4 Tertiary care

Question 1

Why is it hard to define tertiary prevention?

Answer 1

lack of clear margins (chronic symptoms)
ongoing process
multimodel long term interventions
poor concensus in medical profession
concept of 'wellness' is vague

Question 2

What are the key characteristics of tertiary care, despite the difficulty defining it

Answer 2

patient has established disease
focus on intervention is either to improve functioning or prevent gradual decline

intervention begins after acute disease process has run its course
timecale for receipt of benefits

Question 3

What is the global significance of chronic disease?

Answer 3

NCD’s account for 71% of mortality now, so primary prevention dominates necessary interventions

Question 4

What is the UK impact of Chronic Disease?

Answer 4

6/10 adults report a chronic illness

patients with >1 conditions cost 6x more

Question 5

What are the 3 levels to the chronic disease pyramid?

Answer 5

1 - self care support / management
2 - Disease / Care
management
3 - Case Management

Question 6

What can we say about distribution of levels of care for chronic disease from the pyramid?

Answer 6

the majority of care for chronic disease happens outside the hospital environment

Question 7

How does DFLE change with affluence?

Answer 7

more affluent people have a higher DFLE, obviously

the gradients mean that poorer people are far worse off than richer people

Question 8

What is significant about the pension age?

Answer 8

DFLE falls before the pension age, with the pension age set to increase, many more people may be spending more of our working lives with a disability

Question 9

For much of modern medicine, what is the impact on life course?

Answer 9

extending poorer quality of life from the end of our lives

Question 10

What are the primary, secondary, and tertiary preventions for Stroke?

Answer 10

1 -smoking / alcohol limitation
2 - TIA management, FAST…
3 - Rehabilitation

Question 11

What is the basis of the National Stroke Strategy?

Answer 11

Early rehab is effective when provided in specialist stroke units, or properly organised, early supported discharge and long-term support in the community

Question 12

How many trials and patients did the Cochrane Collaboration Review of ‘Organised inpatient (stroke unit) care for stroke’ 2013 use?

Answer 12

6000 participants from 28 trials

Question 13

What programme tracked outcomes of stroke patients?

Answer 13

Sentinel stroke national audit programme (SSNAP)

Question 14

What techniques are used for cardio rehab?

Answer 14

lifestyle changes
cardiac reconditioning
psychological techniques

Question 15

What are the phases of cardiovascular disease rehab?

Answer 15

1 - counselling and assessment
2 - post discharge support
3 - structured exercise programme
4 - long term maintenance

Question 16

What proportion of patients offered cardiac rehab turn down the offer?

Answer 16

25%

Question 17

How many RCT’s did the cochrane exercise - based cardiac rehabilitation for coronary heart disease review?

Answer 17

63, showing minimal effect on short term mortality

Question 18

What mechanism does the Adverse Childhood Experiences Investigation use to link adverse childhood experiences to early death?

Answer 18

adverse childhood experiences
disrupted neurodevelopment
social, emotional, and cognitive impairment
adoption of health risk behaviours
disease, disability and social problems
early death