Sequenced Treatment Alternatives to Relieve Depression ( STAR*D ) was a collaborative study on the treatment of depression , funded by the National Institute of Mental Health . Its main focus was on the treatment of depression in patients where the first prescribed antidepressant proved inadequate. A key feature of the study was its aim to be more generalizable to real clinical situations; this was done through the use of minimal exclusion criteria , incorporating patient preference, and not blinding the treatments (i.e. the patient and clinician both knew what treatment the patient was receiving). The STAR*D trial included remission (the near-absence of symptoms, rather than simply a reduction in symptoms) as an outcome measure, as there is evidence that patients with depression who achieve remission function better and are less prone to relapse than those who achieve only partial improvement in symptoms
60-432: This report had profound impact on the promotion of antidepressants but later accused of having been subjected to multiple levels of fraud. The STAR*D trial enrolled 4,041 outpatients with nonpsychotic depression at 23 psychiatric and 18 primary care sites. The trial was completed in 2006, and data from it has been available since 2008. The trial involved four different treatment levels, and patients were encouraged to enter
120-449: A 12-month naturalistic follow-up, during which time the researchers did not have any influence over the treatment plan. Non-remitters were encouraged to enter level two. In level two, there were seven different treatment options, and cognitive behavioral therapy (CBT) was included as the psychotherapy option. There were three combination options (either an antidepressant or CBT added to citalopram), and four switch options (to either
180-642: A basic framework for defining the sector, the United Nations' International Standard Industrial Classification categorizes health care as generally consisting of hospital activities, medical and dental practice activities, and "other human health activities." The last class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, patient advocates or other allied health professions . In addition, according to industry and market classifications, such as
240-404: A business relationship. In veterinary medicine , the client is the owner or guardian of the patient. These may be used by governmental agencies, insurance companies , patient groups, or health care facilities . Individuals who use or have used psychiatric services may alternatively refer to themselves as consumers, users, or survivors . In nursing homes and assisted living facilities,
300-552: A challenge for the design of ICT (information and communication technology) for home care. Because statistics show that over 80 million Americans have taken time off of their primary employment to care for a loved one, many countries have begun offering programs such as the Consumer Directed Personal Assistant Program to allow family members to take care of their loved ones without giving up their entire income. With obesity in children rapidly becoming
360-608: A clear correlation between worse quality and higher spending. Expand the OECD charts below to see the breakdown: The management and administration of health care is vital to the delivery of health care services. In particular, the practice of health professionals and the operation of health care institutions is typically regulated by national or state/provincial authorities through appropriate regulatory bodies for purposes of quality assurance . Most countries have credentialing staff in regulatory boards or health departments who document
420-459: A decade, medical errors are even more likely to happen in a doctor's office or outpatient clinic or center. A day patient (or day-patient ) is a patient who is using the full range of services of a hospital or clinic but is not expected to stay the night. The term was originally used by psychiatric hospital services using of this patient type to care for people needing support to make the transition from in-patient to out-patient care. However,
480-410: A different antidepressant or CBT). Those who remitted or responded were offered 12-month naturalistic follow-up; non-remitters after two medication trials were encouraged to enter level 3; other non-remitters entered level 2A, which involved a second antidepressant trial. In level three, patients were offered the addition of lithium or triiodothyronine (a thyroid hormone) to their antidepressant, or
540-496: A formal hospital admission or an overnight stay, and this is called outpatient surgery or day surgery, which has many benefits including lowered healthcare cost , reducing the amount of medication prescribed, and using the physician's or surgeon's time more efficiently. Outpatient surgery is suited best for more healthy patients undergoing minor or intermediate procedures (limited urinary-tract , eye , or ear, nose, and throat procedures and procedures involving superficial skin and
600-591: A gain of 10 years since 1970. The US (78.7 years) ranges only on place 26 among the 34 OECD member countries, but has the highest costs by far. All OECD countries have achieved universal (or almost universal) health coverage, except the US and Mexico . (see also international comparisons .) In the United States , where around 18% of GDP is spent on health care, the Commonwealth Fund analysis of spend and quality shows
660-474: A higher step, the chances of remission were smaller – and this decrease was particularly significant after level two. For those who did achieve full remission, there was a decreased chance of relapse at 12-month (naturalistic) follow-up compared to those patients who only responded. A reanalysis published in 2023 concluded that STAR*D’s cumulative remission rate was approximately half of that reported. Criticism of bias has been raised by certain researchers about
