HCS- exam 3
PDC equation
Proportion of days covered (PDC) = ((number of days with drug on hand) / (number of days in a specified time interval)) * 100%
what are distribution of health examples
agents, causes, risk factors and sources
agent
an infectious pathogen
switch
when a patient changes therapy during the course of treatment, any excess medication from the original prescription is assumed to be discarded
medication persistence
# of days taking medication (without exceeding permissible gap)
incidence rate
(Number of new cases of a disease during a specified period) / (Total person time of observation in population at risk during that period)
prevalence rate
(Number of persons who have the disease at any time during a specified period) / (Number of persons in the population during that specified period)
permissible gap
-60 day gap between refilling patterns -ex. permissible gap of 60 days, MPR = 90 / (90+60) = 60%
chronic disease
-causes are more complex, no single, known cause -not contagious in nature -disease process is length and involves preclinical or asymptomatic phase -incurable and potentially detrimental to quality of life
what are examples of direct methods of medication adherence options
-directly observing therapy -biological fluids
continuous measure
-medication possession ratio (MPR): potential of overestimation -proportion of days covered (PDC)
what are some examples of indirect methods of medication adherence options
-patient self-report: interviews, structured instruments, diaries -pill counts -pharmacy claims data
dimensions of health
-physical: health status -mental: mood related -social: connectedness; social interaction
what are the challenges of current public health
-population migrants -complacent to the peaceful life -antibiotic resistance -population ages -medical care and insurance continuously increase
describe the characteristics of the medical model
-primary focus on the individual -personal service ethic, conditioned by awareness of social responsibilities -emphasis on diagnosis, treatment, and care for the whole patient -paradigm places predominant emphasis on medical care
describe the characteristics of the public health model
-primary focus on the population -public service ethic, tempered by concerns for the individual -emphasis on prevention and health promotion for the whole community -paradigm employs a spectrum of interventions aimed at the environment, human behavior and lifestyle, and medical care
what are the 2 missions of public health
-to fulfill society's interest -highlight the supportive role in the health of the populace, assuring conditions in which people can be healthy
what are 3 medication adherence problem solution key points to remember
1. consider sixty (60) days permissible gap 2. Non-switch 3. Switch
what are the 3 steps to an epidemiologists approach
1. count: cases 2. divide: number of cases by appropriate denominator (rate) 3. compare: different time, different groups of time
what are the conditions for the exponential growth of communicable diseases?
1. early stage of the epidemic with most people uninfected 2. no other interventions (such as social distances, mandatory guidelines, effective vaccinations) 3. remain normal contact between people
understand the public concerns of covid-19 vaccines
1. they worry the vaccine will give them the virus 2. they worry the vaccine was rushed, and long-term impacts are unknown 3. they are confused about how the vaccine works to help the body build immunity and fear it will alter DNA.
"Shortfalls" in health care account for what percentage of leading causes of premature deaths
10%
what year did John Snow create the cholera mortality map to find the reason behind the spread of disease
1854
what year was New York Metropolitan board of health established
1866
in which year did the US declare the elimination of measles
2000
what was the mortality rate of cholera in the london epidemic
30%
what is our rate of infant mortality in the US
5.6/1000 live births -we are ranked 44th
what is the SARS mortality rate?
8-17% ranges from 0%-50% depending on the age group
dichotomous measure
80% threshold
Patient Mylan receives prescriptions for a cholesterol-lowering drug. The record of herprescription fills is listed as follows. As all of the fills have the same GPI6 identifier, the patient isconsidered to be on single-drug therapy.ID GPI6 Fill Date Days of SupplyA 394000---HMG-CoA Reductase Inhibitors 12/20/2017 30A 394000---HMG-CoA Reductase Inhibitors 08/25/2018 30A 394000---HMG-CoA Reductase Inhibitors 09/05/2018 30A 394000---HMG-CoA Reductase Inhibitors 09/26/2018 30A 394000---HMG-CoA Reductase Inhibitors 12/10/2018 30Calculate the PDC for this patient in the calendar year 2018?
88.1 %
Prescription-fill record shows that Clark's Aspirin was filled on 6/1/2018,7/1/018, 8/1/2018. The quantity of 30 tablets was filled at each time.What is the medication adherence for patient Clark between 6/1/2018 to8/30/2018 (3 months: assuming 30 days of each month)?
