Patient dumping

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Patient_dumping 

Homeless veteran receives medical treatment. Homeless patients are one of the groups who are especially vulnerable to patient dumping.

Patient dumping or homeless dumping is the practice of hospitals and emergency services inappropriately releasing homeless or indigent patients to public hospitals or on the streets instead of placing them with a homeless shelter or retaining them, especially when they may require expensive medical care with minimal government reimbursement from Medicaid or Medicare. The term homeless dumping has been used since the late 19th century and resurfaced throughout the 20th century alongside legislation and policy changes aimed at addressing the issue. Studies of the issue have indicated mixed results from the United States' policy interventions and have proposed varying ideas to remedy the problem.

History

Early history

The term "patient dumping" was first mentioned in several New York Times articles published in the late 1870s, which described the practice of private New York hospitals transporting poor and sickly patients by horse drawn ambulance to Bellevue Hospital, the city's preeminent public facility. The jarring ride and lack of stabilized care typically resulted in death of the patient and outrage of the public. Scholars report that private hospital administrations were motivated by a desire to keep mortality rates and costs down when they advised ambulance drivers to send poor patients in critical condition directly to the public hospitals like Bellevue even if a private hospital was closer. After the deaths associated with patient dumping or inappropriate patient transfer added up, the first attempt at legislative reform in the United States was pushed through the New York Senate around 1907, largely by Julius Harburger. The legislation penalized private hospitals when they sent ill patients away or obligated staff to transfer them to another hospital. Notwithstanding the passage of city ordinances prohibiting the practice, it continued. The practice of patient dumping continued for several decades, and in the 1960s it was brought back into the public eye by the media, but not much was done to resolve the issue. Many homeless people who have mental health problems can no longer find a place in a psychiatric hospital because of the trend towards mental health deinstitutionalization from the 1960s onwards. It continues to this day especially in New York City, where Bellevue receives a large share of Manhattan's indigent.

1980s resurface in the public eye and policy interventions

"Patient dumping" resurfaced in the 1980s, nationwide, with private hospitals refusing to examine or treat the poor and uninsured in the emergency departments (ED) and transferring them to public hospitals for further care and treatment. In 1987 33 complaints of patient dumping were made to the US Department of Health and Human Services, and the following year 1988, 185 complaints were made. Since private hospitals ceased publishing their mortality rates, analysts pointed to high costs of dealing with Medicaid's reimbursements and uninsured patients as the motivation. This refusal of care resulted in patient deaths and public outcry culminating with the passage of a federal anti-patient dumping law in 1986 known as the Emergency Medical Treatment and Active Labor Act (EMTALA). In 1985 the Consolidated Omnibus Budget Reconciliation Act (COBRA) was passed which was meant to regulate how patients were transferred and also end patient dumping. COBRA was not a complete solution, and in the years after its passage hospitals struggled with creating appropriate discharge protocols and the cost of providing health care for homeless patients. Statistically, Texas and Illinois had the highest rates of patient dumping because of economic difficulties. Researchers have reported that the language in COBRA was not precise enough to significantly disincentivise healthcare providers to discontinue patient dumping practices. For example, in the 1980s Texas state law had a loop hole that allowed hospitals to transfer patients to nursing homes.

Early 21st century policy

Homeless dumping continued to be an issue in the United States into the 21st century. University of California Los Angeles professor Abel (2011) claimed that these policy interventions have not been effective because the United States' health care system is too heavily influenced by the patients ability to pay. In the early 21st century, illegal immigrants were reportedly subject to patient dumping by being deported or repatriated. Research articles also describe dumping of homeless individuals or mentally ill individuals by police as another form of inappropriately shifting people from one area of a city to another instead of taking them to adequate care facilities like shelters. In September 2014, the U.S. Commission on Civil Rights issued a report entitled "Patient Dumping".

Statistics

A report published in 2001 by Public Citizen's Health Research Group stated that there were widespread violations of EMTALA throughout the United States in 527 hospitals. Between 2005 and 2014 another study reported 43% of the US hospitals studied had been under EMTALA investigation which resulted citations for 27% of the hospitals. The other findings of this study were that the number of EMTALA violations have been decreasing for the period between 2005 and 2014, and that the majority of the citations were given to hospitals for issues with policy enforcement. However, there is not a consensus among researchers about how to effectively measure the effects of EMTALA at reducing patient dumping or improving patient care.

Associated factors

Patients living in poverty or in homelessness are often seen as less than ideal patients for hospital administrations because they are unlikely to be able to pay for their healthcare and tend to be hospitalized with severe illness. Other factors associated with patient dumping are being part of a minority group and being uninsured. Historically, hospitals have been reported to compete against each other to maintain low mortality rates at the expense of low-income patients. Competition within hospitals to see more patients and faster also increases the rate of inappropriate patient discharges.

Some researchers and scholars trace the issue of homeless dumping to the issue of homelessness and claim that addressing the issues of homelessness will prevent patient dumping. The increase of homelessness and poverty rates increases the number of people who are unable to pay for consistent healthcare which leads to emergency hospitalization of patients with exacerbated medical conditions. Social factors have allowed homelessness and poverty rates to further increase, and deinstitutionalization has led to psychiatric patients to lose access to services and be dumped on the streets.

