Quality Management In Health Care - Research Paper Example

Quality Management In Health Care Table of Contents Quality Management In Health Care 1 Table of Contents 1 Introduction 1 Presentation and Development of the Controversial Issue 2 Health Care In The United States Introduction The United States health care system is complex network consisting of several thousands of health organizations and millions of health specialist that deliver health services to the citizens of the United States. This network works with several other governments and multinational organizations in order to protect the citizen's health domestically and globally. (Glasper & Pogson, 2000) The U.S. health care system is characterized by an enormous diversity, complexity, and dynamism of its elements. Besides differing by types of care delivered across the continuum, system components vary from relatively simple individual physician practices to large, complex organizations such as academic medical centers. Relationships among system components are constantly evolving in response to shifting market dynamics. The growing predominance of chronic illness, and the search for less costly delivery settings, post acute and long-term mental and physical health care services are increasingly important.( Huq & Martin , 2005) Expenditures for nursing homes and home health care have grown as a percentage of NHE from 8% or $48.9 billion in 1988, to 13.2% or $171.5 billion in 2000. Presentation and Development of the Controversial Issue Medication is one of the most important tool for the health care and psychological field in the United States used to help treat people with mental health problems and psychological abnormalities. (Carson, K. D., Carson , Roe, C. W., Birkenmeie & Phillips, J. C., 1999). Statement of Problem During past decade, mental health researchers and professionals have seen a rise in the number of prescriptions being given to mental health patients in the United States, especially to children. Keeping that in mind, it has been tried to find if overmedicate these mental health patients in the U.S? Nursing homes are the principal institutions for long-term care delivery to patients with mental health issues. In 2000, there were 17 thousand federally qualified nursing homes in the United States. Medicaid is the primary payer for nursing home services, accounting for 68% of nursing home patients in 1999. Medicare covers only a small percentage of nursing home services, accounting for 9% of patients in 1999. (Grol, R., 2001) In contrast to hospitals, two thirds of all of nursing homes are under private, for-profit ownership. Hospitals and inpatient care have long been a central feature of the U.S. health care services industry. (Huq, Z., & Martin, T., 2005) With the development of antibiotics and improved surgical techniques and anesthesia in the mid-20th century, the hospital became the hub for the practice of medicine, earning its designation as “the physician's workshop.” Hospital care accounted for $412.1 billion, or 32% of NHE, in 2000, representing the largest category of health care spending. Position A Mental health Researchers like Dr. Julie Zito are anxious about the increasing statistical and computerized data showing a rise of over medication to these mental patients in the United States, found specially in young population of U.S with Attention-Deficit/Hyperactivity Disorder (ADHD). According to Dr. Julie Zito's findings, the number of kids using medication in order to control behavior in the 1990's have grown to nearly the number of adults using these drugs. In addition, from 1987 to 1996, psychiatric drug prescriptions tripled in children and young adults (up to age 20) who were patients in HMO's in the Midwest. Moreover, about 6 percent of the nearly 900,000 children studied had prescriptions for psychiatric medication such as Ritalin and other stimulants which were prescribed most often, with antidepressants second, and mood stabilizers third (2003). With this information in mind, the consequences of children been overmedicated can lead to serious side effects. Repercussions from over medicating children can have physiological effects such as: poor appetite, insomnia, irritability, headaches, stomachaches, and so on (Harrison). In addition, some children develop a physical dependence on the medication that can possibly lead to substance abuse with this and other drugs in the future. One of the worse side affects of all is that overmedicating takes away from a child's spontaneity or "spark" and they progressively act like robots. As the number of Americans requiring long-term care services has grown, the industry has responded with innovative approaches to long-term care. Adult day care programs offer community-based day care as an alternative to institutionalization. Assisted living facilities provide residents support for activities of daily living while allowing them to maintain independence. (McKinley, C. O., Parmer,E., Saint-Amand A., & Darbin, (2006) Continuing care retirement communities enable residents to transition from independent to assisted living, and then to skilled nursing facilities as their health needs change. Health care systems of most industrialized nations are governed by a central authority that specifies how the components will link to each other. The mental health care system in the United States, however, is highly fragmented, having evolved as a result of government policies and economic, technological, and social forces into a loosely linked network of public and private providers, payers, financing arrangements, and payment mechanisms. Position B In contrast to research that suggests over medicating mental patients in the United States (especially children with ADHD); other researchers believe that there is a lack of medicating among mental patients. For instance, data has shown that 3-13% of children have symptoms of ADHD, yet only 2-3% are receiving treatment. In addition, treatment rates are much lower for girls, minorities, and children receiving care through public service systems (Quinn).         