91.11%
brand name of Pfizer-BioNTech
COMIRNATY
mission of modern public health
Continued to be preventing and controlling communicable or infectious disease
Determinant vs. Distribution tabulate the frequency of clinical signs, symptoms, and laboratory findings among children with chickenpox in Cincinnati, Ohio
Distribution
who is the father of epidemiology
Dr. John Snow
incidence rate equation
Incidence rate = number of new cases of a disease during a specified period / total persontime of observation in population at risk during that period
what is the equation for MPR
MPR = (sum of days supply within refill interval) / (number of days in refill interval)
Patient Caroline refilled her medication of Lipitor. During the 3 claims timescenario, she refilled a 30-day supply of medications on 1/13/2018 (the first dayof refill), 2/3/2018, 3/21/2018. The overlapping dispensing is moved forward tothe first day that she does not have medication from the previous dispensing.Her medication adherence between 1/13/2018 to 4/12/2018 is going to bestudied (3 months: assuming 30 days of each month).
MPR = 90/90 = 1
what covid vaccine is safe for populations 18 and older and is given as 2 injections 28 days apart ( the second dose can be given up to 6 weeks after the first dose if needed)
Moderna
PDC equation
PDC = (number of days with drug on hand) / (number of days in a specified time interval) * 100%
what covid vaccine is safe for populations 16 and older and is given as 2 injections 21 days apart (second dose can be given up to 6 weeks after the first dose if needed)
Pfizer-BioNTech
what COVID-19 vaccine was approved by the US FDA?
Pfizer-BioNTech mRNA COVID-19 vaccine received US FDA approval in 2021
what is the R0
R- naught the reproduction number -the number of people that one sick person will infect (on average) is called R0
what is the formula to calculate vaccine efficacy
R0 ^n -so if R0 = 2, and N = 1 it would be: 2^1 = 2 or if 0 = 2, and N =2 it would be 2^2 = 4
rates of occurrence
how the incidence/ prevalence of a disease changes under given conditions
infectious disease
a single, known identifiable cause, potential transmission, vaccines may prevent
what is the lab testing for COVID
a viral test (nasal swab) or an antibody test with blood sample
the effective R0
accounts for the individuals in the population that aren't susceptible to a disease. -more sensitive -can vary depending on susceptibility, demographics, socioeconomics, and environmental factors
index date of medication adherence rate
arbitrarily defined by the investigator: -the date of the first fill of the medication -the beginning of the observation period
during the influenza epidemic, why was the incidence high but not contribute to the prevalence?
because of the high, spontaneous rate of disease resolution. in the case of a disease that has a low (or zero) cure rate, but where maintenance treatment permits sustained survival, then incidence contributes to the continuous growth of prevalence.
analytical epidemiology
build around the analysis of the relationship between two items -exposures and outcomes looking for determinants or possible causes of disease -utilizes observational and experimental study designs to test health outcome hypotheses
outbreak
carries the same definition of epidemic (sudden increase in disease above what is normally expected in that population in that area) but is often used for a more limited geographic area
dose-response relationship
change in effect based on differing levels of exposure
clinical criteria of a case study
confirmatory lab tests, combined with symptoms and signs
what are the interventions for communicable diseases?
control and interrupt the transmission -protect portals of entry: gloves, masks -isolation, quarantine -vaccination: increase host's defenses
what are the types of epidemiology
descriptive epidemiology and analytical epidemiology
Determinant vs. Distribution compare food histories between persons with staphylococcus food poisoning and those without
determinant
Determinant vs. Distribution compare frequency of brain cancer amount petrochemical workers with frequency in the general population
determinant
when a patient changes therapy during the course of treatment, any excess medication from the original prescription is assumed to be:
discarded
to define a community as a "healthy community" what needs to be looked at?
disease statistics, open spaces, public transportation, medical resources, climate, air quality
casuality
diseases do not occur by chance
Determinant vs. Distribution graph the number of cases of hepatitis B by year for the country
distribution
Determinant vs. Distribution mark on a map the residencies of all children born with birth defects within 2 miles of hazardous waste site
distribution
what was the impact of COVID-19 on society
economics on public, sociopolitical, public health systems
what are the 5 parts to public health
epidemiology, biostatistics, environmental health, health and management policy, and social and behavioral health
five disciplines of public health
epidemiology, biostatistics, environmental health, health management and policy, social and behavioral science
suspected cases / probable cases
exposure history, constant clinical syndrome
T/F coronavirus is the flu
false
social and behavioral science
focus on individual level factors and the impact of external factors on health
descriptive epidemiology
focuses on identifying and reporting both the pattern and frequency of health events in a population
what did Dr. John Snow do to prevent the cholera outbreak at Broadway street, london in 1854?
he proposed an alternative method of of spread (not through air) but through water contamination with human feces from a person who had cholera. He tested his hypothesis by collecting data comparing water supply sources in cholera cases. He carefully made a map of cases surrounding the Broadway St. pump and the pump handle was removed on Sep. 8, 1854
why did john snow not believe the original cause of cholera?
