Lecture 12, Introduction To Public Health.

Introduction To Public Health
Lecture 12
Magda Khutsishvili, Pharm B, MPH

Lecturer in the University of Georgia
School of Health Sciences
magda.khutsishvili@ug.edu.ge
• Theme: Application of health systems science competencies in patient
care
• Reading materials: HEALTH SYSTEMS SCIENCE AMA Education Consortium
SECOND EDITION Editors-in-Chief: Susan E. Skochelak, MD chapter: 15
Evidence-based Medicine
• Evidence-based medicine: is the practice of identifying and
applying the best available scientific evidence to guide
practice and reduce unnecessary variation in health care
delivery. This practice is required to ensure that care is
effective.
• Effective implementation of best evidence in daily practice

remains a major challenge, barriers include:
1. Poor generalizability of the evidence to the real world since
most studies are conducted in academic medical settings
2. Lack of systems designed to support best practice
3. Complexity of the intervention or new practice
4. Lack of readiness for adoption of change
5. Underuse of effective strategies, approaches, and tools to
facilitate change
The key to Evidence-based Medicine
Adoption
• In order to improve the
Adoption and
implementation of best
evidence, into daily
practice, health care
delivery systems can
develop several
strategies, like:
1. Practice guidelines
2. Evidence-based
pathways
3. Drug formularies
Clinical practice guidelines
• Clinical practice guidelines have been developed since the 1990s, and published in order to
enhance the practice of medicine by helping to reduce inappropriate practice variation
and to improve the quality and safety of health care.
• These guidelines are based on consensus, include multiple possible evidence-based
options, and are not localized to a specific practice or health care delivery system.
Clinical Pathways
• Clinical pathways are: standardized, evidence-based
clinical decision tools developed to guide practice at
the local level.
• Clinical pathways are used by: physicians and other
health care professionals to treat patients with
specific diagnoses or conditions according to
evidence-based medicine.
• Clinical pathways may help health care systems to:
1. Reduce variation in clinical performance
2. Identify patients who are eligible for clinical trials,
3. Improve the efficiency of care delivery,
4. Improve the quality and outcomes of patient care,
5. Improve the safety of care delivery, and reduce the
costs of care.
Implementation of Clinical Pathways
• Health care systems should incorporate the
pathways into the routine workflow of its
clinicians and simplify the use of the
pathways by integrating them into the
electronic health record (EHR).
• Pathways cannot be followed in 100% of
cases because a clinician needs to
personalize the therapy by taking into
account the patient’s preferences.
• It is generally accepted that pathways apply
to 80% of cases, and personalization of the
pathway is needed 20% of the time.
• Clinical guidelines and pathways are at risk
of biases, and they have the potential to be
manipulated by the sponsors of the studies
generating the evidence.
Formularies
• A Formulary: is continually updated list of medications and medication-associated products or
devices, medication use policies, ancillary drug information, decision support tools, and
organizational guidelines.
• A formulary system: is the ongoing process through which a health care organization
establishes policies regarding the use of drugs, therapies, and drug-related products and
identifies those that are most medically appropriate and cost-effective to best serve the
health interests of a given patient population.
Formulary systems are used in:

1. Hospitals
2. Acute care facilities
3. Home care settings
4. Long-term care facilities, as well as by
payers such as Medicare, Medicaid,
insurance companies
5. Managed care organizations.
The Pharmacy and Therapeutics (P&T)
committee
• The pharmacy and therapeutics (P&T)
committee: is composed of actively practicing
physicians, other prescribers, pharmacists,
nurses, administrators, quality improvement
managers, and other health care professionals
and staff who participate in the medication use
process.
• Responsibilities of the P&T committee include:
1. Managing the formulary system
2. Evaluation of medication use
3. Adverse drug event monitoring and reporting
4. Medication error prevention
5. Development of clinical care plans and
guidelines
6. Addressing patient safety
Antimicrobial Stewardship
• Antimicrobial stewardship is: a method by which health care institutions manage the
appropriate selection, dosing, route, and duration of antimicrobial therapy.
• Antimicrobial stewardship is one of the activities conducted and monitored by the
formulary system and used to improve care delivery: decreasing unnecessary variation
and improving safety.
Communication skills via new technology
• Patient-centered care and efforts to provide high-value care for them require a mechanism for
patients to interact with care teams with concerns or questions that do not require face-to-
face visits.
• Health care delivery systems use new information technology by designing and
implementing:
1. Electronic Patient Portals

2. Social Media Platforms
3. Telemedicine
Electronic Patient Portals [1]
• Electronic patient portals: are

electronic communication
platforms that provide patients
with different degrees of access
to their health information
stored in an EHR-Electronic
Health Record and managed by
the health care system.
Electronic Patient Portals [2]
• Benefits of electronic patient portals:
1. Improve the efficiency of care
2. Reduce the frequency of patient clinic visits
3. Reduce the cost of care
4. Monitor the accuracy of listed medications
• Challenges of electronic patient portals:

1. Low computer literacy of patients
2. Patients may experience confusion or distress when they view abnormal test results
before a physician explains them
3. Documents and information are presented in a medical clinician–centric rather than a
patient-friendly language.
4. Increased access to physicians will translate to increased nonreimbursed physician
effort.
Social Media platforms
• The adoption of social media, especially social networking, by health care systems and
professionals may lead to: a more patient-centered health care system, may enhance
patient engagement, health information exchange, and the communication between
patients, health care providers (physicians, nurses, pharmacists), and health care
administrators.
The challenges of Social

Media are regarding:
1. Confidentiality,
2. Privacy,
3. Personal identity,
4. Professionalism
5. Information inaccuracy.
Telemedicine
• Telemedicine is: the distribution of health-
related services and information via electronic
information and telecommunication
technologies, which provides long-distance
patients with the medical care through video
conferencing.
• Benefits of Telemedicine are: improved access
for homebound patients, decreased costs of
travel, and convenience.
• Challenges of Telemedicine are: limitations in
assessing patients, privacy and security of
communication, accreditation, licensure, and
billing and insurance reimbursement.
Team Work in Healthcare
• Health care is delivered via teams.
• Providing care today requires an understanding of how effective teams function.
• Examples of Formal teams that have been designed to enhance health care quality are:
1. Accountable care teams, which foster inter professional collaboration and collegiality.
2. Rapid response systems, which have demonstrated significant improvements in patient
survival and other metrics through enhanced teamwork.
Professionalism in Healthcare
• Health care professionals face challenges to their professionalism. These challenges may
take the form of crises, such as the determination that patients may have inadvertently
been exposed to infectious disease.
• Institutions can also face the challenge of dealing with disruptive professionals, staff, and
clients and can prepare through formulating appropriate responses.
Thank You For Your Attention!

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Introduction To Public Health

Magda Khutsishvili, Pharm B, MPH

• Effective implementation of best evidence in daily practice

Formulary systems are used in:

1. Electronic Patient Portals

• Electronic patient portals: are

• Challenges of electronic patient portals:

The challenges of Social

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