Dentist In Society Flashcards
1
Q
What are the explanations for power imbalance in a dentist-patient relationship?
A
- Different roles of the patient and dentist in the appointment -the dentist is always the leader and operator whilst the patient is being worked on and told what to do.
- Setting of the social encounter -unfamiliar and sometimes a threatening environment (clinical smell, white walls, chair at the centre of the room, little decor) that leaves patient feeling uncomfortable and with lack of control over the situation. Once they enter the surgery they feel they can’t leave, unlike the GP they know things will be done to them. Also noisy atmosphere makes it difficult to hear.
- Professional status of dentistry -patients feel inferior due to the cultural and medical authority of dentists that gives them social power.
- Nature of consultation -how dentists communicate with patient eg. do they talk down to them or tell them off.
- Physical factors -patients in pain can’t communicate as well (vulnerable/weak state). Dentist invades personal space of patient unusually only reserved for intimate relationships.
2
Q
What does the transformative experience refer to?
A
When patients undergo a change of character upon entering the dental surgery. Patients become shy, less confident, less questioning and more compliant to the recommendations of the dentist. Occurs due to the patients perceived social, cultural and medical authority of the dentist that leads them to feel a power imbalance.
3
Q
What is are the 4 categories of proxemics?
A
- Intimate -emotionally close eg.husband, boyfriend/girlfriend
- Personal -close friends
- Social -don’t know well
- Group
4
Q
What are the implications of power imbalance in patient-dentist relationship?
A
Patient low and dentist high, they will never meet in the middle. Can’t build a relationship based on mutual respect and trust. Patient becomes passive in the appointment, does not engage with OHI and is a poor attender. Also if patient concerns are not met then they may not consent to treatment they need, medical condition worsens requiring additional appointments using up dentist time and resources.
5
Q
How can you as a dentist reduce power imbalance with your patients?
A
- Create a friendly and welcoming dental environment -warm colours, decor, TV on ceiling, equipment out of site, windows etc. Patient feels more comfortable and less foreign.
- Involve patients in the consultation, ask for their thoughts. Discuss why they are finding their oral hygiene regime difficult and find a solution rather than just telling off. Give all info possible so treatment so they are an active participant in treatment decisions.
- Avoid medical jargon that would make patient feel overpowered by medical authority.
- Change communication techniques, language and subjects of conversation suitable for each patient so that bring you and the patient to the same level.
- Patience if patient is in pain and having trouble communicating.
6
Q
What is meant by the paternalistic communication model?
A
Patient plays a passive/low input role in the dental consultation. Dentist leas and controls, deflects questions, does not justify diagnosis or treatment and limits information given to patient.
7
Q
What is the purpose of screening?
A
- Detect presymptomatic stage of disease
- Identify high risk individuals so risk can be lowered
- Screening of embryos for informed reproductive choices
- Improve public health to lower health expenditure
8
Q
At what point in the progression of disease is screening carried out?
A
During ‘cause’ (exposure to risk factors and causative agents) and ‘induction’ of disease with initial pathology but still presymptomatic to the individual
9
Q
Screening is diagnostic, true or false?
A
False, gives and indication of risk of disease or disease at presymptomatic stage. Requires further investigations to confirm diagnosis.
10
Q
What is the difference between selective and mass screening?
A
Selective is carried out on high risk individuals and can be screening for a single disease or for a number of disease/conditions (multiphasic). Mass is carried out on a large target group of eg. All women age 18-21 for cervical cancer or routine checks of all over 75yrs, mammograms for women over 60yrs.
11
Q
What it opportunistic screening?
A
Opportunistic screening happens when someone asks their doctor or health professional for a check or test, or a check or test is offered by a doctor or health professional. Unlike an organised screening programme, opportunistic screening may not be checked or monitored.
12
Q
What are the key benefits of screening?
A
- Lower morbidity and mortality in population
- Lower NHS expenditure
- Reduce need for invasive treatment.