Other information has also shown that the mental patients that do receive professional care have higher success rates with medication and/or integrated with medication in other types of therapy. (Bodenheimer, T. , 2006) One study according to the MTA Cooperative Group, studied a 14-month clinical trial of treatment strategies for children suffering from ADHD found that while behavioral treatment and community scored fairly well in treating children with the disorder, medication management did slightly better (1999). Moreover with regular medication management, children with ADHD improved in attentiveness in the classroom, and can help avoid a humiliating situation of visiting the nurse to receive medication or going to behavioral therapy sessions while in school. Presentation and Defense of Your Position In this controversial issue of whether mental patients are being over medicated or not in the United States, I firmly believe that we do over medicated patients, especially children. However, there are a few flaws that I acknowledge in my position. As any parent would know, children can be a hand full. Children are typically described as active, spontaneous, and unattentive. However, for many parents, they believe that these child characteristics are symptoms of Attention- Deficit/Hyperactivity Disorder (ADHD). As a result, Americans are quick to decide that their children have an absolute problem that can not be fixed on the parents' helped alone, and rely on mental health professionals to "fix" their children's problem. Many resort to medications such as Ritalin, Concerta, and anti-depressants. (Harrison, D., 2000) However, because of parents trying to find a quick fix for their children to have a "normal" personality, children are often over-diagnosis and over medicated. As a result, we have seen a 500 percent increase of the use of Ritalin in the United States since 1990. Another reason why mental patients are being over medicated is that many of the drugs that are suppose to help the patient with their illness have serious side effects that develop into physiological problems. As a result, these side effects are sometimes misinterpreted by mental health professionals as other illnesses and are treated with more drugs. (McKinley, C. O., Parmer,E., Saint-Amand A., & Darbin, (2006) Consequently, the drugs that are suppose to help the patient for his/her illness is doing more harm than good. In addition to the physiological effects that happen to the patients, many of them develop substance abuse. For example, according to a governmental hearing report dealing with the overmedication of children with ADHD, they found that "...Journal of American Medicine Association showed that Ritalin was a more potent transport than cocaine...One study, found more drug addiction in children with ADHD who took Ritalin compared with children with ADHD who took no drug..." (2002). From this information, its no wonder why children are growing up to be drug addicts and impairing themselves to be productive citizens. While I support the findings that overmedication is becoming an epidemic in this country, the research does have its flaws. For instance, according to Dr. Susan Candace Dosreis, she reported that while Caucasians boys are more likely to be diagnosis and treated with medication for ADHD than non-Caucasians, more research was needed to corroborate these findings (2000). In addition, most researchers believe that much of the increase of stimulants for treatment reflects a more effective treatment especially if it is combined with behavioral therapy. ( Stewart, M. A., 2004) Implications and Application         The reason I picked children with ADHD as the focus of my position of why mental patients are being over medicated in the United States is because this is one of many increasing trends that reflect the country today. Many of us think that we are supposed to act a certain way, and if we do not, we have a problem. And to some extent, some people do have a problem however we don't have to jump the gun and start taking medications to fix it. ( MTA Cooperative Group, 1999) Taking medication is not the only option people have to treat their mental illness, options such as behavioral therapies have proved to be helpful in curing mental illness over the years. Conquently, so many of us should not experience those painful side effects that occur. At last, it is believed that more research needs to be practiced in order to correlate overmedication with certain groups in the United States as when we do, after that maybe we can educate our youth and other citizens that a psychological problems can be resolved within ourselves with our own minds instead of using drugs. Conclusion In conclusion it has been observed that researchers and mental health specialist believe that the most important points to noted are whether parents of the patient receive a balanced description of every possible intervention, it should be considered that both the effected child and parents should participate in service-delivery process, there should be equitable funding for all the proven treatments. It has been suggested by the specialists to spend equal amount of time, money and effort in order to improve performance of psycho social behavior of the society as we spend on the pharmacological intervention. Works Cited Bodenheimer, T. (2006). The American health care system-the movement for improved quality in health care. The New England Journal of Medicine, pg 488-492. Carson, K. D., Carson P. P., Roe, C. W., Birkenmeier, B. J., & Phillips, J. C. (1999). Four commitment profiles and their relationships to empowerment, service recomvery, and work attitudes. Public Personnel Management, pg 1-13. Glasper, E. A., & Pogson, D. (2000). Who is responsible for quality improvement? British Journal of Nursing, pg 461. Grol, R. (2001). Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction. JAMA, pg 2578-2585. Harrison, D. (2000, Aug). Attention Deficit-Hyperactivity: Special education report. Medical Review, 26 (18), 135. Huq, Z., & Martin, T. N. (2005). Workforce cultural factors in TQM/CQI implementation in hospitals. Quality Management in Health Care, pg 43-57. McKinley, C. O., Parmer,E., Saint-Amand A., & Darbin, (2006). Performance improvement organizations quest. Quality Management in Health Care, pg 50-59. MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073-1086. Stewart, M. A. (2004). Effective physician-patient communication and health outcomes: A review. Canadian Medical Association Journal, pg 1423-1433 Zito, J. (2003, January). Research on the use of psychiatric drugs in children. Mind and Spirit. (16)4, 87-89. Read More