Intervention strategies

The introduction of Medicaid and Medicare had helped hospitals shoulder the burden of providing care to poverty-level and elderly patients, but the many people in United States without health insurance were still vulnerable to inappropriate patient transfer or dumping. Scholars and researchers point to these patients' lack of access to preventative and consistent healthcare treatment as well as inappropriate discharge procedures and follow-up protocols as the causes behind the frequent rehospitalization.

In 1985 Illinois developed the Illinois Competitive Access and Reimbursement Equity (ICARE) program, but it had adverse effects like disrupting indigent patient's continuity of care, losing patients, and creating two hospital systems: one for uninsured lower-income patients and one for insured higher-income patients. The ICARE policy had a negative impact on the quality of healthcare that low-income and homeless patients received because it created disjointed treatment experiences when hospitals met their allocated funding quota and transferred patients to (or dumped patients on) other hospitals that still had funding and public hospitals. Proponents of the ICARE policy cited the reduction in Illinois' Medicare expenditure as evidence of the policy's success.

The 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) was meant to regulate Medicare-participating hospitals and ensure that patients received appropriate medical treatment regardless of their ability to pay. Some scholars described how EMTALA provided a means to take legal action against healthcare providers and hospitals that did not comply, and provided examples of cases in Florida, California, and North Carolina. Even though hospitals have had to pay penalties, patient dumping remained an issue throughout the country. Legal scholars Kahntroff and Watson (2009) also reported that the implementation of the policy has been flawed with issues of lack of adherence and confusion on what is compliance. A study that looked at 5,594 hospitals in the United States between 2005 and 2014 reported that the number of EMTALA investigations has decreased through that period which may be an indication that hospitals and physicians are improving their adherence to EMTALA protocols. The decrease in EMTALA investigations might also indicate that patient access to emergency care and treatment is improving. Researchers also interviewed doctors who reported that EMTALA citation fines were a disincentive to violate EMTALA protocols.

In 1988 the COBRA Act was meant to be a series of revised regulations which required hospital emergency rooms to treat every patient that walked through the door and doubled the fine for violations. News Editor for the American Journal of Nursing, Brider (1987), reported that public hospital staff in Illinois were under a lot of pressure due to the influx of patients that were being sent to them from other hospitals, and that the incidence of patient transfers or patient dumping increased through a loophole in COBRA.

The incentives offered to doctors in terms of payment for their services have an effect with patient care outcomes and can minimize the chance of patient dumping or shifting patients to other providers. A study conducted on doctors at the Fairview Health Services hospital in Minnesota reported that grouping doctors into teams to incentivize collaboration between the doctors to ensure the average of the team provided high quality health care for the patient. But doctors who out performed other doctors on their teams did not like the program because the other doctors who were underperforming did not have the incentive to improve. Some of the doctors interviewed in the study claimed that underperforming doctors would only start providing better care if their pay was affected by their lower quality services.

Discussion of intervention strategies

Some researchers and scholars have concluded that despite the policy interventions of the 1980s, the practice of patient dumping continued to be a problem in the United States and that a solution required a reformation of the entire healthcare system. These researchers shared the opinion that the most effective solution to address the health care needs of people living in poverty and those who are homeless is to provide universal healthcare because that would eliminate hospitals incentives to turn patients away based on their ability to pay for services. Other researchers emphasize that better developed protocols and procedures for patient discharge are one of the most important strategies to reduce rehospitalization rates because patients living in homelessness and poverty lack appropriate dwelling to continue the recuperation process. Another strategy to minimize rehospitalization rates proposed by researchers was to create recuperation programs for patient who lack access to one after they are discharge. Respite programs can be especially helpful for homeless patients to have safe places to recuperate and stop the cycle of chronic re-admittance. A study conducted using information about homeless patients in New Haven, Connecticut, reported that homeless patients had a 22% higher hospital readmittance rate than patients with insurance.

Regional or community wide programs to oversee under-resourced patient recuperation or respite care seem to be the most sustainable because they pool resources from multiple hospitals and a larger population to provide appropriate recuperation facilities and minimize the risk of any one hospital or healthcare facility from having to provide the majority of the resources and cost associated with the increase of patients from the area's underserved patient population. Researchers say that the cost of rehospitalizing patients for more critical conditions is higher than the cost of providing appropriate healthcare and following careful patient discharge procedures, which in some cases are beyond the requirements outlined by policies like the EMTALA.

However, there are studies that have indicated that hospitals sometimes face delays when discharging a homeless patient because they also have the responsibility of finding appropriate housing and care. Extended hospitalization increases the chance of infectious disease transmission and draws resources from other patients.

Global perspective

Canada

A study conducted on physicians in Ontario investigated how different payment systems impacted patient care in terms of the number of cost shifts and dumping incidences and reported that other factors like altruism or ethics of the doctors and patient behavior played a role in how doctors shifted costs. Some researchers hold the view that the Canadian healthcare system is better designed to minimize the occurrences of patient dumping.