- Prevent disease
- Reassure those deemed healthy
13
Q
What are the requirements of screening?
A
- Accepted by public
- Diagnosis and treatment available with suitable resources to provide it. Treatment must be acceptable.
- Pathology and natural progression of disease understood
- Evidence that it lowers morbidity/mortality
- Recognisable early symptomatic stage
- Benefits outweigh harm
- Economically viable
- Policy of who and who not to give treatment to.
14
Q
Which diseases are suitable for screening?
A
- Those where early therapy gives better outcome than therapy later in disease progression.
- Diseases with slow progression
- Effects of a disease outcome in the individual would be significant eg. Life threatening, affect work, sleep and quality of life.
- High prevalence -mass screening of rare diseases would be ineffective and a waste of time and money.
15
Q
What are the 4 stages of the screening process?
A
- Identify high risk individuals or target group (women over 60yrs at risk of breast cancer)
- Carry out screening test (offer mammogram to all over 60yrs)
- Carry out diagnostic tests if screening result was positive (biopsy and blood work up)
- Carry out treatment if disease diagnosed (mastectomy, chemotherapy, radiotherapy)
16
Q
What does sensitivity of screening test refer to?
A
Probability that the screening test will give a positive result when disease is truly present ie. Ability of test to identify those with disease.
17
Q
When is the ideal time to screen?
A
When health is declining and disease is just setting in. Waste of time to screen everyone who is healthy and normal (before health decline) and at an advanced stage of disease there is no longer a purpose to screening (couldn’t prevent disease or need for invasive treatment at this stage).
18
Q
What are the benefits of screening for caries?
A
- Can also pick up other intraoral problems and/or diseases eg. PD, plaque retentive restoration, damaged teeth/restorations, occlusal problems etc.
- Identify high risk caries individuals
19
Q
What is the evidence for the effectiveness of screening children in schools for caries?
A
Ineffective at reducing caries levels and so no longer carried out.
20
Q
Which target group are still screened for caries?
A
Specialist needs children at high risk. Detection of caries or risk of caries helps reduce prevalence of caries occurring or becoming severe (with need for extraction) so preventing requirement for GA sedation which would be traumatic for these children.
21
Q
What are the risk markers for caries that could be used in screening?
A
Behaviour and sociodemographics
22
Q
Why is selection of appropriate method for caries screening pragmatic?
A
- Plaque levels ineffective -don’t know how long ago patient brushed teeth, score could be low just because it’s been since the morning they last brushed.
- No physical characteristics to identify individuals as high risk
23
Q
According to the socioenvironmental approach what factors affect overall oral health?
A
Behaviour (lifestyle), physiology (immunity, BP) and psychosocial components (feelings, motivation) which are affected by risk factors associated with social class and environment (poverty, stress, working environment).
24
Q
Are environment and lifestyle (behaviours) independent?
A
No behaviour is not always a choice and can be dependant on an individual’s environment eg. Night workers increased risk of caries as eating when they have low salivary flow, athletes are mouth breathers and have high sugar isotonic drinks.
25
What does the black report 1982 state and what is the relevance to dentistry?
Higher death rates in low social classes, children have lower birth rates and shorter stature. Major diseases affect social classes 4+5 more than classes 1+2. Dentists should be aware that health inequalities are related to socioeconomic class. Patients of classes 4+5 are more at risk of poor oral health and caries.
26
What percentage of children worldwide have caries?
60-90%
27
How many cases of oral cancer are there worldwide per 100,000 people?
1-10 cases
28
What percentage of the NHS expenditure is spent on oral health?
5-10%
29
What is the WHO definition of oral health promotion?
Process of enabling people to increase control over and to improve their health.
-Provides them with the skills, knowledge and motivation to change to positive health behaviour.
30
What are the 5As of smoking cessation?
Ask, advise, assess, assist, arrange
31
What are the principles of health promotion?
Involves entire population
Involves public participation
Action targets determinants of health
32
What are the 5 components of health promotion?
