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RC-FoPC2 > 1. The impact of long term conditions > Flashcards

1. The impact of long term conditions Flashcards

1
Q

What is person centred care?

A

Placing the patient at the centre of their care.

Care systems are often built around diseases rather than patients themselves. This is a recognition that we treat the patient and not the disease itself.

We all have biases, so it’s important to be aware of these things and listen what the patient tells you.

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2
Q

Using the concept of patient care, what is the difference between treating chronic migraine and treating a patient who suffers from chronic migrane?

A

Treating chronic migraine is a series of investigations and treatments.

Treating a chronic sufferer of this condition requires a more complex awareness of the patient’s ideas, concerns and expectations.

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3
Q

What is meant by incidence?

A

The number of new cases of a condition in a specified period of time.

Helps us define the risk of this condition - what is the likelihood of being diagnosed.

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4
Q

What is meant by prevalence?

A

The total number of people in a population with a condition, either at a single point in time, or over a given time period.

Helps us understand the burden of disease.

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5
Q

What are the consequences of long term conditions?

DIIBBS

A 
Disability
Individual responses to LTC
Impact on family/community/society
Biographical disruption
Burden of treatment
Stigma of long term conditions
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6
Q

What are long term conditions?

A

Conditions for which there are no cure, and which are managed with drugs and other treatments. They affect multiple organ systems, including mental health.

e.g. diabetes, IHD, COPD, IBD, chronic pain

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7
Q

Appreciate geographical differences in LTC health

A

LTC are highly prevalent and have a positive association with increasing age and increasing deprivation.

Twice as likely to suffer a LTC if living in a deprived vs. affluent area.

Deprived patients with LTC twice as likely to be admitted to hospital with it.

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8
Q

Describe the aetiology of long term conditions?

A

LTC aetiology is complex and multifactorial.

Genetic factors, environmental factors, both or neither play a part.

Vulnerability is the capacity to resist disease, repair damage and restore physiological homeostasis. This varies between individuals and between body organs/systems.

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9
Q

Describe how long-term conditions can have variable courses and degrees of severity in different individuals?

A

Acute onset - e.g. stroke, MI may be treated and resolve, may lead residual symptoms or impairment of function.

Gradual onset or presentation - e.g. angina, COPD persist over time and get worse, gradually or acutely.

Relapsing or remitting - e.g. MS, cancer can increase in severity of change slightly between presentation.

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10
Q

What are the current trends in long-term conditions?

A

Changing patterns:
Many infectious conditions, including TB, have become more treatable. As people survive these conditions and live longer, other conditions become more significant contributors to morbidity and mortality - such as many LTC being a risk factor for severe covid.

e.g. DM is lived WITH for a long time

This is the pattern for long term conditions. They cause burden of symptoms to the individual affected and impact on their years lived in good health.

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11
Q

What are the aims of treatment of long term conditions?

A

The aim is to treat the condition to improve morbidity and mortality from it.

Acceptance of having a lack of cure can be challenging for both patient and doctor, e.g. chronic unexplained pain.

Difficult conversations needed to be had require trust, empathy and honesty.

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12
Q

What is Biographical Disruption?

A

Applied to the diagnosis of a LTC, biographical disruption describes a significant and life changing event that alters life plans and direction.

Presents a challenge to self identity and requires re-negotiation of relationships:

  • Self, i.e. loss of confidence
  • Friends, family
  • Work
  • Wider society
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13
Q

What is the stigma of long term conditions?

A

People affected by LTC often feel stigmatised by these.

The impact may not always be visible, hence a lack of understanding may cause labelling. A worry about stigma may cause fear of disclosing illness, creating challenges in navigating relationships.

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14
Q

What is ‘The Burden of Treatment’?

A

Symptoms of a disease burden patients but so do the treatments we prescribe for the diseases, including:

  • monitoring and self mx of symptoms
  • complex treatments/multiple medications
  • challenging behaviour/ helping to modify the behaviour of others
  • engagement with health services

Increased burden of treatment can lead to reduced quality of life, poor adherence and value of care.

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15
Q

Where does ‘The Burden of Treatment’ arise from?

A
  1. Workload of healthcare

2. Endurance of deficiencies in healthcare

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16
Q

What six key factors influence the ability to tolerate the burden of treatment?

A 
Personal attributes and skills 
Physical and cognitive abilities
Support network 
Financial status
Life workload
Environment
17
Q

What is the broad impact of on an individual in having a long term condition?

A

Can be positive or negative
Individual
Family, society, community

Consider finances, use of resources emotional and physical impact of long term conditions to all above groups.

18
Q

Understand the multiple factors influencing symptoms, chronicity and disability.

A

Living with a long term condition depends on:

  • nature of LTC
  • personality of individual, mood and emotional reactions
  • coping strategies; support networks
  • information base of individual
  • time to adapt
  • additional resources
  • mood
19
Q

What is the ‘sick role’?

A

Within the social model of health - our health is not only determined by our illness but by our own reactions and those of society.

