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HaDSoc > 9: Patient evaluations and complementary therapies > Flashcards

9: Patient evaluations and complementary therapies Flashcards

1
Q

Describe the policy background to growth of interest in patient views of health services

A
  • NHS plan/ patient prospectus - account of patient views and resulting action published annually
  • Involving patients and the public in healthcare (2001) formal response to BRI inquiry
  • NHS act: 2006 - Health authorities and trusts must involve and consult the public
  • Latest White Paper - new consumer champion HealthWatch England in the CQC, voice for patients. Use of patient experience surveys, informed choice
  • NHS Outcomes framework - 1 of the 5 domains is positive experience of care
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2
Q

What is the role of Local HealthWatch?

A
  • Power to enter and view services
  • Independent networks
  • Influence how services are set up and commissioned
  • reports influence design and delivery
  • Pass recommendations to healthwatch England and the CQC
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3
Q

What are 2 ways of indirectly investigating patients views?

A
  • PALS - Patient Advice and Liason Services

- Parliamentary and health service ombudmans reports

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4
Q

What is the role of PALS?

A

Trust based, confidential advice and support of health related matters and services.
On the spot, listen to ICE
Info on NHS
Early warning system
Information about complaints procedures in the NHS

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5
Q

What is the role of the Parliamentary and Health Service Ombudsman Reports?

A

Independent investigations; complaints than the NHS has not acted fairly or properly, or provided poor services.

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6
Q

Describe the NHS complaints procedure?

A

Informally raising with PALS or frontline staff
Patient or rep makes complaints - oral, electronic, in writing
Decide whether to complain to the CCG or to the hospital
CCG can pass it on to the hospital if appropriate
Either resolved or passed onto the Health Services Ombudsman if not satisfied

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7
Q

What are two ways to directly investigate patient’s views?

A
  • Qualititative

- Quantitative

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8
Q

How can patient views be investigated qualitatively?

A
  • Interviews, focus groups, observations

- Identify priorities and how they evaluate care

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9
Q

How can patient views be investigated quantitatively?

A
  • More common
  • Questionnaires
  • Cheap, easy, anonymous
  • Monitor performance over time/organisations
  • Increased use of national validated surveys - higher reliability, validity and satisfaction
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10
Q

Describe some critical perspectives on patient satisfaction

A
  • Sometimes not reasonable or rational

- unrealistic expectations

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11
Q

Name some things that cause patient dissatisfaction

A
  • Poor communication
  • Hotel - laundry, food
  • Car parking
  • Can’t report concerns fully
  • Not a full history
  • Reassurance not conveyed
  • Appropriate advice not provided
  • Inconvenience, waiting times, access, poor hygiene, poor continuity
  • Competence
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12
Q

What are some advantages of using patient based outcomes to assess the performance of doctors?

A

Ultimately care is for patients - they should feel it is adequate

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13
Q

What are some disadvantages of using patient based outcomes to assess the performance of doctors?

A
  • Patients may not be objective
  • Naturally selfish to improve care
  • Not applicable nationally
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14
Q

What are the 4 sociological approaches to understanding the patient- professional model?

A
  • Functionalism
  • Conflict
  • Interpretive/interactionism
  • Patient centred
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15
Q

Which 3 patient- professional models are explanatory?

A
  • Functionalism
  • Conflict
  • Interpretive/interactionism
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16
Q

Which patient- professional model is aspirational?

A
  • patient centred
17
Q

What is the functionalist patient- professional model?

A
  • Consensus and reciprocity
  • Asymmetrical relationship
  • Powerful doctor
  • Patient in sick role
  • Abstract code of conduct
  • Medicine restores normal social function
  • Lay people do not possess the technical competence to remedy the situation so are helpless
18
Q

What is the conflict patient- professional model?

A
  • Medical dominance and suppressed conflict
  • Doctors are oppressive - control professional values, technical expertise, bureaucratic power. Monopoly on defining health
  • Lay ideas discounted
  • Medicalisation - people dependent on medicine
19
Q

What are some criticisms of the conflict patient- professional model?

A
  • Patients are not passive - they can exert control e.g non-adherence and complementary therapies
  • Patients can seek to medicalise issues to gain benefit
20
Q

What is the interpretivism/interactionism patient- professional model?

A

Emphasises the meanings that people ascribe to social situations - unwritten rules govern most aspects of social life
Set of expectations for every medical encounter. Patients and doctors avoid matters not fitting with the ideal - both orient to an idealised encounter

21
Q

Describe the sick role

A
  • Falling ill is a sociocultural experience
  • Enter a role allowing legitimate freedom from social responsibility
  • Should want to get well and seek technical help
  • Should not abuse the legitimised expectations
22
Q

Describe the doctors role - functionalism

A

Tending to the sickness in society
Use skills for the benefit of others and not ones own
Objective and non-discriminatory
Granted intimate access to patients, autonomy, status and financial reward
Norms and expectations

23
Q

What are some criticisms of the sick role?

A
  • Some people can’t get better
  • Often illegitimately occupied
  • Assumes patients are incompetent and passive
24
Q

Describe the patient-centred patient- professional model

A
  • Less hierarchical, more cooperative
  • Take patients views into account - CONCORDANCE
  • Explore ICE - costs and benefits of alternatives
  • Enhance prevention and health promotion
25
Q

What are some challenges of the patient centred patient- professional model?

A
  • Some people don’t want to share decision making
  • Unknown consequences of involvement
  • Who has final responsibility?
  • Is there enough time for this?
26
Q

What is complementary medicine?

A

Any medical system based on a theory of disease or method of treatment other than the orthodox science of medicine as taught in medical schools.
Alternative to traditional medicine, increasingly combined

27
Q

What are some examples of complementary medicine?

A
  • Acupuncture
  • Aromatherapy
  • Hypnotherapy
  • Indian head massage
  • Reflexology
28
Q

Why do people turn to complementary therapies?

A
  • More time
  • Persistent symptoms
  • Adverse effects
  • More holistic approach
  • Increased availability
  • High level of satisfaction reported
29
Q

What are concerns with complementary medicine from doctors?

A
  • Interactions with other drugs
  • Fragmentation of care
  • No communication between CAM professionals and HCPs
  • Implausible mechanism
  • May refuse conventional treatment
  • Waste of money
  • May miss or delay diagnosis
  • Unregulated and unqualified practitioners
30
Q

Why is it difficult to conduct clinical trials on complementary medicines?

A

Funding
Difficult to double blind or find placebos
Trial of single intervention unreflective - multifaceted trials are complex
Randomisation

31
Q

Should NICE evaluate complementary therapies?

Pros and cons

A

Pros: high public interest, GPs provide access, address inequalities in access, can apply standards, could stimulate higher quality research

Cons: limited NHS resources, higher priorities, poor quality evidence

32
Q

Describe aromatherapy

A
  • Controlled use of essential oils for therapeutic properties
  • Relieve stress, ease tension, improve health
  • Evaporate quickly
  • Combine with massage
33
Q

Describe acupuncture

A
  • Needles at trigger points - treat patterns of referred pain
  • Used in MSK medicine - treat trigger points with manipulation
  • Human body controlled by energy called Qi, alter its flow at points along meridians
34
Q

What are the implications of complementary medicine for medical practice?

A
  • Fragmentation
  • No communication between doctors and CAM pros
  • Drug interactions
  • Quality and safety issues
  • May be asked to provide access to some complementary therapies

HaDSoc (10 decks)

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