1. Prevention -lower disease levels directly
2. Behaviour change
3. Education
4. Empowerment
5. Social change (collective focus)
33
What is important to consider when developing an oral health promotion campaign?
Economic worth (cost vs effectiveness of intervention)
34
What does a quality adjusted life year (QALY) refer to?
Measure of disease burden:
| Estimates years of life remaining after treatment and scores quality of life for each of those years
35
What is QUALY used for?
Measures cost effectiveness of health promotion by accessing disease burden.
36
Name some settings for health promotion?
Schools, workplace, dentists, community, population level (mass media campaigns)
37
What is the Ottawa Charter?
A series of actions agreed internationally to achieve the goal of 'health for all'. It is what health promotion campaigns are founded upon.
38
What are the Five action areas for health promotion identified in the Ottawa charter?
1. Build health policy
2. Create supportive environment
3. Community action
4. Develop personal skills
5. Reorientation of health services
39
In accordance to the Ottawa charter how can health professionals create a supportive environment?
Improve population living/working conditions so they are safe, stimulating, enjoyable and satisfying. Encouraging an environment where individuals help each other out. This will improve individual's general well being as part of the holistic approach to health.
40
In accordance to the Ottawa charter how can health professionals build health policy?
Encourage the government to make new policies in a number of different sectors (education, housing, fiscal, health, food business etc.) that will ultimately address health issues. Aim is to make positive health behaviour the cheaper and easier option. Eg. Tax on high sugar drinks, implementing diet and oral health in to school curriculum.
41
How can we strengthen community action in oral health promotion as dentists?
Encourage local cookery clubs which teach young mums how to cook easy and low cost family meals that are nutritious and low in sugar, promote farmers markets so members are the community can by healthy fresh foods and low costs whilst supporting local businesses . Getting community to work together and provide opportunity for social interaction that will make members happier and more likely to pursue health.
42
How can dentists works to develop personal skills of populations in health promotion?
One to one OHI at the dentist, school visits teaching children and parents how to brush teeth, explaining the importance of oral health at dentist appointments and community events. Supports personal development by giving patients the skills and knowledge that enable them to take control over and carry out positive health behaviour (empowerment)
43
In the Ottawa charter what does reorientation of health services refer to?
Modify approach of dental care (and healthcare in general) to one of prevention and promotion as opposed to curative services/treatment.
44
What is health?
State of complete physical, mental and social wellbeing.
45
Health is a resource not a need, what is meant by this?
Health required for personal, social and economic development as well as quality of life therefore it is seen as a resource not an objective in life.
46
What is meant by advocacy?
Process of making political, economic, cultural, social, behavioural, environmental and biological factors favourable through advocacy of health. This will help to provide a solid foundation in the prerequisites of health
47
What is meant by mediation?
The prerequisites and prospects for health cannot be ensured by the health sector alone. Good health promotion involves mediating between different group eg. Government, community, health services, local authorities, media etc. in the pursuit of health.
48
What is meant by enabling?
Allowing individuals to achieve their full health potential by providing equal resources and opportunities so they can take control of their health determinants. Such as development of life skills, supportive environments and access to information.
49
What are the problems with health promotion?
1. Healthism -tendency to remove ourselves from areas with severe health needs.
2. Inverse care log
3. Political controversies
4. Time between preventive strategy and noticeable improvements in health.
5. Time taken to build trust in the community and to change health policies
6. Financial burden
7. Health Inaccessibility factors eg. Language, transport etc.
50
What is the main cause of referrals to paediatric specialist?
Behaviour management of paediatric patients not the nature/complexity of their condition.
51
How can we as dentists engage children?
Come down to their level.
1. Pretend games to stimulate their creative minds eg. Chair is a rocket
2. Give them a challenge eg. asking them to carry out a task is seen as a game not a demand.
3. False choice questions -involves a situation in which only limited alternatives are considered, when in fact there is at least one additional option eg. Do you want to get I the chair this side or left side.