Illness can be view as ‘deviant’ behaviour from normal societal expectation.

Rights and obligations exist for sick person and doctor.

20
Q

What are the benefits of the sick role for patients?

A

Exemption from normal socially expected duties.

Being cared for, without blame.

21
Q

Name two patient rights

A

Temporary exemption from normal social roles.

Not to be blamed for their illness and be cared for until well.

22
Q

Name two patient obligations

A

To see the illness as undesirable and to get well as quickly as possible.

To seek and cooperate with help, when required.

23
Q

Name the obligations of a doctor

A

To be highly trained and motivated

To be bound by rules of professional conduct

24
Q

What is meant by ‘the expert patient’?

A

Idea of: “my patient understands their disease better than I do”

Knowledge and experience of the patient may greatly benefit the quality of the patient’s care and ultimately their QoL.

25
Q

What is the WHO definition for ‘disability’?

A

An umbrella term for impairments, activity limitations and participation restrictions.

It is the interaction between individuals with a health condition and personal and environmental factors.

Rights and responsibilities are protected under Equality Act 2010

26
Q

Contrast medical and social models of disability

A

Medical model:
Disability is a feature of the person, directly caused by the disease or trauma, which medical care provided by health professionals. this calls for treatment to ‘correct’ the problem.

Social model:
Disability is a socially created problem and not at all an attribute of an individual. The problem is created by an unaccommodating physical environment brought about by attitudes and features of the social environment.

27
Q

What is the Biopsychosocial model of health?

A

Health conditions affect body functions and structures, activities and participation.

There is an interaction between these things with environmental and personal factors.

i.e. have a recognition of the complexity of the interaction between social and medical models.

28
Q

Definition of body function vs. body structure (Biopsychological model)

A

Body functions are physiological functions of body systems.

Body structures are anatomical parts of the body, such as organs, limbs and their components.

29
Q

Definition of activity and activity limitation

Biopsychological model

A

Activity is the execution of a task or action by an individual.

Activity limitations are difficulties an individual may have in executing activities. e.g. walking longer distances and getting up and down stairs in COPD.

30
Q

Definition of participation and participation restrictions

Biopsychological model

A

Participation is involvement in a life situation

Participation restrictions are problems an individual may experience in executing activities. e.g. unable to take part in social activities, visit family or go shopping in COPD.

31
Q

Definition of impairment

Biopsychological model

A

Problems in body function or structure, such as a significant deviation or loss

e.g. disruption of normal respiratory physiology in COPD leading to SOB and expectoration of sputum.

32
Q

Definition of environmental factors

Biopsychological model

A

Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives.

33
Q

Name examples of psychological/social/familial impact of activity limitation

A

Psychological - anxiety, depression, self-identity, self esteem

Social - withdrawal from activities, isolation

Familial - worry, guilt, need for increased input and care.

34
Q

Broadly define the epidemiology of disability

A 
Congenital
Injury - accidents
Communicable/non-communicable disease
Alcohol
Drugs 
Psychiatric illness
Obesity 
Malnutrition
35
Q

What is screening?

A

Increasing prevalence of chronic diseases, of insidious onset.

Early detection of unrecognised disease may increase the chances of cure.
Not intended to be diagnostic, further referral and investigation is needed for treatment.

36
Q

Name the six national screening programmes in Scotland

A 
Cervical cancer screening
Bowel cancer screening 
Breast cancer screening 
AAA screening 
Pregnancy and newborn screening 
Diabetic retinopathy screening
37
Q

What are first five Wilson and Jungner screening criteria?

… with pulmonary TB as an example

NB these criteria have moved evolved to reflect the era or genomics, changing screening criteria.

A
  1. Condition should be important health problem
    e. g. Pul TB
  2. Natural history of disease should be understood
    e. g. natural history of the precursor stage of the disease has been elucidated; early infiltration does lead to overt disease
  3. Recognisable latent or early symptomatic stage
    e. g. positive tuberculin reaction and infiltration
  4. Suitable test or examination/facilities for diagnosis are available
    e. g. tuberculin reaction and mass radiography (MR).
  5. Test should be acceptable to the population
38
Q

What are final five Wilson and Jungner screening criteria?

… with pulmonary TB as an example

NB these criteria have moved evolved to reflect the era or genomics, changing screening criteria.

A
  1. There is an agreed policy on whom to treat as patients.
  2. There is an accepted and effective treatment
  3. Persons without recognised disease, (e.g. small fibroses infiltrations) are not treated as patients.
  4. The cost is economically balanced to possible health care expenditure as a whole, e.g. TB treatment costs
  5. Long-term follow up should be a continuous process
39
Q

Name the Wilson and Junger screening criteria

I Understand SCCREEN

A
  • Important health problem
  • Understanding of disease natural history
  • Suitable test/ examination
  • Common treatment for recognised disease
  • Continuous process
  • Rx facilities available
  • Early stage/latent stage identification
  • Expenditure of finding = economically balanced with total expenditure as a whole on health
  • Non-invasive test

RC-FoPC2 (7 decks)

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