Taiwan

A study published in 2006 that used voluntary surveys in its methods claimed that the results of the surveys indicated patient dumping was a problem within Taiwan's healthcare system. Researchers report that funding issues with government budgets and pressure that hospitals felt to stay competitive were among of the contributing factors to patient dumping. A previous study published in 2003 also supported the claim that Taiwan's healthcare system is negatively impacted by patient dumping in terms of healthcare quality and increased costs.

United Kingdom

In the a study conducted in the United Kingdom the issue of inappropriately discharging a patient has more to do with delaying the discharge than expediting the discharge. In 2004 a report was published in the UK that claimed that prisons were overcrowded and that one of the populations at risk of living in adverse conditions were mentally ill incarcerated individuals who were dumped in prisons.

Usage

Other associated names or terms

Other terms used in related to the practice of patient dumping are frequent-user patient, revolving-door, and bed block-blockers. These terms were contrived by some hospital staff who noted how these patients had reoccurring hospitalizations. Other ways homeless dumping is described is with phrases like inappropriate patient discharges and economically motivated transfers.

Usage in the media and press

• Associated Press; February 9, 2007; Los Angeles. A hospital van dropped off a homeless paraplegic man on Skid Row and left him crawling in the street with nothing more than a soiled gown and a broken colostomy bag, police said.... Police said the incident was a case of "homeless dumping" and were questioning officials from the hospital.
• Associated Press, October 25, 2006; Los Angeles. "L.A. Police Allege Homeless Dumping." Authorities have launched a criminal investigation into suspected dumping of homeless people on Skid Row after police witnessed ambulances leaving five people on a street there during the weekend.

Archaeology of religion and ritual

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Archaeology_of_religion_and_ritual 

The archaeology of religion and ritual is a growing field of study within archaeology that applies ideas from religious studies, theory and methods, anthropological theory, and archaeological and historical methods and theories to the study of religion and ritual in past human societies from a material perspective.

Definitions

Religion may be defined as "a set of beliefs concerning the cause, nature, and purpose of the universe, especially when considered as the creation of a superhuman agency or agencies, usually involving devotional and ritual observances, and often containing a moral code governing the conduct of human affairs,"  whereas ritual is "an established or prescribed procedure for a religious or other rite." Archaeologists may study the material traces of religious ritual (for example, the ritual destruction of ceramic vessels during the Aztec New Fire ceremony) or the material correlates of religion as a totalized worldview (for example, Elizabeth Kyder-Reid's study of the Southern Redemptorists’ reconfiguration of landscape and artifacts to reflect their ideals of community and poverty in material form).

As in religious studies and the Anthropology of religion, many archaeologists differentiate between "world religions," and "traditional" or "indigenous religions." "World religions" are defined by Bowie (2000: 26) as:

1. Based on written scriptures.
2. Has a notion of salvation, often from outside.
3. Universal, or potentially universal.
4. Can subsume or supplant primal religions.
5. Often forms a separate sphere of activity.

while indigenous religions are defined as:

1. Oral, or if literate, lacks written/formal scriptures and creeds.
2. ‘This worldly’.
3. Confined to a single language or ethnic group.
4. Form basis from which world religions have developed.
5. Religious and social life are inseparable.

However, Timothy Insoll (2004: 9)  has argued that these categorizations arise from a much-critiqued neo-evolutionary perspective. Strict dichotomies of religious forms may also contribute to skewing research toward state religions, leaving household religious practice, and the relationships between these, under-investigated (a trend noted by Elson and Smith, 2001). Insoll (2004:9) argues that archaeologists may contribute to blurring the boundaries of world and indigenous religions.

The archaeology of religion also incorporates related anthropological or religious concepts and terms such as magic, tradition, symbolism, and the sacred.

Theory

Anthropology of religion

Theory within the archaeology of religion borrows heavily from the Anthropology of religion, which encompasses a broad range of perspectives. These include: Émile Durkheim's functionalist understanding of religion as serving to separate the sacred and the profane; Karl Marx's idea of religion as "the opium of the masses" or a false consciousness, Clifford Geertz's loose definition of religion as a "system of symbols" that orders the world, Victor Turner's work on ritual, including rites of passage and liminality, Max Weber's religious types and thoughts on the relationship between economics and religion; Claude Lévi-Strauss’ structuralist understandings of totemism and myth; and Mary Douglas’ idea of the division of "purity and danger".

Religion, identity, and practice

Archaeological studies of religion increasingly recognize religion as an organizing principle in social life, rather than as a separate sphere of activity. They include religion as an axis of identity that structures social life and personal experience. Therefore, entire artifact assemblages (rather than specifically "religious" artifacts, such as rosary beads) can be interpreted according to the ways that they simultaneously create, display, and constrain notions of self according to religious ideas. For example, John Chenoweth (2009) interpreted ceramic assemblages and burials according to Quaker ideals of plainness and modesty.