4. Make notes about their favourite teddy, t shirt, shoes so you can free back to them at a later stage and develop rapport.
52
What are the 4 stages of child development?
1. Physical
2. Motor
3. Cognitive
4. Social
53
What is object permanence?
When child realises that objects still exist even if they cannot be seen, heard, tasted or smelt. Occurs between 0-2yrs.
54
What is egocentrism and at what age does it occur?
Child unable to to take another's point of view. Occurs between 2-7 yrs. can be difficult to manage in dental consultation
55
What is the concrete operational stage?
Marks the start of logical thinking, child is able to understand that objects retain certain characteristics like mass and volume even when they change shape or are divided.
56
What is the formal operational stage?
High order reasoning, abstract thinking, manipulating ideas in the mind. 12yrs+ although some will never reach this stage.
57
What are the three modes of behavioural development and learning?
1. Classical conditioning -pairing conditioned and unconditioned stimuli with a conditioned response.
2. Operant conditioning -learning via the consequences of behaviour resulting in increase of that behaviour (reinforcement) or ceasing behaviour (punishment).
3. Social learning -learning from the environment through observation
58
What are the implications of stranger and separation anxiety and what are the consequences?
Stranger anxiety (7-10 months) when child becomes aware of other people not familiar to them. Leads to separation anxiety where child is becomes distressed when taken from their parents/guardians. Children become clingy, difficult to manage, hard to gain trust. Dentist should avoid taking child from parent.
1. Friendly non threatening environment
2. Communication and tone of voice
3. Toys, posters, Tv
4. Keep parents close by
5. Colourful scrubs
59
Name some behavioural disorders in children
ADHD 5/10%
Learning Difficulties
Autism
60
How should a GDP treat children with disorders?
1. Set clear goals together with the child for appointment and end consultation when goal reached. Must follow through with what you say you will do.
2. Work at a speed suited to the child
3. Reward good behaviour and ignore bad behaviour
4. Desensitise child to dental environment to reduce anxiety
5. Pharmacology (sedation)
61
What are the methods of assessing pain and how is dental pain assessed in children?
Self Reporting pain on a scale
Ask parent if child has complained of pain
Assess child's sleeping and eating habits -BEST INDICATOR
62
How does a child's perception of pain change during development?
1. Pre-operational -early childhood when pain is seen as a global phenomena
2. Concrete operational -understanding that pain improves over time
3. Formal operational -late childhood when the child's understand when and why pain occurs and are able to score it on a level.
63
How does the appearance of a child affect their social development?
Children with dental facial abnormalities have weaker social skills, low popularity, isolation, bullying which all impair psychosocial development in to adulthood.
64
What type of children are most commonly abused?
Irritable, defiant, look different, unresponsive
65
Who are the abuser in child abuse?
Often those who were abused themselves and thus have stronger physiological reactions to social signals like distress. Distress seen as assign of rejection.
66
What are the oral manifestations and signs of pica patients?
Lesions to the oral mucosa and damage to teeth caused by trauma from foreign instruments. Usually patients with learning difficulties.
67
What is pain?
An unpleasant experience with sensory, cognitive and affective components modulated by psychological, social and contextual factors.
68
What are the implications of pain?
Working days lost.
Anxiety
Avoidance of the dentist
Quality of life
69
According to the FDPQ what are the most painful dental procedures?
Removal of lumps in mouth, mandible being drilled, burning away gingivae, RCT
70
What are the affective components of pain?
How the pain makes the individual feel eg. Anxious, scared, sad, angry, frustrated, as well as feelings about the implications of pain on social life and sleep.
71
Where in the body are pain signals registered and perceived as an unpleasant painful experience?
Lymbic system
72
What factors affect the overall pain experience?
1. Context (environment and emotional state)
2. Attention
3. Anxiety
4. Memory -learned response of pain to certain treatments, seems worse than the level of pain expected.
5. Personality
73
What are neurotic patient and how do they respond to pain?
