Health service management (1)

Health Service Management for
Pharmacy Students
By
Chetan M. Bhalgat
PhD
Chetanbhalgat2004@gmail.com
1

• Is the part of the civic infrastructure that
keeps communities safe and healthy.
• Mission of public health is:
– “Promote physical and mental health, and
prevent disease, injury, and disability.”

Who are public health professionals?
• Pharmacist
• Nurses
• Physicians
• Laboratory technicians.
• Educators
• Nutritionists
• Social workers.
• Biostatisticians
• Epidemiologists.
• Economists
• Lawyers.
• Community-based or “grassroots” workers might include concerned
parents, grandparents, or civic leaders who volunteer their time.

Ten Essential Public Health
Services

What are the Ten Essential Public
Health Services?
• The core functions of public health are
divided into.
1. Assessment.
2. Policy Development.
3. Assurance.

Assessment:
– Monitor health status to identify community health
problems.
– Diagnose and investigate health problems and health
hazards in the community.
Policy Development:
•Inform, educate, and empower people about health issues.
•Mobilize community partnerships to identify and solve
health problems.
•Develop policies and plans that support individual and
community health efforts.

Assurance:
– Enforce laws and regulations that protect health and
ensure safety.
– Link people to needed personal health services and
assure the provision of health care when otherwise
unavailable.
– Assure a competent public health and personal health
care workforce.
– Evaluate effectiveness, accessibility, and quality of
personal and population-based health services.
– Research for new insights and innovative solutions to
health problems.

The challenge of caring for a billion

• India is the second most populous country in the
world
• The death rate has declined but birth rates continue to be
high in most of the states.
• Health care structure in the country is over-burdened by
increasing population
• Family planning programs
need to be (re)activated

Challenge: Burden of Disease
in the new millenium
India faces the twin epidemic of
1. Continuing/Emerging infectious diseases:
 Related to poor implementation of the public health programs
2. Chronic degenerative diseases.
 Demographic transition with increase in life expectancy.

•Economic deprivation results in poor access to
health care.
•Poor educational leads to non-utilization of health
services and increase in avoidable risk factors.
•Advances in medicine are giving partial
improvement in health indices.
Economic development, Education and
Health

Human Development Indicators: A
challenge for all
• Longevity, literacy and GDP (Gross domestic product) per
capita are the main indicators of human development
• Longevity is a measure of state of health,
• Longevity is linked to income and education
• Weakness in health sector has an adverse effect on
longevity
• India ranks low (115th) by HDI (Human development index)

High Burden of Disease in India
• Lack of environmental sanitation and safe drinking
water,
• Under-nutrition,
• Poor living conditions, and
• Limited access to preventive and curative health
services

• Lack of education, gender inequality and population explosion
growth
• Full impact of the HIV epidemic and tobacco related diseases is
yet to be felt

Health Care in India
• Less Expenditure on health by the Government.
• Not viewed as an investment but as a dead loss!
• Financial constraints cut expenditure on health
• Growth in national income is not enough,
if
No sufficient food, No better access to health and
education: Amartyo K Sen

Human health has probably improved more over the
past half century then over the previous three
millennia.
Despite the increasing devastating impact that HIV/AIDS
in south east Asia, it is likely that, overall, human health
will continue to improve steadily during the coming
decades.

• Almost everywhere, the poor suffer poor health and
the very poor suffer appallingly (very badly).
• Gap in health between rich and poor remains very
wide.
• Gap in health will have dire consequences for the
global economy, for social order and justice.
Inequity in Health Care

Deaths by age groups in developed and
developing world
0
2
4
6
8
10
12
14
Deaths in
millions
0-4 5--14 15-29 30-44 45-59 60-69 >70
Age group in years Developed
Developing

• India has 48 doctors per 100,000 persons which is fewer than
in developed nations
• Wide urban-rural gap in the availability of medical services:
Inequity
• Poor facilities even in large Government institutions compared
to corporate hospitals (Lack of funds, poor management,
political and bureaucratic interference, lack of leadership in
medical community)

Health Care in India:
Curative Health Services
• Increasing cost of curative medical services
• High tech curative services not free even in
government hospitals
• Limited health benefits to employees
• Health insurance expensive
• Curative health services not accessible to rural
populations

• Private practitioners and hospitals major providers of
health care in India
• Practitioners of alternate systems(Ayurveda,
Homeopathy, Unani) of medicine also play a major role
• Concerns regarding ethics, medical negligence,
commercialization of medicine
• Increasing cost of medical care and threat to healthy
doctor patient relationship

• Prevention, and early diagnosis and treatment, if
feasible, are the most cost-effective strategies for
most diseases
Promoting healthy life style
• Needs to be incorporated
in school curricula.
• Need for increasing public
awareness.

