Hal 105-108

Alternative (Complementary) Care Provider

Alternative or complementary health care refers to those practices not
commonly considered part of western medicine. See chapter 19 for detailed
description of these. Chiropractors,herbalist, acunpunturists,massage
therapist,reflexologists, holistic health healers, and other health care provides
are playing increasing roles in the contemporary health care system. These
providers may practice alongside Western health care providers, or clients may
use their services in conjunction with,or in lieu of, western therapies.

Case Manager
The case manager’s role is to ensure that clients receive fiscally sound,
appropriate care in the best setting. This role is often filled by the member of the
health care team who is most in volved in the client’s care. Depending on the
nature of the client’s concerns,the case manager may be a nurse, a social
worker, an occupational therapist, a physical therapist, or any other member of
the health care team.

Dentist
Dentist diagnose and treat mouth, jaw, and dental problems. Dentist (and their
dental hygienist ) are also actively involved in preventive measures to maintain
healthy oral structures (e.g., teeth and gums)

Dietitian or Nutritionist
A dietitian has special knowledge about the diets required to maintain health
and to treat disease. Dietitians in hospitals generally are concerned with
theraupetic diets, supervise the preparation of meals to ensure that clients
receive the properdiet, and may design special diets to meet the nutritional need
of individual clients.

A nutritionist is a person who has special knowledge about nutrition and food.
Community nutritionist often function at the preventive level. They promote
health and prevent disease, for example, by advising families about balanced
diets for growing children and pregnant women.

Emergency Medical Personnel

Several different categories of providers are associated with ambulance or
emergency medical services agencies (e.g., fire departments) that provide first-
responder care in the community. Titles,education, and certification vary for
emergency medical technicians (EMTs) and paramedics. In general, however,
these personnel are trained to asses, treat, and transport clients experiencing a
medical emergency, accident, or trauma.

Occupational Therapist
An occupational therapist (OT) assists clients with impaired function to gain the
skills to perform activities of daily living. For example, an OT might teach a
man with severe arthritis in can continue to cook. The OT teaches skills that are
therapeutic and the same time provide some fulfillment. For example, weaving
is a recreational activity but also exercises the arthritic man’s arms and hands.

Paramedical Technologist
Laboratory technologists, radiologic,technologist, and nuclear medicine
technologists are just three kinds of paramedical technologist in the expanding
field of medical technology. Paramedical means having some connection with
medicine. The radiologic technologist assists with a wide variety of x-ray film
procedures,from simple chest radiography to more complex fluoroscopy. the
nuclear medicine technologist uses radioactive substance to provide diagnostic
information and can administer radioactive materials as part of a theraupetic
regimen.

Pharmacist
A pharmachist prepares and dispenses pharmaceuticals in hospital and
community settings. The role of the pharmaticts in monitoring and evaluating
the actions and effects of medications on clients is becoming increasingly
prominent. Pharmacists also work directly with clients and with other health
care team members to ensure safe integration of medications into the client’s
comprehensive health plan.

Physical Therapist
The licensed physical therapist (PT) assists clients with nusculoskeletal
problems. Physical therapists treat movement dysfunction by means of heat,
water, exercise,massage,and electric current. The functions of PT include
assessing client mobility and strength, providing theraupetic measure
(e.g.,exercise and heat applications to improve mobility and strength) and
teaching new skills (e.g., how to walk with an artificial leg ). Some PTs provide
their service in hospitals, however independent practitioners establish offices in
communities and serve clients either at the office or in home.

Physician
The physician is responsible for medical diagnosis and for determining the
theraphy required by a person who has a disease or injury. The physician ‘s role
has traditionally been the treatment of disease and trauma ( injury) :however,
many physicians are now including health promotion and disease prevention in
their practice. Some physicians are primary care practitioners ( also known as
general or family practitionsers) ; others specialist such as
dermatologists,neurologists,oncologists,orthopedists,pediatricians,psychiatrists,r
adiologists, or surgeons- to name a few. Primary care physicians are those who
provide the first point of contact for most clients and can include
allopathie(western ) medical doctors (MDs) trained in areas such as internal
medicine ,gynecology, and geriatries, and doctors of osteopathy (Dos), a branch
of medicine traditionally focused on primary care. Differences between
allopathic and osteopathic physicians are becoming fewer ( Shannon &
Teitelbaum,2009).