Because social identity is both imposed and negotiated through social practice, including material practice, archaeologies of religion increasingly incorporate practice-based theory. Building upon Anthony Giddens’ idea of structuration and Pierre Bourdieu's ideas of both practice and cultural capital, theories of material practice posit that people use material goods to negotiate their places within social structures. Examples of the archaeological interpretation of religion and ritual as part of social negotiation, transformation or reinforcement include Chenoweth's work on Quaker religious practice, Kyder-Reid's work on the Southern Redemptorists, and Timothy Pauketat's work on feasting in Cahokia (Pauketat et al., 2002).

Religion, power, and inequality

Because religion and political power are often intertwined particularly in early states, the archaeology of religion may also engage theories of power and inequality. John Janusek's study of Tiwanaku religion, for example, explored the ways that religion served to integrate societies within the Andean state. Colonial regimes frequently justified expansion through a commitment to religious conversion; archaeologies of coloniality may therefore intersect with the archaeology of religion. James Delle's 2001 article on missions and landscape in Jamaica and Barbara Voss’ work on missions, sexuality and empire demonstrate how religion has intersected with colonial regimes.

Historical method and theory

Historical archaeologists have made major contributions to the understanding of the religion and ritual of peoples who have remained underrepresented (or misrepresented) in the historical record, such as colonized peoples, indigenous peoples, and enslaved peoples. Mandatory religious conversion was common in many colonial situations (e.g. the Spanish colonization of the Americas), which led to syncretic religious practice, rejection or resistance to new religions, covert practice of indigenous religions, and/or misunderstandings and misinterpretations of both indigenous and colonizer religions (Hanks 2010  Klor de Alva 1982, Wernke 2007).

This research combines archaeological and anthropological method and theory with historical method and theory. In addition to recovering, recording, and analyzing material culture, historical archaeologists use archives, oral histories, ethnohistorical accounts. Researchers read texts critically, emphasizing the historical context of the documents (especially regarding underrepresented peoples whose voices may be distorted or missing) in order to better understand religious practices that may have been discouraged or even severely punished. Combined archaeological, historical, and anthropological data sets may contradict each other, or the material record may illuminate the details of covert or syncretic religious practice, as well as resistance to dominant religious forms. For example, our understanding of the religious practice of enslaved peoples in the United States (e.g. Leone and Frye 2001, Fennell 2007 ^[30]) has increased dramatically thanks to research in historical archaeology.

Material correlates

Because archaeology studies human history through objects, buildings, bodies, and spaces, archaeologists must engage theories that connect anthropological and sociological theories of religion to material culture and landscapes. Theories of materiality and landscape serve to connect human activities, experiences, and behaviors to social practices, including religion. Theories of embodiment also serve to interpret human remains as they relate to religion and ritual.

The archaeology of religion makes use of the same material evidence as other branches of archaeology, but certain artifact classes are particularly emphasized in studying religion and ritual in the past:

• Human remains and burial assemblages can offer many clues to religious and ritual activity. Human remains themselves are used in all branches of archaeology for information on sex, age, occupation, and disease. Methods of interment (including burial position, cremation, burial location, primary and secondary burials, etc.) contribute to understanding changing religious practice, as well as social difference within groups (e.g. Lohmann 2005). Total burial contexts, i.e., the setting, artifacts, ecofacts, and human remains themselves, may provide evidence of religious beliefs about death and the afterworld.
• Religious buildings, such as temple complexes, kivas, and missions, are often used to examine communal religious and ritual activity (e.g. Barnes 1995, Graham 1998, Reid et al. 1997). Part of archaeoastronomy is the investigation of how buildings are aligned to astral bodies and events, such as solstices, which often coincide with religious or ritual activities. Archaeological examinations of religious buildings can reveal unequal access to religious knowledge and ritual. Religious buildings frequently contain religious iconography that provides insight into the symbolic dimensions of religious life.
• Within landscape archaeology, sacred landscapes are an increasingly important focus of study (e.g. Clendinnen 1980 ). Landscapes are imbued with sacred meaning throughout the world; aboriginal Australian songlines, and the related belief that mythical events are marked on the landscape, are one example. Human modifications to landscapes, such as Kyder-Reid's study of the Redemtorists’ modifications of their estate to emphasize communality, may point to the enactment of religious views.
• Religious iconography, symbols, ethnographic texts and ethnographic analogy are important tools that archaeologists use to compare with the material record to examine religions in the past (e.g. Clendinnen 1980, Elson and Smith 2001). Though texts are not direct "windows to the past," particularly for societies with few or no written records, they are valuable lines of evidence that may be contradicted or supported by the material record.
• Common artifact classes such as ceramics have been increasingly reinterpreted within a religious framework. According to the idea of religion as a form of social practice and a total worldview, any artifact may potentially be used to embody religious ideas and ideals in material form. Patterns of artifact and ecofact use within ritual contexts may expose preferences or sacred meanings of certain materials; the ritual use of pine among the ancient Maya is one example (Morehart, Lentz, and Prufer 2005).

