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Health Care 1

Health and Social Care

[Name of the Writer]

[Name of the institution]

Health Care 2

Health and social Care


This paper is a twofold paper, one is analyse the contemporary issues in health and social

care and the other is continuing development for health care. To discussing the health and social

care, healthcare is an important topic of study; quality healthcare is a need of all people. Proper

first-response care and the transportation of trauma victims to emergency hospitals are extremely

important for the victim’s chances of survival. Physician quality and availability, as well as

availability of services are also important concerns to the public.

Contemporary Issues in Health and Social Care

Providing care to victims of trauma is an important first step in their treatment.

Ambulance services must be able to respond to emergencies rapidly, and to this end, it seems

logical to state that the farther a responding ambulance is away from a scene, the longer a

patient goes without care, and faces longer transport time to the hospital. Furthermore, the

professionals staffing the ambulance should have the highest levels of training possible in order

to provide the most comprehensive treatment upon arrival at a trauma scene, as this first contact

with emergency medical service. Properly integrating the retrieval service with the receiving

facility is also important, since delivery of pertinent information on the patient’s condition also

has an effect on survival. This task is more difficult to accomplish in rural areas than in urban

areas, as technological advances are less likely to be adopted and implemented by independent

rural facilities, including EMS and hospitals alike (Culler et al., 2006).

Compared to urban communities, rural communities have been shown to have

disproportionately higher injury and mortality rates for injuries resulting from motor vehicle
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accidents, occupational accidents, drowning, accidental firearm injuries, residential accidents,

and electrocutions, fatality rates in rural areas are more than twice that of urban areas (PeekAsa

et al., 2004). Of these causes of death, motor vehicle crashes in rural areas are the highest,

accounting for 61 percent of all traffic fatalities in the United States, while rural miles traveled

accounts for only 39 percent of all miles travelled (NHTSA, 2001). Peek-Asa et al. (2004) noted

that traffic fatality rates in rural counties across the United States are nearly double that of urban

counties, with head-on collisions, and collisions with farm machinery being the leading causes of

traffic fatalities in rural areas.

The primary issue with injured individuals in remote locations is that they are often

transferred without being stabilized or provided with appropriate intubation to protect the airway.

Establishment of a retrieval service in remote rural locations greatly decreased patient scores on

several indices related to patient condition upon arrival at a hospital. A decrease of the index

value denoted a more stable condition, and consequently, an increased chance of survival

(Corfield et al., 2006). As transportation of trauma victims in rural areas is an important

contribution to the chance of patient survival, monitoring the extent of use of ambulance services

in rural areas is another important factor in improving survival. Patterson et al. (2006a)

developed the expected annual emergency miles per ambulance (EXAMB) index to provide a

uniform measure of emergency Medical Service (EMS infrastructure concerning ambulance use.

Transportation to a hospital via an EMS, as stated earlier, can increase the chance of

patient survival. Herlitz et al. (2006) noted that victims of acute chest pain in rural areas

commonly have large myocardial infarctions (MI) during transport to the hospital than patients

in urban areas. There are offered possible explanations for this. First, victims of acute chest pain

in rural areas are generally older residents, who are more likely to visit a general practitioner at
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the onset of chest pain. This means that by the time and ambulance reaches those residents, their

chances of being in an advanced state of MI are greater. The desire to seek out the advice of a

general practitioner rather than summon an EMS may be tied to the idea that older residents of

rural areas are generally seen as more traditional (Rye, 2006), preferring the country doctor’s

care to transport via ambulance to an urban area. Second, patients in rural areas are, again, more

likely to be older, and have a previous history of angina (chest pain and/or tightness due to

insufficient blood flow), diabetes, MI, or some other heart-related condition than residents in

urban areas (Herlitz et al., 2006). These two considerations provide additional challenges to EMS

operations in rural areas, as the treatment of acute chest pain presents differently in rural areas as

opposed to urban areas.

Continuing Development of Healthcare

Access to care has changed for the better in the new millennium but there are significant

gaps in receiving care especially in vulnerable populations such as the older adults. The

demographics of the United States reflects an aging population with an increase in numbers of

people at the age of 65 years or older. Older adults are living longer and retaining their teeth,

resulting in an increasing need for improvement in accessibility to oral care services. Access to

care is essential for the best possible health outcome and to help reduce premature morbidity and

mortality, preserve function and enhance overall quality of life‘(Smith, 2008, 89-98).

