Personal Health Services Health Article

SOURCES OF PERSONAL HEALTH CARE

There are many sources of personal health care for individuals. These include institutional settings; emergency departments; practitioners' offices; special clinical settings, such as ambulatory surgical centers; and less formal clinical settings in schools, workplaces, and recreational facilities. Formal health services, depending on how they are defined, can be received almost anywhere, including the modest community facilities of some developing countries, sites where nutrition advice or psychological counseling are offered, long-term care facilities, retail pharmacies, and ambulances and other medical transport units. Today, more personal health care encounters occur in the ambulatory setting than in all other settings combined. In fact, the proportion of encounters occurring in institutional settings, such as hospitals, nursing homes, chronic-care facilities, rehabilitation units, and some hospice programs, is generally declining. There are several reasons for this, including their increased geographic distance from most persons, their generally higher costs, the intense amount of requisite labor and technology, and their lesser desirability to patients.

An increasing amount of personal health care is being brought into the home; and sometimes this care can be as complex as that occurring in many ambulatory care or institutional settings. Complex treatments, various kinds of medications, physical or occupational therapy, and chore services have all been brought to the home for reasons of efficiency, quality-of-life, and convenience. Electronic technologies have also brought personal health care into the home in the form of telemedicine. This can represent a great many forms of care, including routine conversations with health professionals, educational activities with health educators or other professionals, automated educational activities or queries about health status, disease management reminders, videoconferencing, and the transmission of physiological and biochemical information relevant to medical practice. Telemedicine has also been used to provide personal health care in special remote settings, such as jobsites or in the military.

The context of care for individual illnesses or for prevention and health promotion also includes less formal health care and healing activities that are not conducted by health professionals. Two of the most important types of informal care are care-giving, which is provided by lay social networks and organizations, and self-care. The most important lay caregivers are families, but such care may also be provided by other relatives, friends, colleagues, the clergy, or representatives of charitable organizations. This source of care cannot be underestimated in terms of amount or importance, and it is an essential complement to formal caregiving within or outside the home, particularly for those with chronic illness and disability. Caregivers assist with major or minor aspects of personal care, including: (a) dispensing of medications and other treatments, (b) providing appropriate nutrition and exercise regimens, (c) assistance with basic personal hygienic activities, (d) general care of children, elders, and those with special needs, (e) transportation to medical facilities or other locations, (f) physiological monitoring, and (g) emotional support through complex illnesses. Caregiving may be extremely burdensome to the caregiver, and it may be detrimental to their emotional and health status.

Self-care is also a necessary and integral part of personal health care. It takes many forms and is often derived from experiences and education within the mainstream care system. Most persons with acute and chronic illnesses must take part in their own care. This might involve physiological and biochemical monitoring, such as blood pressure or blood sugar for diabetes mellitus; communicating a changing health status and symptom manifestations; actively complying with treatment regimens; and even modulation of specific treatments according to signs, symptoms, and other personal data. Self-care also involves health promotion and disease prevention. Much of the burden of maintaining healthful behavior falls to individuals themselves, and while there should be adequate educational and informational resources, including health professional counseling, personal attention to minimizing disease risk and maximizing health status remains critical.

As noted in the introduction, no matter how the mainstream healing system is constituted, there are often alternative healing systems and practices. In most Western societies, a substantial amount of "healing" and perceived prevention comes from alternative or complementary healers and from personal self-care practices. For example, in Western countries, there are many forms of alternative prevention or healing activities that lie outside the orthodox allopathic health care system, and these are often used simultaneously within mainstream care. A substantial proportion of persons take a variety of herbs, nutrition supplements, and other products for health purposes without instructions from mainstream sources. It is likely that all cultures, to a varying extent, indulge in multiple healing systems and practices, and conflicts among them to become dominant are often contentious.