they live. (ii) the decongestion of hospital beds (iii) the ever increasing cost of hospital care.
What does home health care mean ? Home health care is that component of a continuum of comprehensive health care whereby health services are provided to individuals and families in their places of residence for the purpose of promoting, maintaining, or restoring health, or of maximizing the level of independence, while minimizing illness.
Introduction Home Health Care is a formal, regulated program of care delivered by a variety of health care professionals in the patient’s home.
Health care provision at home is part of the continuous health care, where health services are PAGE 9
provided to individuals & families at the place of their residence, aiming at the promotion & or conservation of health, rehabilitation or optimization of the level of independence & quality of life. For many reasons, the need for home health care is continuously increasing in our days.
23. What are the type of agencies ? (type of agencies, write whether its profitable or not) In most of the country, the mix of home care agencies more commonly includes other types of agencies such as official, proprietary & hospital based agencies.
1. Official Agencies Official or public agencies are supported by tax dollars & are given power through statutes enacted by legislation. An example of an official agency involved in home health care would be state or local health department with a nursing division.
2. Voluntary Agencies - Voluntary home health care agencies are governed by a volunteer board of director & are supported primarily with nontax funds such as donations, endowments, United Way contributions, & reimbursements for third-party payers (eg., Medicare, Medicaid, & Private insurance). - Voluntary agencies are non-profit & therefore are tax exempt. Non-profit status is not exactly what the name implies.
3. Private Agencies - Private home health care agencies can be either for-profit or not-for-profit. - Private, not-for-profit home health care agencies are governed by either a board of directors or the agency’s owner. The majority of private agencies are proprietary in nature, which means they plan to make a profit on the home care they provide.
4. Hospital-based Agencies - Hospitals began entering the home health care industry in large numbers in the 1980s to maintain clients within their health care system, provide a more comprehensive program of health service, & increase revenue. - In a managed care framework, hospital-based home care agencies allow for close collaboration to facilitate the movement of the client across the health care continuum. PAGE 10
- The hospital-based home health care agency is governed by the sponsoring hospital’s board of directors & receives the majority of its referrals from the sponsoring hospital.
5. Home Care Aide Agencies A home care aide agency provides paraprofessional services such as homemaking, companionship, or custodial care to clients. These agencies are usually privately owned & receive direct payment from a client or a private insurance company.
6. Certified Hospice Agencies Many communities have home health care agencies that provide hospice care to the terminally ill in the community. These agencies have received certification from the federal government as a Medicare hospice provider. Hospice home care has grown as a result of a trend toward providing terminal care in the home. Some hospice agencies are freestanding are serve only hospice clients.
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