Dog Brothers Public Forum
Return To Homepage
Welcome, Guest. Please login or register.
March 02, 2015, 09:11:32 AM

Login with username, password and session length
Search:     Advanced search
Welcome to the Dog Brothers Public Forum.
85098 Posts in 2266 Topics by 1068 Members
Latest Member: cdenny
* Home Help Search Login Register
+  Dog Brothers Public Forum
|-+  Politics, Religion, Science, Culture and Humanities
| |-+  Politics & Religion
| | |-+  The Politics of Health Care
« previous next »
Pages: 1 ... 27 28 [29] Print
Author Topic: The Politics of Health Care  (Read 209425 times)
ccp
Power User
***
Posts: 4369


« Reply #1400 on: February 12, 2015, 10:32:49 AM »

There will be a crush of middle players finding ways to ring money out of this.   Will this save us money?  Short answer:  no.   While I am not totally against this as IMHO there is some reasonable aspects to this, I won't like how it will be "sold" to the public.  It will be sold as "all in the  interests of patient  care".  The real driver is costs. 

****IMPROVING PATIENT CARE
 
Engaging Public Health in End-of-Life Issues: It Is Time to Step Up to the Plate
 
Jaya K. Rao, MD, MHS, Deputy Editor

The Doctor: For Life and at the End of Life

Ann Intern Med.  2015;162(3):230-231. doi:10.7326/M14-2479

This article was published online first at www.annals.org on 9 December 2014.

 

In September 2014, the Institute of Medicine (IOM) released its fifth full report on end-of-life issues, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life” (1). Acknowledging the substantial progress made since its first report on these issues was published in 1997 (2), this report identifies recommendations within 5 domains. It is particularly encouraging to see the following recommendation for public education and engagement in the report: “Civic leaders, public health and other governmental agencies ... should engage their constituents and provide fact based information about care of people with advanced serious illness to encourage advance care planning and informed choice based on the needs and values of individuals.” Because I was one of the first authors to articulate a role for public health with respect to end-of-life issues (3) while I was working at the Centers for Disease Control and Prevention (CDC), it is noteworthy that this is the first IOM report to explicitly mention that public health has a role in this arena. By describing the work on end-of-life issues done by the public health community during the past decade, I hope that policymakers, members of the IOM Committee, and health professionals can use and build on these efforts.

Although end-of-life issues have long been considered a societal problem that needs to be improved, the field of public health has only begun to embrace end-of-life as a health concern. Because public health's primary focus is to prevent illness and premature death due to chronic disease and other health threats, public health professionals' reluctance to acknowledge death or its circumstances may be understandable. However—whether we wish to admit it or not—prevention has its limits, and everyone will die eventually. Some public health professionals may also believe that end-of-life issues are a health system problem rather than a priority to be addressed through population health efforts. Public health priorities tend to have at least one of the following characteristics: a large population burden, a major effect in terms of health and other consequences, and the potential for prevention.
 
In 2002, a literature review that I coauthored (3) clearly showed that end-of-life issues met the criteria of a public health priority. This review was designed as a primer to document the relevance and importance of these issues to the public health community. Given that public health is a key partner of the health care system for many health issues, we proposed that public health could disseminate culturally appropriate materials about advance care planning to the public, thus reaching persons before they were faced with making end-of-life decisions. In addition, we made a case for considering advance care planning as a critical part of chronic disease management programs.
 
Working closely with the CDC, chronic disease partners in state health departments identified priority end-of-life actions for public health (4). More than 200 public health stakeholders were engaged in this effort and made 103 recommendations for end-of-life activities across a range of topics (for example, public education, professional education, and research and evaluation). Of note, 3 of the 5 initial priorities identified as public health end-of-life actions are consistent with the spirit of the IOM's recommendation to educate and engage the public: to educate the public about hospice and palliative care and the importance of having an advance directive or health care proxy and to collect, analyze, and share data about the end of life through state surveys.

One of these actions has resulted in the development of online information on advance care planning for the public and public health and aging services professionals. For example, the CDC's Healthy Aging Web site (www.cdc.gov/aging/advancecareplanning/index.htm) presents materials for the public on advance care planning, including links to decision aids, state-specific advance directive forms, legal guides, and other end-of-life resources (such as hospice and palliative care organizations and information for caregivers). An online modular training course on advance care planning also was developed for public health and aging services professionals. Since then, more than 1000 health professionals have completed the course (Anderson L. Personal communication.), which is available for free and offers continuing education credits (www.cdc.gov/aging/advancecareplanning/care-planning-course.htm).