Negative emotional state and sensitive to environmental stress. They rate pain in the same intensity as more unpleasant with greater impact on their life compared to patients with an optimistic personality.
74
How can we measure pain?
Physiology (cortisol, BP, HR)
Facial expressions
Self report
75
What are the problems with self reported pain?
Scales and questionnaires are subjective to tolerance, cultural differences, gender and power play with dentist.
76
What is the major component that contributes to pain experience in adolescents at the dentist?
Lack of control
77
Why is adolescence such a crucial time for dentists in pain management?
Teen undergoing key learning and cognitive evaluation so if they experience dental pain at this time they are much more likely to fear dentist and non attend
78
How can pain be alleviated?
Sensory -pharmaceuticals
Affective -distraction and enhance their sense of control
Cognitive -hypnosis , non threatening language
79
Are we in agreement on the characteristics of a healthy diet?
Reducing sugar 'vipone study' one thin agreed upon.
80
What is a strategy?
A plan for obtaining a specific goal or result
81
What do we need oral health strategies?
Oral diseases are preventable but prevalent
82
What are the three principles of strategy design?
Aim -what do you want to achieve eg. Lower percentage of children with caries by 10%
Objectives -how are you going to achieve aim eg. Oral health education in schools, fissure sealants, dietary advice in community.
Data collection -identify problem and understand it, find solutions and evaluate/feedback
83
What is the difference between health education and promotion?
Promotion aims to enable people to take control of their health determinants and thus improve health. Educational activities aim to achieve a health goal which contributes to health promotion.
84
Which 2 approaches in oral health promotion are covered by prevention in practice?
Behaviour change (education, smoking cessation) and prevention (fluoride and non fluoride)
85
What are the 3 domains of learning used for effective oral health promotion?
Cognitive -acquire facts eg. High Sugar diet causes caries.
Affective -acquire/change attitudes and beliefs eg. Sugar is bad, veg is good, dentist will make me feel better
Behavioural -acquire skills and actions eg. Tooth brush technique
86
What 3 main theories describe the process of behaviour change?
1. Locus of control
2. Health belief model
3. Stages of change/transtheoretical model
87
What is meant by the health locus of control?
Health behaviour change model. Describes that behaviour change depends on the extent to which an individual believes their health status is influenced by their own behaviour or the behaviour of others.
88
Describe a patient with a high locus of control?
Strong belief in the own ability and skill to determine their health.
89
Describe a patient with a high chance locus of control?
Believe their health is determined by chance and that their behaviour had little influence over the health outcome.
90
Describe the health belief model?
Model that describes process of health behaviour change. States that individuals self-assess risk/benefits of changing their behaviour based on the health threat and its severity eg. A smoker considers lung cancer as a threat and how severe/life impacting the disease is. They also consider value of changing behaviour eg. Would it make them feel better, look nicer, live longer etc.
Also requires a trigger eg. Anti-smoking campaign, friend dying of lung cancer, developing symptoms eg.pain
91
What is the transtheoretical model and name the stages?
Model used to describe process of behaviour change.
1. Precontemplation (not aware of need to change)
2. Contemplation (aware and motivated to change)
3. Preparation/planning (develop action plan)
4. Action
5. Maintenance
6. Termination or relapse
92
What is the role of dentist at each stage in the stages of change/transtheoretical model?
Pre contemplation -encourage patient to consider need to change behaviour
Contemplation -support decision to change
Preparation -help patient develop action plan
Action -provide support and encouragement to lad to long term maintanance
93
What are the Barriers to health behaviour change?
Lack of resources (Tepe brushes too expensive)
Lack of support at home
Lack of knowledge (thinking brushing once a day is enough)
Health results are not immediate
Conflicting information re. Need to change
Conflicting motives
Put off by failure
94
What are the criticisms of stages of change model?
