Akademik

In medicine and public health, a general term for the application of knowledge to the benefit of a community or individual.

- comprehensive medical c. a concept that includes not only the traditional c. of the acutely or chronically ill patient, but also the prevention and early detection of disease and the rehabilitation of the disabled.

- end-of-life c. multidimensional and multidisciplinary physical, emotional, and spiritual c. of the patient with terminal illness, including support of family and caregivers.End-of-life c. has received increasing attention in recent years. The pioneer studies of Elisabeth Kübler-Ross on death and dying, begun in the 1960s, have afforded valuable insights into the evolving emotions, experiences, and needs of the dying person. Health professionals have formally recognized the importance of rendering humane and competent c. at the end of life in ways that preserve the dignity and autonomy of the patient. Physicians, particularly oncologists, who treat patients with terminal illness have focused on the need to distinguish clearly between aggressive and palliative forms of treatment and to establish guidelines for the c. of patients for whom further cure-oriented treatment will be of no benefit. In particular, they have recognized the importance of providing adequate pain relief to persons with advanced cancer. Increased attention has also been given to the control of nausea and dyspnea, which often occur in terminal illness. Studies have shown that pain relief in terminal patients is often inadequate because physicians fear to induce narcotic addiction or to be accused of hastening death. Wider use of opioid analgesics and development of patient-controlled analgesia and anesthesia systems have improved control of pain in terminal cancer and AIDS. Professional nurses have embraced the obligation to provide relief of suffering, comfort, companionship, and, when possible, a death that is congruent with the dying person's wishes. The hospice movement has established programs and facilities within the organized health c. system that focus on the special needs of dying persons for comfort and c. rather than efforts at cure. These programs include support of caregivers and family members during and after the patient's final illness. End-of-life c. emphasizes the importance of frank, timely, supportive discussion of such matters as preferences for life-extending c., including cardiopulmonary resuscitation, before such measures become necessary. Legislatures have sought to preserve the dignity and independence of persons nearing the end of life by allowing them to enact advance directives for their c. in the event that they become incompetent or comatose. The integrity of the relationship between patients and health professionals has been threatened by growing social and legal toleration of physician-assisted suicide. The American Medical Association and the American Nurses Association have issued official position statements opposing assisted suicide. See Also advance directive; physician-assisted suicide.

- health c. services provided to individuals or communities by agents of the health services or professions for the purpose of promoting, maintaining, monitoring, or restoring health.

- intensive c. management and c. of critically ill patients. SEE ALSO: intensive c. unit.

- managed c. a contractual arrangement whereby a third-party payer (e.g., insurance company, government agency, or corporation) mediates between physicians and patients, negotiating fees for service and overseeing the types of treatment given. SEE ALSO: health maintenance organization.Managed c. has largely replaced traditional medical indemnity insurance plans, under which payment is automatic and oversight procedures are minimal. Under managed c., the third-party payer controls specialty referrals, chiefly by appointing primary c. physicians as “gatekeepers”; restricts the scope of covered services (particularly diagnostic procedures, choice of drugs prescribed, and length of hospital stay) for each diagnosis; and requires precertification review before hospital admission and a second opinion before elective surgery. Standards of c. are regulated by practice guidelines, which may be set forth in oversimplified algorithms featuring binary (yes/no) choices. Prescribing alternatives are typically restricted to drugs listed in the plan's formulary. Practice guidelines, formulary choices, and other policies affecting patient c. incorporate contemporary medical knowledge and professional standards but also strongly reflect strategies for loss control and for the even distribution of actuarial risk over all beneficiaries. The plan may bargain with physicians, hospitals, diagnostic laboratories, and pharmacies for wholesale prices, or may compensate providers by capitation rather than by fees for services. Managed c. organizations typically employ cost-containment measures such as emphasis on preventive medicine, audits of medical records, intensive review of claims, and punitive action against noncompliant providers.

- medical c. the portion of c. under a physician's direction.

- primary medical c. c. of a patient by a member of the health c. system who has initial contact with the patient.

- secondary medical c. medical c. by a physician who acts as a consultant at the request of the primary physician.

- tertiary medical c. specialized consultative c., usually on referral from primary or secondary medical c. personnel, by specialists working in a center that has personnel and facilities for special investigation and treatment.

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care 'ka(ə)r, 'ke(ə)r n responsibility for or attention to health, well-being, and safety see ACUTE CARE, HEALTH CARE, INTENSIVE CARE, PRIMARY CARE, TERTIARY CARE

care vi, cared; car·ing