The Role of Pharmacists in Managed Health Care
Organizations

The Role of Pharmacists in Managed
Health Care Organizations
Delivery of prescription drug benefits to patients.
Broad and diversified range of clinical, quality-oriented
drug management services.
Make assured plan they design provides appropriate
drugs and drug therapies, conveniently and cost-
effectively.
Committed to ensure that medications are used
appropriately to improve a patient’s health.

Performing following functions
Drug Distribution and Dispensing
Patient Safety
Clinical Program Development
Communication with Patients, Prescribers
and Pharmacists
Drug Benefit Design
Business Management
Cost Management

Drug Distribution and Dispensing
Dispensing of prescription drugs to patients
1. Through their own pharmacies
Can Provide enhanced pharmaceutical services,
2. Through community pharmacies
Providing pharmaceutical services to a specific
community.
Responsibilities
Dispensing Service
Repeat Dispensing Service
Disposal of Unwanted Medicines.
Promotion of Healthy Lifestyles.
Signposting to other Services.

Support for Self-Care
keep detailed records of their patient’s medications.
Widely available Advanced Services:
Medicines Use Review & Prescription Intervention.
New Medicine Service.
Enhanced Services which are not available unless locally
commissioned:
Minimizing Adverse Effects and Admissions Related to
Medicines.
Discharge and Transfer Planning.

3. Through mail order or online service
Conform to the law of prescriptions, eligibility for
coverage, appropriateness of that medication and
safety for the patient
manage or oversee dispensing operations as well
4. Through collaboration with physicians and other
prescribers
Review a patient’s drug profile to safeguard against
unintended side effects
Drugs prescribed are eligible for coverage; are lower
cost, high quality generic products when appropriate;
and are projected to do no harm

Patient Safety
Ensure patient safety by
1. Analyzing prescription
2. Correct problematic prescription
3. Educating prescribers about best practices
They design and administer:
• Drug Utilization Review (DUR) programs:
Identify potential prescription-related problems such as
 Drug/Drug interactions,
 Duplication of drugs,
 Known allergies,
 Under or overdosing or inappropriate therapy.

• Prior Authorization programs:
An approval process that encourages proper use of
medications and discourages inappropriate prescribing
of complex drugs.
• Monitoring programs:
Monitoring for dosage adjustment.
Monitoring programs assure that drugs that are
prescribed safely and used appropriately.
• Quality Assurance (QA) programs:
 Programs that enhance patient safety
 Improve the ways in which patients use drugs.

Clinical Program Development
Particularly for patients with chronic conditions whose quality of
life depends on prescription drugs,
Evaluate scientific evidence and clinical data in order to select
appropriate drugs for a patient population by a panel of clinical
experts
Assess the effectiveness of new treatments for diseases…
Use evidence-based clinical and research data to create disease
management programs …

Increase understanding of the ways in which clinical
therapies are carried out...
Explore ways of managing patients with chronic
conditions on comprehensive drug therapies...
Design and conduct outcomes-based research in
order to help patients achieve the desired results
from their drug therapy,

Communications with Patients, Prescribers and
Pharmacists
Design and use communication protocols to assure that there is an
exchange of necessary information between patients, their
physicians and their pharmacists
Communications are required to
Help physicians and other prescribers choose drugs that will
meet patients’ needs and be eligible for coverage…
Provide information on individual prescription history

Educate patients about drugs they are taking or
those being suggested by their physicians…
Provide patient’s drug profile in order to identify any
potential adverse drug reactions or duplicate
therapies…
Help patients to manage their heath care and
Help physicians to address complex drug therapy
questions.

Plan Benefit Design
Collaborate to design effective benefit structures that will service
a specific population’s needs.
Uses clinical knowledge and practical experience to address such
design matters as:
Whether a formulary should be used and, if so, whether it
should be a “restricted” or “open” plan; whether to establish a
patient cost-sharing structure.
“participating” pharmacy network should be established which
may include community, mail order and online pharmacies be to
service the population properly;

criteria and procedures for drug utilization should be
established for
1. Patient safety and best outcomes are maximized, and
2. Patients receive the correct drug at the correct dosage,
3. Understand why they are asked to take the drug, and
make them compliant in taking the drug.

Business Management
Contract with employer and health plan clients, pharmacies and
manufacturers to structure business arrangements which:
Allow their clients to customize clinical and reporting
requirements that meet their individual population needs…
Negotiate with manufacturers for discounts on drug prices …
Assist clients in assessing the appropriateness of new drugs...
Establish networks of pharmacies to provide accessibility for
patient populations and
Assure participating pharmacy compliance with patient safety
and quality programs…

Cost Management
Help their clients (employers, HMOs, trust funds, Medicaid, etc.)
evaluate and improve their pharmacy benefit by:
Encouraging prescribers to make cost effective drug choices
Integrating improvements so that costs are actually saved,
Introducing system interventions that enhances the quality of
patient care and saves costs…
Using data to identify compliance and noncompliance with
prescribing guidelines, and,
by creating measures for assessing physician performance,
identifying prescribing patterns and determining opportunities for
improvement.

Health service management (1)

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