Too simplistic -doesn't account for no. attempts at changing behaviour or time since last change or social, cultural and economic factors
95
What is the evidence for the effectiveness of in-practice DHP?
1. Fluoride interventions reduce caries
2. DHE in schools not effective
3. Chairside DHE expensive and effective short term but not long term
4. Effectively increase dental health knowledge but not positive health behaviour
96
What is the responsibility of dentists in delivering smoking cessation?
Should regularly check patient smoking status.
Smokers should be informed of risks to health and advised to stop.
Smokers should be advised to attend local NHS stop smoking group.
97
How can a dentist carry out a brief intervention in smoking cessation?
5-10 mins, identify if the smoker wants to stop, review past attempts, Identify problems they may encounter in stopping, identify support system, make a plan of action and consider nicotine replacement therapy.
98
What is the evidence for the effectiveness of chairside smoking cessation behavioural intervention?
Yes it is effective, has a positive effect on smokers, barriers for dentists are lack of time and resources.
99
Name the in-practice prevention methods for oral disease?
```
No fluoride:
Diet modification
OHI
Chewing gum
Chlorhexidine
```
Fluoride:
Varnish, gels, tablets, toothpaste
Fissure sealants
100
What is the evidence for fissure sealants?
Effective prevention as majority of caries occurs in fissures. GIC fluoride releasing materials are good when there moisture control issues. 77% non sealed surfaces decayed vs 27% (systemic review)
101
What are the uses of chlorhexidine?
Mouthwash, varnish, gel for post op infection, perio disease although not effective in treating caries and causes staining. Effectiveness of varnish for caries is inconclusive
102
What is e evidence for the effectiveness of chewing gum?
6 RCTs: xylitol reduced caries by 59%. Thought to have direct effect on s.mutans
103
What are the limitations of written communication that can lead to ambiguity about what's being said?
Lacks tone, facial expression, context, para language so interpretation is subjective.
104
Name the dental uses of communication?
Prescriptions, referrals, clinical notes, documents, leaflets, reports, essays
105
What affects the comprehensibility of written communication?
Syntax, grammar, easy to understand language, handwriting, size
106
What are the implications of poor written communication?
1. Danger to patients -wrong drug prescribed, inaccurate medical history, failure to provide diagnosis so patient does not receive treatment.
2. Complaints/court case
3. PI Leaflets are ineffective -confusion, misunderstandings, disengagement
4. Referral letters have insufficient information eg. failure to inform clinician of patient aggression
107
What are the guidelines from prescribing drugs?
1. Clear and unambiguous writing with regard to dose and frequency.
2. Use the correct drug name
3. Date
4. Name of patient
5. Do not use abbreviations
108
Reading is a interactive and dynamic process, what is meant by this?
The reader reads text, constructs meaning, responds emotionally, behaviourally or cognitively.
109
What did the 2013 audit of BDH patient notes show?
Compliance with standards of note taking was deemed poor and in need of improvement for...
1. Allergies
2. Next of kin
3. Abbreviations and corrections
4. Approved signatures
5. Signing and dating
110
What did the audit of paediatric referrals at BDH in 2011 show?
Areas for improvement were giving full details of GMP details, justification of general anaesthesia, radiographs.
111
What should be included in a standard referral letter?
```
Full details of referrer and GP
Reason for referral
Justification of GA
Relevant MH and DH
Radiographs
Diagnosis and Treatment plan
```
112
What is the purpose of educative written communication in dentistry?
- Improve knowledge of condition and treatment options
- Informed consent
- Strategy for health promotion
- More likely to adhere to advise and OHI
- Lower anxiety
- Increase patient satisfaction
- Prepares patient for procedure
113
What are the problems with delivering written educational services?
Around 5 million adults in England are functionally illiterate.
114
What is meant by functional illiteracy?
Lack reading skills necessary for coping with most jobs and everyday situations.
115
How can we deliver written dental education to individuals with poor literacy?
Short words and sentences, big font, personal pronouns, reduce use of capitols, base text on familiar topics.