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#1733094189949720-441: A licensed independent practitioner such as a physiotherapist , or a non-physician primary care provider such as a physician assistant or nurse practitioner . Depending on the locality and health system organization, the patient may see another health care professional first, such as a pharmacist or nurse . Depending on the nature of the health condition, patients may be referred for secondary or tertiary care. Primary care
780-419: A major concern, health services often set up programs in schools aimed at educating children about nutritional eating habits, making physical education a requirement and teaching young adolescents to have a positive self-image. Health care ratings are ratings or evaluations of health care used to evaluate the process of care and health care structures and/or outcomes of health care services. This information
840-400: A primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check-ups and preventive care , health education , and every time they require an initial consultation about a new health problem. The International Classification of Primary Care (ICPC)
900-633: A short period of time for a brief but serious illness, injury, or other health condition. This care is often found in a hospital emergency department . Secondary care also includes skilled attendance during childbirth , intensive care , and medical imaging services. The term "secondary care" is sometimes used synonymously with "hospital care". However, many secondary care providers, such as psychiatrists , clinical psychologists , occupational therapists , most dental specialties or physiotherapists , do not necessarily work in hospitals. Some primary care services are delivered within hospitals. Depending on
960-986: A significant part of a country's economy , development, and industrialization . Health care is an important determinant in promoting the general physical and mental health and well-being of people around the world. An example of this was the worldwide eradication of smallpox in 1980, declared by the WHO, as the first disease in human history to be eliminated by deliberate healthcare interventions. The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams . This includes professionals in medicine , psychology , physiotherapy , nursing , dentistry , midwifery and allied health , along with many others such as public health practitioners , community health workers and assistive personnel , who systematically provide personal and population-based preventive, curative and rehabilitative care services. While
1020-988: A switch to another antidepressant ( mirtazapine or nortriptyline ). This continued for 12 weeks. Level four consisted of the monoamine oxidase inhibitor tranylcypromine or a combination of venlafaxine and mirtazapine . For level one, the remission rate was 28-33% (depending on the symptom scale used), and the response rate was 47%. Higher remission rates were seen in patients who were Caucasian, female, employed, or had higher levels of income or education . Lower remission rates were seen in those with longer depressive episodes , co-occurring anxiety or substance use disorders, and more physical illness. For level two, patients who received CBT, either alone or combined with citalopram , had similar response and remission rates compared to those who were receiving medication(s) only; however, for those patients who remained on citalopram, those who had another antidepressant added achieved remission more rapidly than those who had CBT added. Among
1080-411: Is a patient who attends an outpatient clinic with no plan to stay beyond the duration of the visit. Even if the patient will not be formally admitted with a note as an outpatient, their attendance is still registered, and the provider will usually give a note explaining the reason for the visit , tests , or procedure / surgery , which should include the names and titles of the participating personnel,
1140-494: Is a standardized tool for understanding and analyzing information on interventions in primary care based on the reason for the patient's visit. Common chronic illnesses usually treated in primary care may include, for example, hypertension , diabetes , asthma , COPD , depression and anxiety , back pain , arthritis or thyroid dysfunction . Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations . In
1200-481: Is called inpatient care . The admission to the hospital involves the production of an admission note . The leaving of the hospital is officially termed discharge , and involves a corresponding discharge note , and sometimes an assessment process to consider ongoing needs. In the English National Health Service this may take the form of "Discharge to Assess" - where the assessment takes place after
1260-417: Is considered necessary, regardless of whether the funding is from private insurance schemes or national health insurance . Allied health professionals , such as physical therapists , respiratory therapists , occupational therapists , speech therapists , and dietitians , also generally work in secondary care, accessed through either patient self-referral or through physician referral. Tertiary care
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#17330941899491320-574: Is often used as the term for the health care services that play a role in the local community. It can be provided in different settings, such as Urgent care centers that provide same-day appointments or services on a walk-in basis. Primary care involves the widest scope of health care, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health , and patients with all types of acute and chronic physical, mental and social health issues, including multiple chronic diseases . Consequently,
