3A summary Flashcards
Health - define
A state of total physical, psychological and emotional wellbeing; not just the absence of disease
Health needs.
a) Felt
b) Expressed
c) Normative
d) Comparative
a) Symptoms/ beliefs
b) Health-seeking behaviour
c) HCP defines the need
d) Comparing 2 populations - one has a need relative to the other
Health needs, demands and supply.
a) Demanded + supplied, but not needed
b) Needed + supplied, but not demanded
c) Demanded + needed, but not supplied
a) Antibiotics for viral infections
b) Smoking cessation
c) Certain anti-cancer drugs?
HNA.
a) Epidemiological
b) Comparative
c) Corporate
a) Look at incidence/prevalence, look at the evidence, assess the study population, etc. and make recommendations
b) Comparing 2 populations? (eg. competing CCGs); only relative not absolute
c) Stakeholders; open to bias and lobbying
Equity.
a) Horizontal
b) Vertical
a) Equal share for equal need
b) Unequal share for unequal need
Donabedian approach.
a) Structure
b) Process
c) Outcome
a) What is there? - Number of things (GPs, nurses, OP clinics) per… (1000 patients) - give denominator
b) What is done?
c) 5 Ds - death, disease, disability, dissatisfaction, discomfort (+ debt)
Quality healthcare.
a) Maxwell’s dimensions of quality: 3 As and 3 Es
b) STEEEP
a) Maxwell’s dimensions:
Effectiveness, efficiency, equity
Acceptability, accessibility, appropriateness
b) Safe Timely Effective Efficient Equitable Patient-centred
Models of behaviour change
Health belief model Theory of planned behaviour Stages of change/trans-theoretical model Nudge theory Social norms theory Motivational interviewing
Health belief model. (BS, BS)
- e.g. to give up smoking
Perceived BENEFITS of behaviour change
- believe that quitting will prevent bad outcome
Perceived SUSCEPTIBILITY
- believe they might get lung Ca
Perceived BARRIERS to taking action.
- believe that they can act
Perceived SEVERITY of ill health.
- believe they are ill enough
Stages of change
- PC PAM
Pre-contemplation Contemplation Preparation Action Maintenance/ relapse
Theory of planned behaviour.
a) 3 things that influence intention
b) What must be bridged? (how?)
a) - Attitudes (health beliefs)
- Subjective norm (what others do)
- Perceived behaviour control (they have control)
b) The intention-behaviour gap:
- Planning
- Self-efficacy
- Action control
Communicable diseases.
a) Features of notifiable diseases
b) Who and how to notify?
c) When?
d) What to tell them?
a) High mortality and morbidity
Highly contagious
Expensive to treat
Effective interventions
b) PHE (contact local health protection authority)
c) - on clinical suspicion
(time frame?)
d) Case details*, NHS no, DOB, contact details, details of the disease, etc.
* can break confidentiality
Disease outbreaks.
a) Define
b) Endemic vs. hyper-endemic
c) Epidemic vs. pandemic
a) An incident in which two or more people experiencing a similar illness are linked in time or place; may be suspected or confirmed
b) - Endemic: a disease that exists permanently in a particular region or population
- Hyperendemic: persistent, high levels of disease occurrence
c) - Epidemic: a widespread occurrence of an infectious disease in a community at a particular time
- Pandemic: an epidemic that has spread throughout a whole country or worldwide
Motivational interviewing: the RULE principles
R - Resist the urge to change the individual’s course of action through didactic means
U - Understand it’s the individual’s reasons for change, not those of the practitioner, that will elicit a change in behaviour
L - Listening is important; the solutions lie within the individual, not the practitioner
E - Empower the individual to understand that they have the ability to change their behaviour.
Lead time bias
- Lead-time bias is the illusion that early diagnosis of a disease prolongs survival with that disease
(in reality you are just catching the disease earlier, and living for the same amount of time with it)
Example:
- Patient gets clinically apparent disease at 50, and dies at 60
- Patient diagnosed via screening at 45. Gets clinically-apparent disease at 50… and still dies at 60