116
What should dental professionals consider when writing PILs?
1. Clear, concise and relevant text.
2. Accurate and in date (patients check the Internet!)
3. Diagrams and visual aids
4. Designed for a target audience
5. Engage and interact with reader (bits to fill in or write notes)
6. Enables patient to make their own decisions
7. Enhance skills
117
What is medical authority?
When a medical professional has scientific knowledge they are able to use to describe and define health and illness.
118
What is clinical autonomy?
Freedom of clinicians to make judgements based on their professional judgement and specialist knowledge.
119
What is cultural authority?
Legitimacy to be an arbitrator of meaning within society as a consequence of ones social role.
120
How is social powerlessness brought about?
Professional role of dentist gives them the legitimacy and authority to exercise power and social control in dental consultation.
121
What are the three ways dental patient can feel powerless?
Physically
Emotionally
Socially
122
How can dentist solve locked in roles of patient/dentist relationship?
1. Change communication style -ask patient open questions.
2. Involve them in decision making process
3. Share info clearly and concisely
4. More personable to build rapport and trust
5. Invite patient to write testimonials and feedback on consultation.
123
What is medical authority?
When a medical professional has scientific knowledge they are able to use to describe and define health and illness.
124
What is clinical autonomy?
Freedom of clinicians to make judgements based on their professional judgement and specialist knowledge.
125
What is cultural authority?
Legitimacy to be an arbitrator of meaning within society as a consequence of ones social role.
126
How is social powerlessness brought about?
Professional role of dentist gives them the legitimacy and authority to exercise power and social control in dental consultation.
127
What are the three ways dental patient can feel powerless?
Physically
Emotionally
Socially
128
What are the principles of strategy design?
1. Aim -what is to be achieved
2. Objective -how are you going to achieve aim
3. Data collection
- identify problem
- understand problem (disease level, access to NHS services, sociodemographs, public concerns)
- needs assess
- evaluate interventions available and choose one to use (evidence based critical analysis and look at available funding/resource)
- continuously evaluate successful eps of strategy during its roll out
- reassess problem and decide if it's time to stop.
129
What is a needs assessment?
Evidence based approach to commissioning and planning health services (using objective and valid).
130
What is a health need?
When a person has an illness of disease where a an acceptable treatment or cure exists.
131
What is meant by need, demand and supply when assessing needs?
Need -what people might benefit from (based on judgment of health professionals)
Demand -what individuals are willing to pay or wish to to use in free healthcare.
Supply -what is actually provided
132
What is the purpose of commissioning?
Aim to make three circles of need demand and supply more congruent.
133
Why do a needs assessment?
1. Facilitate commissioning and planning
2. Assess changes in demography of population
3. Advances in medical care can change demand and need.
4. Assess how severe the need is and act only in areas of high need due to limited resources and health care inflation
5. Identity health inequalities (inverse care law)
134
What are the 3 approaches of health care strategies?
Whole population -addresses whole population to lower average risk of disease.
High risk -targets high risk individuals and offers prevention and treatment
Target group -targets high risk communities, not everyone will be high risk and not all at risk will be included (moderate risk not included).
135
What is an advantage and disadvantage of the whole population approach?
Advantage -tackles underlying health determinants, benefits everyone in society, avoids victim blaming, allows healthy choices to be made
Disadvantages -slow effects, transient governments with different agendas, prevention paradox, takes away free choice.
136
What are the advantages/disadvantages of high risk strategy?
Ad -intervention designed for individuals, cost effective use of resources, readily supported
Disadvantages -downstream approach, can't predict future of individuals, not all individuals at risk are selected (low/medium risk)
137
Which health strategy approach emphasis on reducing health inequalities?
Targeted pop strategy
138
Name a successful target population strategy?
Fluoride rinse program in selected schools
139
What is the common risk factor approach?
Recognising that many diseases share risk factors so direct action to reduce these risk factors and their social determinants help to improve a number of conditions.
