EBM and Audit

Question 1

What is 5 step process of EBM

Answer 1

Ask - an answerable question 
Acquire - best evidence 
Appraise - critically 
Apply - high quality evidence to patient care 
Assess - how you perform

Question 2

How do you form a question

Answer 2

PICO 
Patient/ population 
Intervention
Comparison
Outcome

Question 3

What categories do PICO questions come under and what study is used to assess

Answer 3

Diagnosis - cross-sectional
Prognosis - cohort
Therapy - RCT
Harm - cohort or case control

Question 4

Look at type of questions

Answer 4

OK
Quantitative (numerical) = PICO model
Qualitative

Diagnosis - cross sectional
Prognosis - cohort
Therapy - RCT
Harm - cohort or case control

Question 5

What are observational studies

Answer 5

Case control
- Compare people with and without disease and look at exposure to RF
Prospective Cohort
- People without disease and follow up to see if they develop and compare exposure
Retrospective cohort
- People with disease and look back at exposure
Cross sectional
- Measures prevalence of disease and exposure in given point in time and compare to gold standard

Question 6

What are interventional studies

Answer 6

Controlled clinical trial

- Effects of specific intervention against a control

Question 7

Where can you get evidence

Answer 7

Textbook
SIGN guidelines
Cochrane - RCT + systematic review
Pubmed

Question 8

What are sign guidelines and what are best levels of evidence to worst

Answer 8

Evidence based clinical guidelines
Put medical knowledge into practice
Reduce variation in practice and outcome
Based on critical appraisal of scientific literature
- SIGN provide checklist to critically appraise
Rates level of evidence
Different checklist for different studies

Best to worst
High quality meta-analysis or systematic review of RCT
Well conducted
High quality systematic review of cohort or cast control
Well conducted
Non-analytic studies
Expert opinion

Question 9

What are determinants of health and health inequality

Answer 9

Lifestyle - smoking / diet / exercise / alcohol 
Socio-cultural environment
Poverty and social deprivation
Psychological
Biological and conventional healthcare

Question 10

What is socio-cultural environment

Answer 10

Health related behaviour linked to underlying social and economic circumstance - poverty / unemployment / poor housing

Question 11

What is destitution

Answer 11

Absence of minimum basic resources for physical survival

Question 12

What is an audit

Answer 12

Systematic approach to reviewing provision of healthcare and quality
Highlight area of improvement

Question 13

What is audit cycle

Answer 13

Set standard
Measure current practice
Compare results with current standards
Reflect, plan and change
Re-audit

Question 14

What are Scottish health survey’s

Answer 14

Provide info about lifestyles and health in Scotland
Monitor trends in RF / health behaviour
Annual
Representative of population

Question 15

What do surveys collect info

Answer 15

General / mental health
Recent Dx
Prescribed medication 
Smoking
Alcohol
Fruit / veg
Activity 
BP
BMI
Education
Employment
Ethnicity

Question 16

What is data used for

Answer 16

Measure prevalence of RF
Compare health differences with different countries
Monitor trends

Question 17

What are routine data collection in primary care

Answer 17

Scottish Primary Care Information Resource (SPIRE)

Prescribing Information System for Scotland (PRISM)

Data from Quality Outcomes Framework (QOF)

Data from uptake of immunisation and cervical screening

Question 18

What is SPIRE

Answer 18

Info about consultations representative of population in terms of age, gender, deprivation, urban, rural

Question 19

What is PRISM

Answer 19

Data on prescribed medicines dispensed into community

Used to enhance safe prescribing and reduce poly pharmacy

Question 20

What is data from QOF used for

Answer 20

Pay GP practices for care they provide

Measure achievement of practice against evidence based indicate

Question 21

What is clinical governance

Answer 21

A framework through which NHS organisation responsible for improving quality of services and safeguarding high standards of care

Providing high quality NHS care
Maintain high standards and continuously improve services patients receive
Identify and response to poor practice

Question 22

What does clinical governance include

Answer 22

Clinical effictiveness
Clinical audit
Guidelines e.g. SIGN
Use of routine info about patient outcomes
Progressional development
Profressional regulation and revalidation

Question 23

What is clinical effectiveness

Answer 23

Ensuring individual patients are offered treatment based on best available evidence
Also equity
Patients should have equal access according to need
NO postcode prescribing

Question 24

What is SMC

Answer 24

Advises Scottish health boards about the effectiveness of all newly licensed medicines

Question 25

Type of bias

Answer 25

Recall
- Answer questions that happened in the past
Selection
- Under-represent or over groups of population
Observational
- Aware being observed by scientists which alters answers
Confirmation
- Look for information in data that confirms ideas or opinions
Publishing
- Studies with - ve findings less likely to be published

Question 26

What is discrimination

Answer 26

Unjust or prejudicial treatment of different categories of people

Question 27

What is inequity

Answer 27

Lack of fairness

Question 28

What is prejudice

Answer 28

Opinion not based on experience or reason

Question 29

What is stereotype

Answer 29

Views of every person of group