ILLNESS

GENERAL PRINCIPLES OF HEALTH CARE
CONCEPTS OF HEALTH
HEALTH
 Old English word for “heal” (hael)
“WHOLE”
 Whole person and his or her integrity,
soundness, or well-being
HEALTH
 Is the state of complete physical, mental, and
social well-being, not merely the absence of
disease or infirmity (WHO)
 Is the quality of life involving social,
emotional, mental, and biological fitness on
the part of the individual, which results in
adaptations from the environment
CONCEPTS OF HEALTH
 is a personal state in which the person feels
unhealthy
 is a state in which a person’s physical,
emotional, intellectual, social, developmental
or spiritual functioning is diminished or
impaired compared with previous experience
Precursor of Illness
 HEREDITARY – family history for
diabetes mellitus, hypertension, cancer
 BEHAVIORAL FACTORS – cigarette
smoking, alcohol abuse, high animal fat
intake
 ENVIRONMENTAL FACTORS –
overcrowding, poor sanitation, poor
supply of potable water

Stages of Illness

THE DIMENSIONS OF HEALTH 1. SYMPTOM EXPERIENCE

1. Physical health Examples:
2. Mental health Transition stage
3. Emotional health  The person believes something is wrong
4. Social /environmental health  Experience some symptoms
5. Spiritual health 3 aspects:
 Physical – fever, muscle aches, malaise,
HOLISTIC HEALTH headache
 is an approach that identifies components of  Cognitive – perception of “having Flu”
health that function interdependently to  Emotional (worry on consequences of
influence an individual’s health illness)
WELLNESS
 Wellness is well-being. It involves engaging 2. ASSUMPTION OF SICK ROLE
in attitude and behavior that enhance quality Examples:
of life and maximize personal potential Acceptance of the illness
 Well being is a subjective perceptive of Seeks advice, support for decision to give up
balance, harmony and vitality some activities
 Wellness is a choice
WELLNESS 3. MEDICAL CARE
 Wellness is a way of life Examples:
 Wellness is the integration of body, mind and  Seeks advice of health professionals for
spirit the following reasons
 Wellness is the loving acceptance of one’s  Validation of real illness
self  Explanation of symptoms
 Wellness can also be described as "the  Reassurance or prediction of outcome
constant, conscious pursuit of living life to its
fullest potential. 4. DEPENDENT PATIENT ROLE
Examples:
Travi’s Wellness Model  The person becomes a client dependent on
the health professional for help
 Accepts/rejects health professional’s
suggestions
 Becomes more passive and accepting
  May regress to an earlier behavioral stage
5. RECOVERY/REHABILITATION
Example:
 Gives up the sick role and returns to former roles
and functions
DISEASE
 an alteration in body functions resulting in
reduction of capacities or a shortening of the
normal life span
Common Causes of Disease
 Biological agents – microorganisms
 Inherited Genetic Diseases
-Achondroplasia Developmental defects –
imperforate anus, Cleft palate
 Physical agents – hot and cold
substances, radiation, ultraviolet rays
 Chemical agents – lead, emissions from
smoke-belching cars
 Tissue response to irritation – fever,
inflammation
 Metabolic process – inadequate iodine
causing goiter, inadequate insulin in
diabetes mellitus Emotional/Physical
reaction to stress – anxiety, fear
Risk Factors of a Disease
 Genetic and Physiological Factors
 Age
 Environmental
 Lifestyle
Classification of Disease
According to Etiologic Factors
1. Hereditary – due to defect in the genes of
one or other parent which transmitted to the
offspring
Examples: diabetes mellitus, hypertension
2. Congenital – due to a defect in the
development, hereditary factors, or prenatal
infection; present at birth
Examples: cleft lip, cleft palate
3. Metabolic – due to disturbance or
abnormality in the intricate processes of
metabolism
Examples: diabetes mellitus, hyperthyroidism
4. Deficiency – results from inadequate intake
or absorption of essential dietary factors
Examples: osteomalacia, which is vitamin D
deficiency in adults
5. Traumatic – due to injury Examples:
fractures
6. Allergic – due to abnormal response of the
body to chemical or protein substances or to
physical stimuli
Examples: asthma, skin allergy
7. Neoplastic – due to abnormal or
uncontrolled growth of cancer cells
8. Idiopathic – cause in unknown; self-
originated; of spontaneous origin Example:
cancer
9. Degenerative – results from the
degenerative changes that occur tissue and
organs
Examples: osteoporosis, osteoarthritis
10. Iatrogenic – results from the treatment of a
disease
Examples: hypothyroidism after thyroid
surgery; alopecia (hair Loss) after
chemotherapy
According to Duration or Onset
1. Acute illness – usually has a short duration
and is severe
Examples: appendicitis
2. Chronic illness – usually longer than 6
months and can also affect functioning in any
dimension
Examples: hypertension
Remission – period during which the
disease is controlled and symptoms
are not obvious
Exacerbation – The disease becomes more
active again at a future time, with
recurrence of pronounced symptoms
3. Sub–acute - symptoms are pronounced but
more prolonged than in acute disease
Example: sub-acute bacterial
endocarditis
Other diseases may also described as:
1. Organic –any health condition in which there
is an observable and measurable disease
process, e.g. inflammation or tissue damage
2. Functional – no anatomical changes are
observed to account for the symptoms
present, may result from abnormal responses
to stimuli
Examples: irritable bowel syndrome
3. Occupational – results from factors
associated with the occupation engaged in by
the patient
Examples: cancer among chemical
factory workers
4. Familial – occurs in several individuals of the
same family
Examples: hypertensive, cancer
