7 - Community Medicine Flashcards
What is the role of community hospitals?
Community hospitals play a crucial role in providing accessible and essential healthcare services to local populations. Their key functions include:
1. Primary and Emergency Care – They offer immediate medical attention, including emergency services, outpatient care, and minor surgical procedures.
2. Inpatient and Specialized Services – Many community hospitals provide maternity care, geriatric services, rehabilitation, and palliative care.
3. Preventive and Public Health Programs – They support vaccination programs, health screenings, chronic disease management, and wellness education to prevent illnesses and promote community well-being.
4. Continuity of Care – They coordinate with larger hospitals and specialists for referrals and ongoing treatment, ensuring seamless care for patients with complex needs.
5. Local Economic and Social Impact – Community hospitals create jobs, support local healthcare infrastructure, and foster partnerships with community organizations to address social determinants of health.
These hospitals serve as a vital bridge between primary care and larger medical centers, ensuring that healthcare remains accessible, affordable, and tailored to the specific needs of the community.
What is NHS continuing healthcare?
When people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS
If you are not eligible for NHS continuing healthcare, you can be referred to your local council. If you still have some health needs then the NHS may pay for part of the package of support. This is sometimes known as a “joint package” of care.
How are patients assessed by the CCG to see if they are eligible for NHS continuing healthcare?
Initial checklist assessment: used to decide if you need a full assessment, completed by nurse, social worker or doctor.
If don’t pass then not eligible
Full assessment to see if eligible: done by MDT looking at lots of parameters (see image) and scoring them “priority”, “severe”, “high”, “moderate”, “low” or “no needs”
Fast Track Assessment: if terminal, package of care done in 48 hours rather than 28 days
If 1 priority or 2 severe then usually eligible
How often is NHS continuing care reviewed?
- Takes 28 days to put into place
- 3 month review
- Annually thereafter
What is Discharge to Assess?
Discharge to Assess (D2A) means patients leave the hospital as soon as they are medically stable and have their care needs assessed at home or in a community setting instead of staying in the hospital.
How It Works:
1. Go Home Sooner – Once you’re well enough, you don’t have to stay in the hospital just for assessment.
2. Get Support at Home – A healthcare team checks what help you need while you’re in a familiar environment.
3. Different Levels of Care – Some people manage on their own, some get short-term help, and others may need rehab or long-term care.
4. Better for Recovery – Being at home or in the right place helps people regain independence faster and keeps hospital beds free for those who need them most.
It’s a way to make sure people get the right care in the right place, without unnecessary hospital stays.
What are the different pathways in Discharge to Assess?
Four Pathways:
• Pathway 0: No ongoing care needed; patient returns home with minimal support.
• Pathway 1: Short-term care support provided at home.
• Pathway 2: Rehabilitation or intermediate care in a community setting (e.g., care home or rehab center).
• Pathway 3: Long-term residential or nursing home care required.
What is the definition of the following:
- Continuing Care
- Nursing Home Care
- Residential Care
- Intermediate Care
- Interim Care
- Continuing Care: is a fully-funded package of care that some people are entitled to receive as a result of disability, accident or illness
- Nursing Home Care: Personal care but always 1 or more qualified nurse on duty to provide nursing care
- Residential Care: No medical staff on site, just help with personal care, lower level of care than above
- Intermediate Care: Free short term service in your own home after acute hospital stay or fall. Includes physios, OTs etc. More rehabilitation
- Interim Care: Patient ready to be discharged from hospital but family are not sure about long-term care yet as patient has developed more health needs so can have short time of help
What is the concept of rehabilitation?
Multidisciplinary set of interventions to restore functional ability or enhance residual functional capacity
Reduces the negative impact of the acute illness and slows down the decline of physical/psychological and social functional abilities
Usually occurs in community hospitals
What is the definition of
- Impairment
- Disability
- Handicap
What are some factors that can contribute to deconditioning in the elderly?
- Polypharmacy
- Acute illness
- Laying in bed
- Unusual environment of hospital
What are some different discharge destinations for elderly patients?
What is a fast track discharge?
Seamless discharge from hospital to patient’s preferred place of care when they have a rapidly deteriorating illness
Should take max of 48 hours
Need to think about anticipatory care needs, anticipatory meds, symptom control, DNACPR
What are the different discharge pathways following a stroke?
- ESDS: Intense short term
- Home First: package of care
- CINNS