Physician Assistant

Physician assistants( Pas) perform certain tasks under the direction of a

physician . They treat certain diseases,conditions, and injuries. In many states
are not legally permitted to follow a PA’s orders unless they are co-signed by a
physician.In some settings,PAs and nurse practitioners have similar job
descriptions.

Podiatrist

Doctors of podiatric medicine (DPM) diagnose and treat foot and ankle
conditions. They are licensed to perorm surgery and prescribe medications.

Respiratory Therapist
 A respiratory therapist is skilled in therapeutic measure used in the care of
clients with respiratory problems. These theraphists are knowledgeable about
oxygen theraphy devices,respirators,mechanical ventilators, and accessory
devices used in inhalation therapy . Respiratory therapists administer many of
the pulmonary function test.

Social worker

A social worker councels clients and their support person regarding problems
such as finances,marial difficulties,and adoption of children.It is not unusual for
health problems to produce problems in day-to-day living and vice versa. For
example ,an elderly woman who lives alone and has a stroke resulting
intimpaired walking may find it impossible to continue to live in her third=floor
apartement. Finding a more suitable living arrangement can be the
responsibility of the social worker if the client has no support network in place.

Spiritual Support Personnel

Chaplains pastors,rabbis,priests, and other religions or spiritual advisors serve

as part of the health care team by attending to the spiritual needs of clients.In
most facilities ,local elergy volunteer services on a regular or on-call basis.
Hospitals affiliated with specific religions,as well as many large medical centers
,have full-time chaplains on staff.The nurse is often instrumental,have full-time
chaplains on staff. The nurse is often in identifying the clients desire for
spiritual support and notifying the appropriate person.

Unlicensed Assistive Personnel

Unlicensed Assistive Personnel (UAP’s) are health care staff who assume
delegated aspects of basic client care. These tasks include bathing, assisting
with feeding, and collecting specimens. UAP titles include certified nurse
assistants, hospital attendants, nurse technicians, patient care technicians, and
orderlies.Some of these categories of provider may have standardized education
and job duties (e.g., certified nurse assistants) , while others do not. The
parameters regarding nurse delegation to UAPs are delineated by state boards of
nursing.

Factors Affecting Health Care Delivery

Today’s health care consumers have greater knowledge about their health than
previous years,and they are increasingly influencing health care delivery.
Formerly, people expected a primary care provider to make decisions about
their care ; today, however, consumers expect to be involved in making any
decisions. Consumers have also become aware of how ligfestyle affects health.
As a result. They desire more information and services related to health
promotion and illness prevention. A number of other factors affect the health
care delivery system.

Increasing Number of Older Adults

By the year 2020,it is estimated that number of U.S. adults over the age of 65
years will be more than 54 million (U.S. Census Bureau,2005). Long-term
illnesses are prevalent among this group,and they frequently require special
housing, treatment services, financial support,and social networks. The frail
elderly, considered to be people over age 85, are projected to be the fastest
growing population in the United States and will number more than 7 million by
2020 and 9.6 million by 2030 (U.S. Cencus Bureau, 2005). Because less than
5% of older adults are institutionalized with health problems, substantial home
management and nursing support services are required to assist those living in
their homes and communities.

Older adults also need to feel they are part of community even though they
are approaching the end of their lives. The feeling of being a useful, wanted,
and productive citizen is essential to every person’s health. Special programs
are being designed in communities so that the talents and skills of this group
will be used and not lost to society.

Advances in Technology

Scientific knowledge and technology related to health care are rapidly

increasing. Improved diagnosic procedurs and sophisticated equipment permit
early recognition of diseases that might otherwise have remained undected.
New medication are continually being manufactured to treat infections and
multidrugresistant organisms. Surgical procedures involving the heart, lungs,
and liver that were nonexistent 20 years ago are common today. Lasser and
microsospic procedures streamline the treatment of diseases that required
surgery in the past.

Computers, bedside charting, and the ability to store and retrieve large
volumes of information in databases are common place in health care
organizations. In addition, as a result of the availability of internet and world
wide web access to medical information similar to that of health care providers
(although not all websites provide accurate information). One example of a
reliable source of health care information for clients is the agency for healthcare
research and quality (2005).

These discoveries have changed the profile of the client . Clients are now
more likely to be treated in the community, utilizing resources,technology,and
treatments outside the hospital. For example, years ago a person having cataract
surgery had to remain in bed in the hospital for days; 10 today, most cataract
removals are performed in outpatient surgery centers.