1380-502: Is seen from the analysis carried out each year by Bloomberg. Clearly this kind of analysis is flawed in that life expectancy is only one measure of a health system's performance, but equally, the notion that more funding is better is not supported. In 2011, the health care industry consumed an average of 9.3 percent of the GDP or US$ 3,322 ( PPP-adjusted ) per capita across the 34 members of OECD countries. The US (17.7%, or US$ PPP 8,508),
1440-622: Is sometimes used as an extension of tertiary care in reference to advanced levels of medicine which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centers. Many types of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance, distribution of condoms and needle-exchange programs for
1500-545: Is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital . Examples of tertiary care services are cancer management, neurosurgery , cardiac surgery , plastic surgery , treatment for severe burns , advanced neonatology services, palliative, and other complex medical and surgical interventions. The term quaternary care
1560-414: Is translated into report cards that are generated by quality organizations, nonprofit, consumer groups and media. This evaluation of quality is based on measures of: Access to healthcare may vary across countries, communities, and individuals, influenced by social and economic conditions as well as health policies . Providing health care services means "the timely use of personal health services to achieve
1620-647: The Global Industry Classification Standard and the Industry Classification Benchmark , health care includes many categories of medical equipment, instruments and services including biotechnology , diagnostic laboratories and substances, drug manufacturing and delivery. For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States. The United States dominates
1680-611: The Latin word patiens , the present participle of the deponent verb , patior , meaning 'I am suffering,' and akin to the Greek verb πάσχειν ( paskhein , to suffer) and its cognate noun πάθος ( pathos ). This language has been construed as meaning that the role of patients is to passively accept and tolerate the suffering and treatments prescribed by the healthcare providers, without engaging in shared decision-making about their care. An outpatient (or out-patient )
1740-544: The Netherlands (11.9%, 5,099), France (11.6%, 4,118), Germany (11.3%, 4,495), Canada (11.2%, 5669), and Switzerland (11%, 5,634) were the top spenders, however life expectancy in total population at birth was highest in Switzerland (82.8 years), Japan and Italy (82.7), Spain and Iceland (82.4), France (82.2) and Australia (82.0), while OECD's average exceeds 80 years for the first time ever in 2011: 80.1 years,
1800-481: The biopharmaceutical field, accounting for three-quarters of the world's biotechnology revenues. The quantity and quality of many health care interventions are improved through the results of science, such as advanced through the medical model of health which focuses on the eradication of illness through diagnosis and effective treatment. Many important advances have been made through health research, biomedical research and pharmaceutical research , which form
1860-815: The prevention , diagnosis , treatment , amelioration or cure of disease , illness , injury , and other physical and mental impairments in people. Health care is delivered by health professionals and allied health fields . Medicine , dentistry , pharmacy , midwifery , nursing , optometry , audiology , psychology , occupational therapy , physical therapy , athletic training , and other health professions all constitute health care. The term includes work done in providing primary care , secondary care , tertiary care , and public health . Access to healthcare may vary across countries, communities, and individuals, influenced by social and economic conditions and health policies . Providing health care services means "the timely use of personal health services to achieve
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1920-536: The social model of health and disability , which emphasizes the societal changes that can be made to make populations healthier. Results from health services research often form the basis of evidence-based policy in health care systems. Health services research is also aided by initiatives in the field of artificial intelligence for the development of systems of health assessment that are clinically useful, timely, sensitive to change, culturally sensitive , low-burden, low-cost, built into standard procedures, and involve
1980-451: The STAR*D trial: Patient A patient is any recipient of health care services that are performed by healthcare professionals . The patient is most often ill or injured and in need of treatment by a physician , nurse , optometrist , dentist , veterinarian , or other health care provider . The word patient originally meant 'one who suffers'. This English noun comes from
2040-416: The United States, the 2013 National Health Interview Survey found that skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most common reasons for accessing a physician. In the United States, primary care physicians have begun to deliver primary care outside of
2100-662: The basis for evidence-based medicine and evidence-based practice in health care delivery. Health care research frequently engages directly with patients, and as such issues for whom to engage and how to engage with them become important to consider when seeking to actively include them in studies. While single best practice does not exist, the results of a systematic review on patient engagement suggest that research methods for patient selection need to account for both patient availability and willingness to engage. Health services research can lead to greater efficiency and equitable delivery of health care interventions, as advanced through
