Community Based Medicine - Introduction

Question 1

Overview?

Answer 1

CBM will focus on three broad topics relevant to Primary Care as follows:-

•Minor Illness

•Child Health and vaccinations

•Elderly Care; Chronic Disease Management

Question 2

Skills focus?

Answer 2

•Musculoskeletal (ARC)

–Regional joint examination

–Arthropathies- RA, OA, Gout & minor injuries

• Examination of the child (JP)
• Communication- consultation models: Neighbour (1987) The Disease-Illness model (1984) The Calgary-Cambridge guide (1996) Pendleton (1984, 2003)
• Review of systems (self-directed)

–Including EENT (fundoscopy- DM clinic)

Question 3

Themes?

Answer 3

•Early Diagnosis

•Management Principles

•Therapeutics and Prescribing

• Referral Pathways in routine, rapid and in complex circumstances

Question 4

Matrix Core Conditions
Example

Answer 4

• Acute pharyngitis
• Acute tonsilitis
• Apthous ulcers
• Acute sinusitis
• Allergic Rhinitis
• Epstaxis
• Chronic Sinusitis
• Nasal Polyps
• Acute otitis media
• Cerumen impaction
• Labyrinthitis
• Otitis externa
• Vertigo
• Chronic otitis media
• Influenza
• Croup
• Respiratory syncytial virus infection
• Quinsy (peritonsillar abscess)
• Epiglottis

Question 5

Pre-reading task

Answer 5

•The impact of NHS Health Checks on the prevalence of disease in general practices:

–What are your thoughts?

–Has anyone encountered these checks on placement?

–Chronicity and preventative medicine

Question 6

Chronic disease

Answer 6

1. What makes a disease chronic? How many chronic diseases can you think of that are managed in General Practice?
2. Why might specific management plans for chronic disease be important i.e. if not managed well what might the impact on the patient, health care service, social service etc..?
3. What are our aims in managing Chronic Disease in Primary Care? Make a list.
4. What is the role of the GP in chronic disease management? Who else could be involved?

Discuss the management of a patient with a chronic disease that you have seen in your student surgeries or in nurse led chronic disease clinics using the following

Question 7

Questions around a specific chronic disease

Answer 7

• How common is this chronic disease?
• What are the co-morbidities associated with this particular illness?
• How does the disease progress over time?
• Can this illness be screened for? If yes, who should be screened?
• How is it diagnosed?
• How is it managed?
• What lifestyle advice is given to the patient?
• What are our aims in caring for these patients? Make a list.
• What happens during the annual review?
• What medications would the patient be on? Are there any important drug interactions?
• How can the issue of compliance be tackled?
• What advice about self management can be given to the patient?
• How can an acute exacerbation be managed?
• Why might GPs run a clinic devoted to this chronic illness?
• Which health care professionals are involved in the management of this illness?
• What is the role of the GP in caring for these patients?