The Institute of Medicine (IOM) defines access to care as the timely use of personal

health services to achieve the best possible health outcome (Hathaway, 2009, 561-572). Older

adults should not have to experience the risks associated with lack of oral care and keeping in

mind their age, the presence of other medical conditions, allergy to medications and other
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complications point to the need for access to immediate oral health care services. Despite the

improvements in oral health of older adults, there continues to be profound disparities by

ethnicity, socioeconomic and dentate status.

In the theoretical framework, on access to oral care, the measure of realized access or

success in obtaining care is the likelihood and frequency of health care. Access is influenced by

many factors that can facilitate or can be a barrier to oral care. One of the key barriers to access

is that dental insurance typically ceases with retirement from the workforce. Dental services are

not available in Medicare. The cost of dental care is borne by the individual on a fee-for-service

basis. Significant barriers to receiving needed dental services exist for older adults experiencing

poverty, in institutionalized settings, complex medical illnesses (Guay, 2004, 779-85).

Healthy People 2010 oral health objectives call for an increase in the proportion of adults

who use the oral health care system annually. Many older adults are not frequent users of dental

care, though oral health is crucial to their well-being and overall health. Teeth are exposed to

microbes for the major part of an older adult‘s life. Teeth undergoes natural wear and tear, side

effects from habits such as clenching or grinding of teeth, and oral manifestations from

medications for systemic diseases, radiation or chemotherapy if burdened with illnesses such as

cancer. The reduction in salivary flow as age increases also contributes to development of oral

diseases. Poor oral health can seriously compromise the general health, quality of life and life

expectancy of an individual. According to the (World Health Organization/ National Institute of

Health) International Collaborative Study II (ICSII), the National Center of Health Statistics

(NCHS) oral health survey revealed 46% of 65-74 year old Americans completely edentulous in

1960-1962, compared to 32% in 1984-1986, and 24% in 1991-1992 (Chalmers and Ettinger,
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2008, 423-46). In the same study, access to dental care, gender and income were the best

predictors for dental visits among older adults in the U.S. sample.

The authors, Mueller et al., (1998) analyzed data from the 1994 National Access to Care

Survey to estimate the extent of dental care needs in the U.S. population. The findings showed

8.5 percent of the population in need of, but did not readily obtain dental care in 1994 indicating

variances in demographic and socioeconomic characteristics, and income status.

A surveillance study by Janes et al., (1999) of the National Health Interview Survey

(NHIS), the state-based Behavioral Risk Factor Surveillance System (BRFSS), and the Medicare

Current Beneficiary Study (MCBS) indicated national, regional, and state-specific patterns of

access to and use of preventive services among persons aged 55 years or older and found

decreased use of dental services, due to disparities in oral health care.

According to a 2005 report from the American Dental Association (ADA), a new study

by the Centers for Disease Control and Prevention (CDC) and the NIH examined data reported

from 1988-1994 and 1999-2002 of the National Health and Nutrition Examination Survey

(NHANES), to assess cumulative data from both these periods of oral health status (Smith, 2008,

89-98). The study found that disparities remain though oral health of the population has

improved (Hathaway, 2009, 561-572). It is evident from the literature that the oral health care

needs of older adults are unmet especially in lower income population. About 4 million

individuals age 65 or older live in poverty. In 2001, the per capita public expenditure on health

care for seniors neared $4,400 per senior when compared to seventeen times the per capita public

expenditure on health care for children.

There is growing literature on racial, ethnic, and socioeconomic status (SES) disparities

in oral health care access indicating the poorer health status among low-SES and non-Hispanic
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African Americans when compared to high-SES persons and non-Hispanic whites. A study

published by the ADA, in 2000 demonstrated that U.S. dentists primarily treat patients of their

own racial and ethnic background (Crall, 2006, 1133-1138).


To conclude, it must be sat that healthcare as a resource in rural areas, while highlighting

the difference between the qualities of such care when compared to urban areas. Timely response

to trauma victims has been shown to be an important factor in their chances of survival, and as

such, it is important for EMS services in rural areas to work to improve not only their response

time, but the quality of care a victim receives at the scene of an accident. Attracting properly

trained emergency response and care personnel is another major concern for rural hospitals.

Migration of emergency physicians into urban areas is expected to continue in coming years, and

in order to compensate, rural EMS directors must take advantage of every opportunity to provide

additional training to the staff of rural ERs.

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