5. Venereal – usually acquired through sexual
relation
 Examples: AIDS, gonorrhea
 Epidemic – attacks a large number of
individuals in a community at the same time
Examples: SARS
 Endemic – present more or less
continuously or recurs in a community
 Examples: malaria in Palawan, goiter in
Mountain Province
 Pandemic – an epidemic disease which is
extremely widespread involving an entire
country or continent
 Sporadic – a disease in which only
occasional cases occur
 Example: Dengue during rainy season,
 leptospirosis during floods
 Health Promotion Model
 Individual perceptions
 Modifying factors
 Participation in health
o The momentum developed by your health-
 Individual Perception- perceived
susceptibility to an illness
 Example: Family history to diabetes mellitus
Indicators of Health Status
increases risk to develop the disease
 Perceived seriousness of an illness
o Example: diabetes mellitus is a
lifelong disease
 Perceived threat of an illness
o Example: Diabetes mellitus causes
damage to the brain, heart, eyes,
kidneys, blood vessels
 Modifying Factors
 Demographic variables
o Examples: Age, Sex, Race
 Structural variables
o Example: knowledge about the
disease
 Sociopsychologic variables
 Examples: social pressure or
influence from peers
 Cues action
o Examples:
o internal: fatigue, uncomfortable
symptoms;
 external: mass media,
advice from others
 Leavell and Clark’s Agent Host-
Environment Model
 AGENT – any factor or stressor that can
lead to illness or disease
 HOST – persons who may or may not be
affected by a disease
 ENVIRONMENT – any factor external to the
host that may or may not predispose the
person to a certain disease
 HEALTH STYLE
 the sum of personal health decisions that
affect the individual and the community both
very personal and very interpersonal
 It is described as being influenced by
o The information you have about your
health
o Your values
o Your social support
o Your health-related skills
o Your health-related resources
o The momentum developed by your
health-related decisions
o Your social support
o Your health-related skills
o Your health-related resources
related decisions
 PERSONAL HEALTH STATUS
Satisfaction with life
Zest for life
Functional level of physical fitness
Minimum of illness
 COMMUNITY HEALTH STATUS
MORBIDITY refers to the rate of illness in a
group.
MORTALITY refers to the rate of death in a
group.
LIFE EXPECTANCY refers to the number of
years a person is expected to live
FACTORS that affect HEALTH Behavior
and Status
Race
Sex
Income
 Caucasian American have longer life
expectancy than African American
 Women live longer than men
 middle, high-income than in low-income
groups
Predisposing, Reinforcing, and Enabling
Factors
PREDISPOSING FACTORS
Life experience
Knowledge
Cultural and ethnic heritage
Beliefs and values
ENABLING FACTORS
Abilities
Mental and Emotional capabilities
Resources
Facilities
REINFORCING FACTORS
Support
Encouragement and discouragement from
people in your life
Activities to Promote Health and Prevent
Illness
 Have a regular physical examination (yearly)
 Women: Regular PAP test, Monthly BSE
(breast self-examination)
 Men: Regular testicular self examination
 Annual dental examination
 Regular eye examination
 Exercise regularly (3x/wk for 30 mins.)
 Do not smoke, avoid second hand smoke
 Avoid alcohol, “recreational drugs”
 Reduce fat and increase fiber in diet
 Sleep regularly
 Maintain ideal body weight
HEALTH BACKGROUND
 Sickness has been one of man’s greatest
adversaries
 To identify or diagnose a specific disease or
injury
 Physicians, pharmacists, and other health
care professionals utilize clues
MEDICINE
 Latin word “medicus”
 It is a healing art
 Aims to help people become more active and
live longer and happier lives with less
suffering and disability
 Constant search
 New drugs
 Effective treatments
 More advanced technology
 Health care professionals can prevent,
control or cure hundreds of diseases
MEDICINE
 Has become a part of the health care
industry
 One of the largest industries in the world
 One of the leading employers in most
communities
 At the turn of the 20th century (1900)
 Men and women were frail by age 40
 Life expectancy was 47.3 years
 Effective treatment for diseases were so
scarce
 By the end of the 20th century
 Medical advances
 Life expectancy increased to 76 years
 Today
 People in their 80s and 90s are
independent and physically active
 Medical expansion has been expensive
HISTORY OF HEALTH CARE
 Prehistoric medical practice
 Study of ancient pictographs that show
medical procedures and surgical tools
uncovered from anthropological sites of
ancient societies
 Serious diseases were of primary interest
to early humans but they were not able
to treat them effectively
 Diseases were attributed to the influence
of malevolent demons
 Diseases were believed to project an
alien spirit, a stone, or a worm into the
body of the unsuspecting patient
Demons and Disability
 It was once thought that demons or evil
spirits could cause disabilities such as
mental illness and physical deformities.
 Diseases were warded off by
incantations,dancing, magic charms and
talismans, and various other measures
 Make the body uninhabitable to the
demon by beating, torturing and starving
the patient
Trepanning
Alien spirits are expelled by potions that caused
violent vomiting, or could be driven out through
a hole cut in the skull Remedy for insanity,
epilepsy and headache
 HEALTH CARE PROFESSIONALS
Trepanated skull, Iron age.  11.6 million people work in health care in
The perimeter of the hole in the skull is rounded other countries
off by ingrowth of new bony tissue, indicating that  778,000 physicians, 2.1 M nurses and
the patient survived the operation.  160,000 dentists