2160-501: The best possible health outcomes". Factors to consider in terms of healthcare access include financial limitations (such as insurance coverage), geographical and logistical barriers (such as additional transportation costs and the ability to take paid time off work to use such services), sociocultural expectations, and personal limitations (lack of ability to communicate with health care providers, poor health literacy , low income). Limitations to health care services affect negatively
2220-502: The best possible health outcomes". Factors to consider in terms of healthcare access include financial limitations (such as insurance coverage), geographical and logistical barriers (such as additional transportation costs and the ability to take paid time off work to use such services), sociocultural expectations, and personal limitations (lack of ability to communicate with health care providers, poor health literacy , low income). Limitations to health care services affects negatively
2280-589: The center, and especially that patients themselves are heard loud and clear within health services. There are many reasons for why health services should listen more to patients. Patients spend more time in healthcare services than regulators or quality controllers, and can recognize problems such as service delays, poor hygiene, and poor conduct. Patients are particularly good at identifying soft problems, such as attitudes, communication, and 'caring neglect', that are difficult to capture with institutional monitoring. One important way in which patients can be placed at
2340-413: The centre of healthcare is for health services to be more open about patient complaints. Each year many hundreds of thousands of patients complain about the care they have received, and these complaints contain valuable information for any health services which want to learn about and improve patient experience. Health care Health care , or healthcare , is the improvement of health via
2400-607: The centre of healthcare, when institutional procedures and targets eclipse local concerns, then patient neglect is possible. Incidents, such as the Stafford Hospital scandal , Winterbourne View hospital abuse scandal and the Veterans Health Administration controversy of 2014 have shown the dangers of prioritizing cost control over the patient experience. Investigations into these and other scandals have recommended that healthcare systems put patient experience at
2460-470: The context of global population aging , with increasing numbers of older adults at greater risk of chronic non-communicable diseases , rapidly increasing demand for primary care services is expected in both developed and developing countries. The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy. Secondary care includes acute care : necessary treatment for
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2520-438: The definitions of the various types of health care vary depending on the different cultural , political, organizational, and disciplinary perspectives, there appears to be some consensus that primary care constitutes the first element of a continuing health care process and may also include the provision of secondary and tertiary levels of care. Health care can be defined as either public or private . Primary care refers to
2580-405: The difference was not statistically significant. However, more patients receiving lithium than triiodothyronine left the study due to side effects. For level four, the average remission rate was 13%, with no statistically significant difference between tranylcypromine and the venlafaxine/mirtazapine combination. More patients receiving tranylcypromine left the study due to side effects. Overall,
2640-510: The extremities). More procedures are being performed in a surgeon 's office, termed office-based surgery , rather than in a hospital-based operating room . An inpatient (or in-patient ), on the other hand, is "admitted" to stay in a hospital overnight or for an indeterminate time, usually, several days or weeks, though in some extreme cases, such as with coma or persistent vegetative state , patients can stay in hospitals for years, sometimes until death . Treatment provided in this fashion
2700-515: The managed care (insurance-billing) system through direct primary care which is a subset of the more familiar concierge medicine . Physicians in this model bill patients directly for services, either on a pre-paid monthly, quarterly, or annual basis, or bill for each service in the office. Examples of direct primary care practices include Foundation Health in Colorado and Qliance in Washington. In
2760-410: The next level of treatment if they failed to achieve remission or response (50% reduction in symptoms) after a specified number of weeks. In level one, patients received the selective serotonin reuptake inhibitor (SSRI) citalopram for up to 14 weeks, with adjustment of the dose being managed by their own physicians. If patients achieved remission or response during that time period, they could enter
2820-400: The organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care. In countries that operate under a mixed market health care system, some physicians limit their practice to secondary care by requiring patients to see a primary care provider first. This restriction may be imposed under
2880-425: The patient has gone home. Misdiagnosis is the leading cause of medical error in outpatient facilities. When the U.S. Institute of Medicine 's groundbreaking 1999 report, To Err Is Human , found up to 98,000 hospital patients die from preventable medical errors in the U.S. each year, early efforts focused on inpatient safety. While patient safety efforts have focused on inpatient hospital settings for more than