Technological advances and specialized and procedures may

come,unfortunately, with a high price tag. Some diagnostic equipment may cost
million of dollars. Due to this expenditure plus the expense of training
specialized personnel to perform the test, each procedure can cost consumers
hundreds or thousands of dollars.

Economics
Paying for health care service is becoming a greater problem. The health care
delivery system is very much affecred by a country’s total economic status.
According to the centers for Medicaid and medicare services (CSM,2008),
health spending in 2008 was $2.4 trillion in the United States and projected to
reach $3.6 trillion by 2014, increasing an average of 6.2% per year. This is
currently equal to over $8,000 per year for every man,woman, and child and
will increase to over $11,000 by 2014. About 31% are inpatient hospital
expenses,21% physician office and clinic expenses, 10% prescription drug
expenses, and the reminder emergency department, home care, dental, and the
related service. approximately 42% these costs are paid through private
insurance,33% through public program, and 16% out of pocket (paid directly by
the person) (Kashihara & Carper,2009 )

The major reasons for cost increases are as follows :

 Existing equipment and facilities are continually becoming

obsolete as research oncovers new and better methods in health
care. Health care providers and clients want the newest and the
best, and replacing equipment costs more each year.
 Inflation increases all costs.
  The total population is growing ,especiallythe segment of older
adults who tend to have greater health care need than younger
persons. Expenses for persons over age 65 are more than twice as
much as for those under age 65 (Kashihara & Carper,2009)
 As more people recognize that health is everyone’s right, large
numbers of people are seeking assistance in health matters. The
average American sees a doctor three times per year, but infants
less than 12 months of age and older adults over 75 years of age
average more than seven visits per year ( Cherry,Hing,Woodwell &
Rechtsteiner,2008).
 The relative number of people who provide health care services has
increased.
 The cost of prespciption drugs is increasing. Medicare recipients
are eligible for prescription drug coverage to help cover some basic
and catastrophic medication costs.

Women’s Health
The women’s movement has been instrumental in changing health care
practices. Examples the provision of childbirth services in more relaxed settings
such as birthing centers, and the provision of overnight facilities for parents in
children’s hospitals. Current provision of health care shows an increased
emphasis on the psychosocial aspects of women’s health, including the impact
of career,delayed childbearing, role of caregiver to older family members, and
extended lie span.

Uneven Distribution of Services

Serious problems in the distribution of health services exist in the united
states. Two facest of this problem are (a) uneven distribution and (b) increased
specialization. Uneven distribution is evidenced by the relatively higher number
of nurses per capita in the New England states and the lowest number in the
Southwes. an increasing number of health care perssonel provide specialized
services. Specialization can lead to fragmentation of care and, often, increased
cost of care. To clients, it may mean receiving care from 5 to 30 people during
their hospital experience. This seemingly endless stream of personnel and
required paper work is often confusing and frightening.
Access to Health Insurance
Another problem plaguing individuals is access to health insurance. Without
health insurance, people receive less preventive care, delay or avoid care and
medications are diagnosed later in their illnesses,and have higher mortality. In
addition, be canse of low or absent reimbursement for service,primary care
providers may hesitate to provide care otherwise indicated ( Institute of
Medicine [IOM], 2009).

Data from 2008 show that one in seven whites, one in five blacks, and one in
three Hispanics were uninsured for some portion of the pervious 12 month, and
non-native-born persons are almost three times as likely to be uninsured as are
native-born persons (DeNavas-Walt, Proctor, & Smith, 2009). In addition, lack
of health insurance is related to income. More than one third of persons with
family income less than twice the poverty level have no health insurance
coverage (NCHS,2009). Low income has been associated with relatively higher
rates of infectious diseases (e,g.,tuberculosis, AIDS), problem with substance
abuse,rape, violence, and chronic diseases. Thus, those with the greatest need
for health care are often those least to pay for it.

Governmental sources of health insurances cover persons at both ends of the

age spectrum. Medicare covers those who are disabled or over age 65, and
Medicaid and public children’s insurance programs cover those under age 28.
The number of children covered only by public insurance increased by
morethan 12% to a total of 33,4 percent from 1996 to 2007 ( Chu & Rhoades,
2009). Even though some government assistance is available, eligibility for
government insurance programs and benefits varies considerably from state to
state and is continually being reevaluated.

The Homelesas and the Poor

Because of the conditions in which homeless people live (in shelters, on the
streets, in parks, in tents, under temporary covers and dwellings, in
transportation terminal, or in cars), their health problems are often exacerbated
and sometimes become chronic. Physical, mental,social, and emotional factors
create health care.