The Spinning Treatment was one of many HEALTH CARE PROFESSIONALS

treatments that attempted to rid the body of
mental illness through physical means
The Spread Eagle Cure was used to treat
disorderly patients. Cold water was poured from
a height over the persons face until the patient is
"calm"
Mild electric shock was used to stimulate the
muscles and the mind in this 19th century cure
for mental illness known as Faradization.
 Work in health care services, involved in
the diagnosis and treatment of patients
 Research, teaching or administration of
medical facilities
PHARMACIST
 Has a unique body of knowledge and
skills to contribute in our health care
system Dispenses the appropriate drug
product and has the knowledge to assure
safe and rational use of drugs

 Surgical procedures practiced in ancient EARLY FUNCTIONS OF PHARMACISTS

societies
 Cleaning and treating wounds by cautery  Assisting in the selection of appropriate
(burning or searing tissue), poultices, and drug therapy
sutures  Preparing, compounding and
 Resetting dislocations and fractures, and manufacturing drugs for individualized
using splints to support or immobilize broken patients
bones  Dispensing and packaging the
prescribed drug products including
 Additional therapy included laxatives and proper labeling
enemas to treat constipation and other  Advising and educating patients on
gastrointestinal diseases proper use of drugs
 Monitoring the outcome and responses
Discovery of the narcotic and stimulating of patients to the effect of drugs, both
properties of certain plant extracts Many are still beneficial and adverse
of use today  Serving as a community resource person
o Digoxin, a heart stimulant extracted from on drug and health information
foxglove (Digitalis purpurea)
o Opium poppy (Papaver somniferum) is THE TEN STAR PHARMACIST
the species of plant from which opium Pharmaceutical Care Giver
and poppy seeds are extracted. Opium is Researcher
the source of many opiates, including Manager
morphine (and its derivative heroin), Communicator
thebaine, codeine, papaverine, and Leader
noscapine. Life-long learner
Decision-maker
Systems of medicine, based on magic, folk Entrepreneur
remedies, and elementary surgery, existed Teacher
before the coming of the more advanced Greek Agent of Positive Change
medicine about the 6th century B.C.
  Equal relationship
CONCERNS AMONG HEALTH CARE
PROVIDERS PQL Patient Quality of Life
 Potential abuse, misuse and  Welfare of humanity and the relief of human
inappropriate use of drugs suffering is the primary concern
 Increase in health care cost  Must learn to view medication’s use from the
 Patient suffering patient’s perspective

THE PATIENT-ORIENTED PROFESSIONAl AN OATH

 Able to apply and provide drug “I will use knowledge and skills to the best of my
knowledge to improve drug use in the ability in serving the public and other health
health care system professionals”