Examples of research by area

Africa

• Evolving religious structure in Egypt (Baines 1987) 
• Ritual and political process in Tanzania (Hakansson 1998) 
• Tswana religion and Christianity in Botswana and South Africa (Reid et al. 1997) 

Americas

• Contemporary Maya shrines (Brown 2004) 
• Landscape and Yucatec Maya religious practice (Clendinnen 1980) 
• Christian missions in the Americas (Graham 1998) 
• Religion and the State in the Andes (Janusek 2006) 
• Religious architecture and religious transformation in colonial Peru (Wernke 2007)
• Early American slavery and African American religion (Leone and Frye 2001), Fennell (2007)

Asia

• Buddhism in India, Sri Lanka, and Southeast Asia (Barnes 1995) 
• Early Hinduism in Rajasthan (Hooja 2004) 

Europe

• Christianity and Anglo-Saxon burial practices (Crawford 2004) 
• Religion in Minoan Crete (Herva 2006) 
• Women and medieval burials (Gilchrist 2008) 

Australia/South Pacific

• Burials and religious practice in Papua New Guinea (Lohmann 2005) 
• Dreaming cosmology and Australian seascapes (McNiven 2003) 

Modern debates

Modern religious use of archaeological sites

Contemporary religious groups often claim archaeological sites as part of their heritage, and make use of archaeological sites and artifacts in their religious practice (e.g. Wallis 2003). These practices and religious interpretations of sites may clash with archaeological interpretations, leading to disputes about heritage, preservation, use of sites, and the "ownership" of history (Bender 1999).

Biblical archaeology

Main article: Biblical archaeology

Biblical archaeology is a field of archaeology that seeks to correlate events in the Bible with concrete archaeological sites and artifacts (Meyers 1984, Richardson 1916).

Therapy

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Therapy

 

Therapy
Children undergoing physical therapy. (polio)
MeSH	D013812

A therapy or medical treatment is the attempted remediation of a health problem, usually following a medical diagnosis. Both words, treatment and therapy, are often abbreviated tx, Tx, or T_x.

As a rule, each therapy has indications and contraindications. There are many different types of therapy. Not all therapies are effective. Many therapies can produce unwanted adverse effects.

Treatment and therapy are often synonymous, especially in the usage of health professionals. However, in the context of mental health, the term therapy may refer specifically to psychotherapy.

History

Before the creating of therapy as a formal procedure, people told stories to one another to inform and assist about the world. The term "healing through words" was used over 3,500 years ago in Greek and Egyptian writing. The term psychotherapy was invented in the 19th century, and psychoanalysis was founded by Sigmund Freud under a decade later.

Semantic field

The words care, therapy, treatment, and intervention overlap in a semantic field, and thus they can be synonymous depending on context. Moving rightward through that order, the connotative level of holism decreases and the level of specificity (to concrete instances) increases. Thus, in health care contexts (where its senses are always noncount), the word care tends to imply a broad idea of everything done to protect or improve someone's health (for example, as in the terms preventive care and primary care, which connote ongoing action), although it sometimes implies a narrower idea (for example, in the simplest cases of wound care or postanesthesia care, a few particular steps are sufficient, and the patient's interaction with that provider is soon finished). In contrast, the word intervention tends to be specific and concrete, and thus the word is often countable; for example, one instance of cardiac catheterization is one intervention performed, and coronary care (noncount) can require a series of interventions (count). At the extreme, the piling on of such countable interventions amounts to interventionism, a flawed model of care lacking holistic circumspection—merely treating discrete problems (in billable increments) rather than maintaining health. Therapy and treatment, in the middle of the semantic field, can connote either the holism of care or the discreteness of intervention, with context conveying the intent in each use. Accordingly, they can be used in both noncount and count senses (for example, therapy for chronic kidney disease can involve several dialysis treatments per week).

The words aceology and iamatology are obscure and obsolete synonyms referring to the study of therapies.

The English word therapy comes via Latin therapīa from Greek: θεραπεία and literally means "curing" or "healing".

Types of therapies

See also: List of therapies

Therapy comes in many different forms, and may target mental or physical problems. These types of therapy include cognitive behavioral therapy, dialectical behavior therapy, mindfulness-based cognitive therapy, and physical therapy. Therapists are used daily by many people, and are trained to provide treatment to an individual or group. Therapy was invented in the 1800s by Franz Mesmer, considered the "Father of Western Psychotherapy", who was followed by Sigmund Freud. Therapy is used in many ways to shape and help reform a person. This type of treatment allows individuals to regain standards or goals which would be beneficial or which have been lost. Many individuals come into therapy looking for ways to cope with issues and to receive an emotional release. For example, therapy can assist people who are healing from trauma, in need of support, dealing with emotional baggage, or struggling with other issues. The therapeutic process, the process of being allowed to freely express thoughts and feelings, greatly assists in recovery.