he was a physician familiar was gas anesthesia. spread of cholera did not appear to behave like the diffusion of a gas
of the ten leading causes of death in the US, what is the number 1 cause
heart disease
what are the 3 parts of the epidemiology triad?
host, vector, and agent
when did the U.S. routinely vaccinate the population
in the early 1960s
vector
indirect transmission of a disease through animate intermediaries (vectors can be mosquitoes, fleas, and ticks that may carry and infectious agent through purely mechanical means or may support growth or changes in the agent)
what are signs/symptoms of cholera
infects the intestine and results in diarrhea which can lead to dehydration, shock and death
examples of tertiary preventions to communicable diseases
isolation, quarantine, infection control, treatment
environmental health
largely concerned with the impact of various exposures on health
morbidity
measure of disease incidence or prevalence in a given population
what are the three reasons that a child can be exempt from the immunization requirements at school in washington state?
medical, religious, or philosophical (vast majority)
what type of continuous measure has the potential of overestimation
medication possession ratio (MPR)
what was the generally first accepted theory of cholera cause
miasma, the stench arising like a gas from garbage and other filth that was characteristic of a large city environment
prevalence will continue to grow until:
mortality equals or exceeds the incidence rate
definition of public health
most share the premise that the subject of public health is the health of POPULATIONS - rather than the health of individuals - and that this goal is reached by a generally high level of health throughout the society, rather than the best possible health for a few
are antibiotics effective in treating covid?
no
what is the Quasi-experimental design?
no random assignment nonequivalent groups design
is the life expectancy in the US good?
no- we are ranked 34th out of all the countries in the world. our life expectancy is only 78.5 years
mortality
number of deaths in a population within a prescribed time period
consistency
observation of the association must be repeatable in different populations at different times
what are the different tiers of the health services pyramid starting from bottom to top?
population-based public health services, primary health care, secondary health care, tertiary health care
medication compliance
percent (%) of doses taken as prescribed
public health is the health of _____________ rather than the health of ____________
populations; individuals -high level of health throughout the society rather than the best possible health for a few.
prevalence rate equation
prevalence rate = number of persons who have the disease at any time during a specified period / number of persons in the population during that specified period
modern public health is continued to be ______________ and _____________ communicable or infectious disease
preventing and controlling
biostatistics
provides the tools to understand public health data
what is considered the "gold standard design"
randomized controlled trials (RCTs) - double blinded
define epidemic
refers to a sudden increase in the number of disease cases above what is normally expected in that population in that area
pandemic
refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people
mortality
refers to death
morbidity
refers to illness or disease
host
refers to the human who can get the disease
confirmed cases
report to national notifiable diseased surveillance system
what is the lab testing for SARS
reverse transcription polymerase chain reaction tests for respiratory, blood, and stool specimens antibody testing using an enzyme immunoassay
health management and policy
the discipline most concerned with issues of health care access and policies at various levels of an organization or government, as well as how these policies impact health outcomes
describe what it means if the R < 0
the disease will die out in a population
what is the safe rate of vaccination to stop measles?
somewhere around 90-95% immunization rate
strength of association
statistically the relationship must be clear
pharmacoepidemiology has to deal with what 4 factors
study design, hypothesis testing, risk assessment, and confounding and bias
what are the 5 guidelines for casuality
temporal relationship, strength of association, dose-response relationship, biologic plausibility, consistency
examples of secondary preventions to communicable diseases
testing of at-risk individuals -prophylactic antibiotics -needle and syringe availability programs
temporal relationship
the cause must precede to the effect
risk
what conditions increase the chance of disease
biologic plausibility
the explanation must make sense biologically
the basic R0
the ideal situation -the average number of secondary infections produced by a typical infection (where everyone is susceptible)
non-switch
the overlapping dispensing is moved forward to the first day that the patient does not have medication from the previous dispensing
what is the incubation period
the period of disease before symptoms begin. Preclinical disease pathologic change: asymptomatic
what exactly do epidemiologists study
the sick and well people to determine the primary difference between those who get disease and those who dont
epidemiology
the study of the determinants and distribution of health outcomes
definition of health
the world health organization (WHO) defines health as a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity
T/F a laboratory-confirmed case does not need to meet the clinical case definition
true
T/F factors that cause or contribute to diseases and injuries can be identified by means of systemic investigation
true
T/F human diseases don't occur by chance
true
examples of primary preventions to communicable diseases
vector control -tobacco control -immunizations
what was Dr. John snows alternative proposed method of the spread of cholera
water contamination with human feces from a person who had cholera
What are the determinants of health examples?
who, when, where