Block 12 - part 1 Flashcards
importance of research informed practice
personal experience is biased in various ways, research reports findings for more patients than can hope to see in personal experience, involves application of scientific method, recommendations have been assessed for their clinical and cost effectiveness for the NHS
4 steps of research cycle
identify clinical problem, basic research (lab based), applied (clinical research), clinical care
implementation gap
gap between scientific understanding and patient care
barriers to implementation of research informed practice
characteristics of the recommendations, adopters, organisation and environment
quality improvement
facilitates the uptake and continuing use of evidence-based policy and practice, focussing on recurrent problems within system of care to improve performance, professional development and service-user outcomes
what does quality improvement involve
Engage participants across organisational levels, foster environment and innovation are viewed as normal, empowering staff to strive for change, provide knowledge and methods to implement change, remove barriers to chaneg
examples of QI initiatives
revision of professional roles, introduction of MDTs, change in skill mix or in the setting of service, facilitate audit and benchmarking cycles to identify variations in practice and outcomes that may be targets for QI efforts, network recognition for high-quality practice, promote inter-institutional communication and collabaration (and competition)
what makes a QI initiative effective?
passive dissemination of info is generally ineffective at driving change, multifaceted interventions that act of different levels of barrier to change are more likely to acheive improvements in policy and practice,
Quality and outcomes framework (QOF)
annual reward and incentive programme detailing GP practice achievement results, enables commisioners to reward excellence across key domains, aims to improve standards of patient care by assessing and benchmarking the quality of care patients receive (against previous years)
aims of national CQUINs 2014-15
friends and family test, improvement against NHS safety thermometer, improving dementia and delirium care, improving mental health diagnosis
incidence of falls in the elderly
35% of 65-79yo
45% of 80-89yo
55% of 90+
6 possible consequences of falls
osteoporotic fractures, head injuries, contusions/lacerations, psychological problem, increase in dependance and disability, impact on carers, institutionalisation
risk factors for falls
muscle weakness, Hx of falls, gait deficit, balance deficit, visual deficit, arthritis, impaired ADLs, cognitive impairment, age, medical conditions: stroke, hypotension, PD, depression, epilepsy, dementia
how can falls be prevented/reduce risk
increase activity, weekly walk for exercise, strong family networks, multifactorial falls risk assessment, multifactorial intervention, education/info
what doesn’t help reduce falls
brisk walking, residential care setting (INCREASES) high intensity strength training (increases injury), educational and behaviural alone
QALY
quality adjusted life year, 1 QALY = 1 year in perfect health, e.g. if illness reduced quality of life by 20%, and this affects 10 people, than 2 QALY are lost
How to calculate QALY lost
Amount illness reduces quality of life (percentage) x number of people affectes
cost of falls
£1.3 billion
cost of hip fractures
£12k per patient, around £720 million per year
common fracture in elderly people
neck of femur
2 types of fractured NOF
extracapsular, intracapsular
extracapsular
bone outside joint capsule breaks - sliding hip screw, intramedullary nail
intracapsular
bone within joint capsule breaks - internal fixation - screws, nails, plates, rods
avascular necrosis
death of bone tissue due to lack of blood suply, can lead to tiny breaks in bones and eventual collapse
make risk factor for fracture
osteoporosis
other risk factors for hip fracture
low bone mineral density, age, female, low body weight, fam Hx, personal Hx, smoking, ethnicity (low risk in afrocarribbeans), corticosteroid use, medications
prevention of hip fracture
fall prevention, bone protection - medication, hip protection
primary prevention
avoidance of disease before any signs or symptoms develop
secondary prevention
avoidance of progression or later problems, signs or symptoms present
primary prevention for stroke
no Hx of stroke of TIA
secondary prevention of stroke
Hx of stroke or TIA
prevention paradox
majority of people who suffer a stroke are not at a high risk of a stoke, but if whole population changes their health behaviour via PH mechanisms, this would lead to a much greater effect. (majority of cases come from people at low risk becuase because number of people at high risk is small)
3 effects of targeting population for prevention
large potential benefit to community, low potential benefit to individual, may be low perceived benefit to individual
effects of targeting high risk groups for prevention
larger potential benefit to individual, smaller effect on population rate of stroke, many of conditions treated are asymptomatic, many treatments have side effects
people at highest risk of stroke
people who have already had one - 1/5 of people with stroke will have another after 3 months
medication used for primary prevention of strokes
ischaemic - clopidogrel, statin, antihypertensives, anticoagulant if AF
haemorrhagic - antihypertensives
percentage of people who have strokes under 50
20%
incidence in strokes in men and women
men 25 % higher risk, women tend to live longer so incidence higher in women
non-modifiable risk factors for stroke
age, gender, race (south asians with western lifestyle), family Hx
modifiable risk factors for stroke
hypertension, diabetes, AF, smoking, hyperlipidaemia, obesity
what did the PROGRESS trial show
reducing blood pressure after stroke reduces risk of stroke recurrence
barriers for initiating medical therapies with no obvius symptoms
misinformed, not caring, side effects of tablets, forgetfulness, depression, cognitive impairment