Psychology session

By chronology, priority, or intensity

Levels of care

Levels of care classify health care into categories of chronology, priority, or intensity, as follows:

• Urgent care handles health issues that need to be handled today but are not necessarily emergencies; the urgent care venue can send a patient to the emergency care level if it turns out to be needed.
  • In the United States (and possibly various other countries), urgent care centers also serve another function as their other main purpose: U.S. primary care practices have evolved in recent decades into a configuration whereby urgent care centers provide portions of primary care that cannot wait a month, because getting an appointment with the primary care practitioner is often subject to a waitlist of 2 to 8 weeks.
• Emergency care handles medical emergencies and is a first point of contact or intake for less serious problems, which can be referred to other levels of care as appropriate.
• Intensive care, also called critical care, is care for extremely ill or injured patients. It thus requires high resource intensity, knowledge, and skill, as well as quick decision making.
• Ambulatory care is care provided on an outpatient basis. Typically patients can walk into and out of the clinic under their own power (hence "ambulatory"), usually on the same day.
• Home care is care at home, including care from providers (such as physicians, nurses, and home health aides) making house calls, care from caregivers such as family members, and patient self-care.
• Primary care is meant to be the main kind of care in general, and ideally a medical home that unifies care across referred providers.
• Secondary care is care provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists. A patient reaches secondary care as a next step from primary care, typically by provider referral although sometimes by patient self-initiative.
• Tertiary care is specialized consultative 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.
• Follow-up care is additional care during or after convalescence. Aftercare is generally synonymous with follow-up care.
• End-of-life care is care near the end of one's life. It often includes the following:
  • Palliative care is supportive care, most especially (but not necessarily) near the end of life.
  • Hospice care is palliative care very near the end of life when cure is very unlikely. Its main goal is comfort, both physical and mental.

Lines of therapy

Treatment decisions often follow formal or informal algorithmic guidelines. Treatment options can often be ranked or prioritized into lines of therapy: first-line therapy, second-line therapy, third-line therapy, and so on. First-line therapy (sometimes referred to as induction therapy, primary therapy, or front-line therapy) is the first therapy that will be tried. Its priority over other options is usually either: (1) formally recommended on the basis of clinical trial evidence for its best-available combination of efficacy, safety, and tolerability or (2) chosen based on the clinical experience of the physician. If a first-line therapy either fails to resolve the issue or produces intolerable side effects, additional (second-line) therapies may be substituted or added to the treatment regimen, followed by third-line therapies, and so on.

An example of a context in which the formalization of treatment algorithms and the ranking of lines of therapy is very extensive is chemotherapy regimens. Because of the great difficulty in successfully treating some forms of cancer, one line after another may be tried. In oncology the count of therapy lines may reach 10 or even 20.

Often multiple therapies may be tried simultaneously (combination therapy or polytherapy). Thus combination chemotherapy is also called polychemotherapy, whereas chemotherapy with one agent at a time is called single-agent therapy or monotherapy.

Adjuvant therapy is therapy given in addition to the primary, main, or initial treatment, but simultaneously (as opposed to second-line therapy). Neoadjuvant therapy is therapy that is begun before the main therapy. Thus one can consider surgical excision of a tumor as the first-line therapy for a certain type and stage of cancer even though radiotherapy is used before it; the radiotherapy is neoadjuvant (chronologically first but not primary in the sense of the main event). Premedication is conceptually not far from this, but the words are not interchangeable; cytotoxic drugs to put a tumor "on the ropes" before surgery delivers the "knockout punch" are called neoadjuvant chemotherapy, not premedication, whereas things like anesthetics or prophylactic antibiotics before dental surgery are called premedication.

Step therapy or stepladder therapy is a specific type of prioritization by lines of therapy. It is controversial in American health care because unlike conventional decision-making about what constitutes first-line, second-line, and third-line therapy, which in the U.S. reflects safety and efficacy first and cost only according to the patient's wishes, step therapy attempts to mix cost containment by someone other than the patient (third-party payers) into the algorithm. Therapy freedom and the negotiation between individual and group rights are involved.