2940-411: The patient's name and date of birth , signature of informed consent , estimated pre-and post-service time for history and exam (before and after), any anesthesia , medications or future treatment plans needed, and estimated time of discharge absent any (further) complications . Treatment provided in this fashion is called ambulatory care . Sometimes surgery is performed without the need for
3000-544: The patient. There are generally five primary methods of funding health care systems : In most countries, there is a mix of all five models, but this varies across countries and over time within countries. Aside from financing mechanisms, an important question should always be how much to spend on health care. For the purposes of comparison, this is often expressed as the percentage of GDP spent on health care. In OECD countries for every extra $ 1000 spent on health care, life expectancy falls by 0.4 years. A similar correlation
3060-563: The patients who were switched to a different antidepressant, there was no significant difference among the different antidepressants. For level three, the remission rates based on the HAM-D symptom scale were 12.3% for mirtazapine and 19.8% for nortriptyline, although the difference was not large enough for statistical significance. The remission rates based on the HAM-D in the combination strategy were 15.9% for lithium and 24.7% for triiodothyronine, but
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#17330941899493120-553: The prevention of transmissible diseases. They also include the services of professionals in residential and community settings in support of self-care , home care , long-term care , assisted living , treatment for substance use disorders among other types of health and social care services. Community rehabilitation services can assist with mobility and independence after the loss of limbs or loss of function. This can include prostheses , orthotics , or wheelchairs . Many countries are dealing with aging populations, so one of
3180-577: The priorities of the health care system is to help seniors live full, independent lives in the comfort of their own homes. There is an entire section of health care geared to providing seniors with help in day-to-day activities at home such as transportation to and from doctor's appointments along with many other activities that are essential for their health and well-being. Although they provide home care for older adults in cooperation, family members and care workers may harbor diverging attitudes and values towards their joint efforts. This state of affairs presents
3240-461: The study findings indicate that patients who do not achieve remission or response after several weeks of citalopram treatment could achieve those outcomes by the end of 14 weeks. The STAR*D researchers state that their data "suggest that a patient with persistent depression can get well after trying several treatment strategies, but his or her odds of beating the depression diminish as additional treatment strategies are needed." With failed treatment at
3300-472: The term resident is generally used in lieu of patient . Similarly, those receiving home health care are called clients . The doctor–patient relationship has sometimes been characterized as silencing the voice of patients. It is now widely agreed that putting patients at the centre of healthcare by trying to provide a consistent, informative and respectful service to patients will improve both outcomes and patient satisfaction. When patients are not at
3360-457: The term is now also heavily used for people attending hospitals for day surgery. Because of concerns such as dignity , human rights and political correctness , the term "patient" is not always used to refer to a person receiving health care. Other terms that are sometimes used include health consumer , healthcare consumer , customer or client . However, such terminology may be offensive to those receiving public health care , as it implies
3420-410: The terms of the payment agreements in private or group health insurance plans. In other cases, medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred. In other countries patient self-referral to a medical specialist for secondary care is rare as prior referral from another physician (either a primary care physician or another specialist)
3480-626: The use of medical services, the efficacy of treatments, and overall outcome (well-being, mortality rates). Health care extends beyond the delivery of services to patients, encompassing many related sectors, and is set within a bigger picture of financing and governance structures. A health system , also sometimes referred to as health care system or healthcare system , is the organization of people, institutions, and resources that deliver health care services to populations in need. The healthcare industry incorporates several sectors that are dedicated to providing health care services and products. As
3540-650: The use of medical services, the efficacy of treatments, and overall outcome (well-being, mortality rates). Health systems are the organizations established to meet the health needs of targeted populations. According to the World Health Organization (WHO), a well-functioning healthcare system requires a financing mechanism, a well-trained and adequately paid workforce , reliable information on which to base decisions and policies , and well-maintained health facilities to deliver quality medicines and technologies. An efficient healthcare system can contribute to
3600-401: The work of health professionals who act as a first point of consultation for all patients within the health care system . The primary care model supports first-contact, accessible, continuous, comprehensive and coordinated person-focused care. Such a professional would usually be a primary care physician , such as a general practitioner or family physician . Another professional would be
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