In addition to providing educational materials to the public, the 2014 IOM report suggests that government agencies undertake and share behavioral research aimed at assessing public perceptions and actions with respect to end-of-life care. Although national polls in the United States have provided periodic insights into public perspectives on end-of-life issues, ongoing population-based national surveys currently do not include questions about the end of life (5). Recently, end-of-life surveillance items were administered to a nationally representative sample of U.S. consumers to assess factors associated with completion of advance directives. This survey found that 26.3% of respondents had an advance directive and nearly 70.0% had concerns about end-of-life care, such as the costs of care, the pain that they might have, or their comfort and dignity during this period (6). Black or Hispanic persons or those who lack the knowledge to have concerns about the end of life were less likely to have advance directives; these groups may represent potential targets for intervention.

Although a PubMed search for “public health” and “end of life” still yields few articles addressing a population approach to end-of-life issues (most of which are presented here), the broader public health community has recently begun to acknowledge this issue. Several states (5, 7) and communities included palliative care questions as state-added items to the Behavioral Risk Factor Surveillance System. Other authors have declared end of life as a public health crisis (Cool and the dying as a vulnerable population that should be a concern of public health (9). More recently, the American Public Health Association adopted a policy statement in 2013 on the role of public health in addressing unmet needs in serious illness and at the end of life (10). Such steps represent incremental progress.
 
In making its recommendations, the IOM appropriately considered the end of life as an issue that requires the involvement of sectors beyond the health care system. Hopefully, public health will heed the IOM's call for action and continue to build on the recommendations of the IOM and key public health stakeholders with respect to end-of-life issues. And, when the IOM writes its next end-of-life report, perhaps public health can influence the next set of recommendations.
Logged
ccp
Power User
***
Posts: 4369


« Reply #1401 on: February 14, 2015, 11:58:58 PM »

I really don't want to be a government employee but this is where it is going.   I no of no significant scientific evidence that sex is a decent form or aerobic exercise unless one is being whipped while running on a treadmill.  This is just patently ridiculous:

*****British Doctors Told to Prescribe Sex as Exercise

by A.B. Sanderson13 Feb 201586

Medical experts have recommended that exercise is something which GPs should be prescribing more often, describing it as “a wonder drug” which is important in the prevention of many common diseases.

The report from the Academy of Medical Royal Colleges says that physical activity plays a significant role in the management of long term conditions but its impact is so positive that it needs to take a greater role in the daily routine of children and adults, the Daily Mail reports.

There is, it says, a direct correlation between the increasingly sedentary lifestyle and conditions such as diabetes and obesity.

And worryingly, over 40 per cent of adults do not reach the minimum recommended level of 30 minutes of moderately intense exercise five times per week.

Regular exercise can prevent dementia, type 2 diabetes, some cancers, depression, heart disease and other common serious conditions – reducing the risk of each by at least 30% – better than many drugs.

But rather than simply telling doctors to send their patients down the gym or pounding the streets in lycra, the authors suggest there are a huge number of ways to raise the heart rate which fit into a person’s schedule.

The report says that fun activities are more likely to be sustained, suggesting many activities can be promoted including dog walking, dancing and even having sex. ‘Basing activities in communities leads to sustained acceptance’ it says, although the report offers no comment on whether this applies to the latter activity.

And it is not just the health of patients which will improve with more adults taking part in community dance classes or training for charity events: The costs of physical inactivity to the UK, the NHS and other public bodies are estimated to be in excess of £15bn.

There are also other costs which are less simple to quantify, including the effects of bad health on families and communities. Lack of physical activity is, is says, acknowledged as one of the top four factors responsible for premature deaths and long term diseases.

Chairman of the Academy of Medical Royal Colleges Professor Dame Sue Bailey sailed:

“This is about people and their doctors believing that the small effort involved is worth it because they are worth it.

“There really is a miracle cure staring us in the face, one which too many patients and doctors have quite simply forgotten about.

“This is about people and their doctors believing that the small effort involved is worth it because they are worth it. This needs to work across the life-course, from children to the very elderly.”

But the advice was not welcomed everywhere, with Joyce Robins of Patient Concern saying, “It’s none of GPs’ business to be talking about patients’ sex lives. I would take amiss at that and I’m sure many others would too.

“This is particularly true as nowadays most patients don’t even know their family doctor.”*****
Logged
Pages: 1 ... 27 28 [29] Print 
« previous next »
Jump to:  

Powered by MySQL Powered by PHP Powered by SMF 1.1.19 | SMF © 2013, Simple Machines Valid XHTML 1.0! Valid CSS!