By intent

Therapy type	Description
abortive therapy	A therapy that is intended to stop a medical condition from progressing any further. A medication taken at the earliest signs of a disease, such as an analgesic taken at the very first symptoms of a migraine headache to prevent it from getting worse, is an abortive therapy. Compare abortifacients, which abort a pregnancy.
bridge therapy	A therapy that figuratively provides a bridge to another step or phase, crossing over some immediate chasm (challenge), in contrast with destination therapy, which is the final therapy in cases where clinically appropriate.
consolidation therapy	A therapy given to consolidate the gains from induction therapy. In cancer, this means chasing after any malignant cells that may be left.
curative therapy	A therapy with curative intent, that is, one that seeks to cure the root cause of a disorder. (also called etiotropic therapy)
definitive therapy	A therapy that may be final, superior to others, curative, or all of those.
destination therapy	A therapy that is the final destination rather than a bridge to another therapy. Usually refers to ventricular assist devices to keep the existing heart going, not just until heart transplantation can occur, but for the rest of the patient's life expectancy.
empiric therapy	A therapy given on an empiric basis; that is, one given according to a clinician's educated guess despite uncertainty about the illness's causative factors. For example, empiric antibiotic therapy administers a broad-spectrum antibiotic immediately on the basis of a good chance (given the history, physical examination findings, and risk factors present) that the illness is bacterial and will respond to that drug (even though the bacterial species or variant is not yet known).
gold standard therapy	A therapy that is definitive, just as a gold standard diagnostic test is a definitive test.
investigational therapy	An experimental therapy. Use of experimental therapies must be ethically justified, because by definition they raise the question of standard of care. Physicians have autonomy to provide empirical care (such as off-label care) according to their experience and clinical judgment, but the autonomy has limits that preclude quackery. Thus it may be necessary to design a clinical trial around the new therapy and to use the therapy only per a formal protocol. Sometimes shorthand phrases such as "treated on protocol" imply not just "treated according to a plan" but specifically "treated with investigational therapy".
maintenance therapy	A therapy taken during disease remission to prevent relapse.
palliative therapy	See supportive therapy for connotative distinctions.
preventive therapy (prophylactic therapy)	A therapy that is intended to prevent a medical condition from occurring (also called prophylaxis). For example, many vaccines prevent infectious diseases.
salvage therapy (rescue therapy)	A therapy tried after others have failed; it may be a "last-line" therapy.
stepdown therapy	Therapy that tapers the dosage gradually rather than abruptly cutting it off. For example, a switch from intravenous to oral antibiotics as an infection is brought under control steps down the intensity of therapy.
supportive therapy	A therapy that does not treat or improve the underlying condition, but rather increases the patient's comfort, also called symptomatic treatment (see there for more information). For example, supportive care for flu, colds, or gastrointestinal upset can include rest, fluids, and over-the-counter pain relievers; those things do not treat the cause, but they treat the symptoms and thus provide relief. Supportive therapy may be palliative therapy (palliative care). The two terms are sometimes synonymous, but palliative care often specifically refers to serious illness and end-of-life care. Therapy may be categorized as having curative intent (when it is possible to eliminate the disease) or palliative intent (when eliminating the disease is impossible and the focus shifts to minimizing the distress that it causes). The two are often contradistinguished (mutually exclusive) in some contexts (such as the management of some cancers), but they are not inherently mutually exclusive; often therapy can be both curative and palliative simultaneously. Supportive psychotherapy aims to support the patient by alleviating the worst of the symptoms, with the expectation that definitive therapy can follow later if possible.
systemic therapy	A therapy that is systemic. In the physiological sense, this means affecting the whole body (rather than being local or locoregional), whether via systemic administration, systemic effect, or both. Systemic therapy in the psychotherapeutic sense seeks to address people not only on the individual level but also as people in relationships, dealing with the interactions of groups.

By therapy composition

Treatments can be classified according to the method of treatment:

By matter

• by drugs: pharmacotherapy, chemotherapy (also, medical therapy often means specifically pharmacotherapy)
• by medical devices: implantation
  • cardiac resynchronization therapy
• by specific molecules: molecular therapy (although most drugs are specific molecules, molecular medicine refers in particular to medicine relying on molecular biology)
  • by specific biomolecular targets: targeted therapy
    • molecular chaperone therapy
  • by chelation: chelation therapy
• by specific chemical elements:
  • by metals:
    • by heavy metals:
      • by gold: chrysotherapy (aurotherapy)
      • by platinum-containing drugs: platin therapy
    • by biometals
      • by lithium: lithium therapy
      • by potassium: potassium supplementation
      • by magnesium: magnesium supplementation
      • by chromium: chromium supplementation; phonemic neurological hypochromium therapy
      • by copper: copper supplementation
  • by nonmetals:
    • by diatomic oxygen: oxygen therapy, hyperbaric oxygen therapy (hyperbaric medicine)
      • transdermal continuous oxygen therapy
    • by triatomic oxygen (ozone): ozone therapy
    • by fluoride: fluoride therapy
    • by other gases: medical gas therapy
• by water:
  • hydrotherapy
  • aquatic therapy
  • rehydration therapy
    • oral rehydration therapy
  • water cure (therapy)
• by biological materials (biogenic substances, biomolecules, biotic materials, natural products), including their synthetic equivalents: biotherapy
  • by whole organisms
    • by viruses: virotherapy
    • by bacteriophages: phage therapy
    • by animal interaction: see animal interaction section
  • by constituents or products of organisms
    • by plant parts or extracts (but many drugs are derived from plants, even when the term phytotherapy is not used)
      • scientific type: phytotherapy
      • traditional (prescientific) type: herbalism
    • by animal parts: quackery involving shark fins, tiger parts, and so on, often driving threat or endangerment of species
    • by genes: gene therapy
      • gene therapy for epilepsy
      • gene therapy for osteoarthritis
      • gene therapy for color blindness
      • gene therapy of the human retina
      • gene therapy in Parkinson's disease
    • by epigenetics: epigenetic therapy
    • by proteins: protein therapy (but many drugs are proteins despite not being called protein therapy)
    • by enzymes: enzyme replacement therapy
    • by hormones: hormone therapy
      • hormonal therapy (oncology)
      • hormone replacement therapy
        • estrogen replacement therapy
        • androgen replacement therapy
        • hormone replacement therapy (menopause)
        • transgender hormone therapy
          • feminizing hormone therapy
          • masculinizing hormone therapy
      • antihormone therapy
        • androgen deprivation therapy
    • by whole cells: cell therapy (cytotherapy)
      • by stem cells: stem cell therapy
      • by immune cells: see immune system products below
    • by immune system products: immunotherapy, host modulatory therapy
      • by immune cells:
        • T-cell vaccination
        • cell transfer therapy
        • autologous immune enhancement therapy
        • TK cell therapy
      • by humoral immune factors: antibody therapy
        • by whole serum: serotherapy, including antiserum therapy
        • by immunoglobulins: immunoglobulin therapy
          • by monoclonal antibodies: monoclonal antibody therapy
  • by urine: urine therapy (some scientific forms; many prescientific or pseudoscientific forms)
  • by food and dietary choices:
    • medical nutrition therapy
    • grape therapy (quackery)
• by salts (but many drugs are the salts of organic acids, even when drug therapy is not called by names reflecting that)
  • by salts in the air
    • by natural dry salt air: "taking the cure" in desert locales (especially common in prescientific medicine; for example, one 19th-century way to treat tuberculosis)
    • by artificial dry salt air:
      • low-humidity forms of speleotherapy
      • negative air ionization therapy
    • by moist salt air:
      • by natural moist salt air: seaside cure (especially common in prescientific medicine)
      • by artificial moist salt air: water vapor forms of speleotherapy
  • by salts in the water
    • by mineral water: spa cure ("taking the waters") (especially common in prescientific medicine)
    • by seawater: seaside cure (especially common in prescientific medicine)
• by aroma: aromatherapy
• by other materials with mechanism of action unknown
  • by occlusion with duct tape: duct tape occlusion therapy