PRIMARY AIM HEALTH

 To attain success in the goals for therapy,  A goal to strive for. It is not obtainable. No
pharmacist must approach the patient– one ever achieves a “state complete mental,
counseling encounter as a HELPER and physical and social well being”
an EDUCATOR CURE
 Latin word “cura” CARE
THE TRADITIONAL PHARMACIST CARE
 Involved in the preparation and  Providing for the welfare of another
dispensing of medications  Attentive conscientiousness of devotion
 At the direction of the physician  Conveys a compassionate state of being and
 Strongly allied with the medical not merely an attitude
profession  Involves a profound respect for the
 View that the health professional should “otherness” of the other
be in control of the patient
CHARACTERISTICS OF A CARING
THE MODEL BEHAVIOR: VITAL COMPONENTS OF A
 Shift in the model of pharmacy THERAPEUTIC RELATIONSHIP
 From focus on the medication to a focus on  Mutual respect
the patient  Competence
 Need for a shift in the pharmacist’s approach  Honesty/Authenticity
 From the health professional–centered  Trust
MEDICAL MODEL to the patient–centered  Open communication
HELPING MODEL Exercising patience and understanding
 Cooperation
MEDICAL MODEL  Seeing the patient as a person
 Patient is passive  Collaboration between patient and
 Trust is based on expertise and the practitioner
authority of pharmacist  Empathy
 Pharmacist identifies problem and Promotion of patient independence
determine solutions  Putting the patient first
 Patient is dependent on pharmacist  Sensitivity
 Parent–child relationship  Offering reassurance
 Supporting the patient
HELPING MODEL  Confidence
 Patient is actively involved  Assuming responsibility for intervention
 Trust is based on personal relationship  Paying attention to the patient’s physical and
developed over time emotional comfort
 Pharmacists assist patients in exposing  Offering advocacy
problem and possible solution  Being willing to be held accountable for all
 Patient develops self-confidence to decisions made and recommendations given
manage problems
 HEALTH CARE NEEDS OF A PATIENT FACTORS TO BE CONSIDERED IN
Medical Care I care PHARMACEUTICAL CARE PRACTICE
Mental Health Care Geriatric Care A general understanding of how people feel
Dental Care Pharmaceutical Care about being ill, the seriousness of the
Nursing Care Surgical Care disease(patient’s susceptibility to other
Chiro-practice Care Nutritional Care factors)
Pediatric Care Eye Care DENIAL–“Not me!”
Maternal Care ANGER–“Why me?”
DEPRESSION–“Yes, me!”
INTERACTIONS BARGAINING–“Yes me,
BUT….”
With patients and other health care providers ACCEPTANCE–“I’m ready”
VITAL POINTS
COUNSEL  Don’t assume patients had information from
the doctor
CONSULT  Don’t assume patients understand all
information given
EDUCATION  Don’t assume patients have resources to
comply
 Don’t assume patients don’t care or are
4 R’s OF THE PHILOSOPHY OF PRACTICE stupid
Rules Relationship  Don’t assume patients will comply if they
Roles Responsibilities understand
 Don’t assume others will monitor of follow–
PHARMACEUTICAL CARE up
 A responsible provision of therapy for the  Don’t assume patients will voluntarily seek
purpose of achieving definite outcomes that help or information if there are problems
improve the patients quality of life Hepler
and Strand WHAT A PHARMACIST CAN DO?
Patients on medications experience a lot of “drug
PHARMACEUTICAL CARE misadventures”– adverse effects, drug
 Applying knowledge to promote well- being interactions, errors in the use of
of others medication and non–compliance
 Requires responsiveness, sensitivity and MINIMIZE WASTE and MAXIMIZE
commitment to others BENEFITS of medical treatments
 Generalist practice that emphasizes health,
prevention and care OLD PARADIGM
 A form of primary health care  Emphasis on acute patient care
 Emphasis on treating illness
THE FOCUS  Responsible for individual patients
 Patient–centeredness  All providers are essentially similar
 Addressing both acute and chronic  Success achieved by increasing market
conditions share of in-patient admissions
 Emphasizing prevention  Goal is to fill beds
 Implementing documentation systems that  Hospitals, physicians, and health plans
continuously record patient need and care are separate
provided
 Being accessible to front–line first contact
 Ensuring integration of care
 Being accountable
 Placing emphasis on ambulatory patient
 Including education/health promotional
interventions
NEW PARADIGM
 Emphasis on the continuum of care
 Emphasis on maintaining and promoting
wellness
 Accountable for the health of define
populations
 Differentiation based on ability to add value
 Success achieved by increasing the number
of covered lives and keeping people well
 Goal is to provide care at the most
appropriate level
 Integrated health delivery system

THE ROLE OF THE NEW PHARMACIST

 Has evolved from being product–oriented to
a patient–oriented professional
 Extremely healthy for both patient and
pharmacist
 Dispensers of therapy and drug effect
interpretations as well as drugs

 In the future, pharmacy services must be

evaluated on patient outcome rather than the
number of prescriptions dispensed

 It must evolved towards interpretation and

patient consultation, related to the use of
medication technologies