By energy

• by electric energy as electric current: electrotherapy, electroconvulsive therapy
  • Transcranial magnetic stimulation
  • Vagus nerve stimulation
• by magnetic energy:
  • magnet therapy
  • pulsed electromagnetic field therapy
  • magnetic resonance therapy
• by electromagnetic radiation (EMR):
  • by light: light therapy (phototherapy)
    • ultraviolet light therapy
      • PUVA therapy
    • photodynamic therapy
      • photothermal therapy
      • cytoluminescent therapy
    • blood irradiation therapy
    • by darkness: dark therapy
    • by lasers: laser therapy
      • low level laser therapy
  • by gamma rays: radiosurgery
    • Gamma Knife radiosurgery
    • stereotactic radiation therapy
    • cobalt therapy
  • by radiation generally: radiation therapy (radiotherapy)
    • intraoperative radiation therapy
    • by EMR particles:
      • particle therapy
        • proton therapy
        • electron therapy
          • intraoperative electron radiation therapy
          • Auger therapy
        • neutron therapy
          • fast neutron therapy
          • neutron capture therapy of cancer
    • by radioisotopes emitting EMR:
      • by nuclear medicine
      • by brachytherapy
  • quackery type: electromagnetic therapy (alternative medicine)
• by mechanical: manual therapy as massotherapy and therapy by exercise as in physical therapy
  • inversion therapy
• by sound:
  • by ultrasound:
    • ultrasonic lithotripsy
      • extracorporeal shockwave therapy
    • sonodynamic therapy
  • by music: music therapy
• by temperature
  • by heat: heat therapy (thermotherapy)
    • by moderately elevated ambient temperatures: hyperthermia therapy
      • by dry warm surroundings: Waon therapy
      • by dry or humid warm surroundings: sauna, including infrared sauna, for sweat therapy
  • by cold:
    • by extreme cold to specific tissue volumes: cryotherapy
    • by ice and compression: cold compression therapy
    • by ambient cold:
      • hypothermia therapy for neonatal encephalopathy (in newborns)
      • targeted temperature management (therapeutic hypothermia, protective hypothermia)
  • by hot and cold alternation: contrast bath therapy

By procedure and human interaction

• Surgery
• by counseling, such as psychotherapy (see also: list of psychotherapies)
  • systemic therapy
  • by group psychotherapy
• by cognitive behavioral therapy
  • by cognitive therapy
  • by behaviour therapy
    • by dialectical behavior therapy
  • by cognitive emotional behavioral therapy
• by cognitive rehabilitation therapy
• by family therapy
• by education
  • by psychoeducation
  • by information therapy
• by speech therapy, physical therapy, occupational therapy, vision therapy, massage therapy, chiropractic or acupuncture
• by lifestyle modifications, such as avoiding unhealthy food or maintaining a predictable sleep schedule
• by coaching

By animal interaction

• by pets, assistance animals, or working animals: animal-assisted therapy
  • by horses: equine therapy, hippotherapy
  • by dogs: pet therapy with therapy dogs, including grief therapy dogs
  • by cats: pet therapy with therapy cats
• by fish: ichthyotherapy (wading with fish), aquarium therapy (watching fish)
• by maggots: maggot therapy
• by worms:
  • by internal worms: helminthic therapy
  • by leeches: leech therapy
• by immersion: animal bath

By meditation

• by mindfulness: mindfulness-based cognitive therapy

By reading

• by bibliotherapy

By creativity

• by expression: expressive therapy
  • by writing: writing therapy
    • journal therapy
• by play: play therapy
• by art: art therapy
  • sensory art therapy
  • comic book therapy
• by gardening: horticultural therapy
• by dance: dance therapy
• by drama: drama therapy
• by recreation: recreational therapy
• by music: music therapy

By sleeping and waking

• by deep sleep: deep sleep therapy
• by sleep deprivation: wake therapy