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CPH PPD 2 > EPIDEMIOLOGY > Flashcards

EPIDEMIOLOGY Flashcards

1
Q

Total Hip Replacements (THR) undertaken for two main reasons

A

→ fracture of neck of femur, emergency -20% of all cases

→ osteoarthritis of hip joint, elective - 80% of all cases

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2
Q

Define need

A

Condition susceptible to benefit from treatment

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3
Q

Define demand

A

Treatment for which people are prepared to pay in a market

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4
Q

Define supply

A

Treatment which is actually provided

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5
Q

In a perfect world Need=Demand=Supply, but imbalances can occur for many reasons. List 4 broad reasons

A
  1. Increased needs/demands (aging pop., medical/technological progress, rising expectations). 2, Demands are affected by cultural, social and educational factors
  2. Needs are affected by current research agendas
  3. Supply limitations (restraints on resourcese.g. money, time, space)
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6
Q

When Need>Supply what does this create?

A

Unmet need

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7
Q

What does an unmet need cause within healthcare? 4 listed

A

Low patient satisfaction
Emergency presentations
Patient suffering, morbidity and morality
Pressure on other services

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8
Q

When need>supply there is an unmet need. This gives rise to the need for rationing. List the 4 types of rationing within healthcare

A
  • Implicit
  • Explicit
  • Rational
  • Irrational
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9
Q

What is the problem with rationing in the NHS?

A 
Contradicts NHS’s founding principles: 
Comprehensiveness
Equal accesss
Free at point of need
Universality
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10
Q

Describe and explain the 4 types of need

A

1) Felt need – patient defined
2) Expressed need – patient expresses need to a medical professional
3) Normative need– endorsed by medical professional
4) Comparative need – defined at a population level (vs. another population)

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11
Q

Give example of felt need

A

`I’ve got a bad pain in my hip, which I would like to get rid of.…’

Need expressed by individual - does not take professional views into account -may be culturally determined/influenced

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12
Q

Give example of expressed need

A

`I’ve got a bad pain in my hip… doctor, can you do something about it..? ’

Felt need which has been expressed, by making a demand upon health service -does not take professional views into account

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13
Q

Explain normative need with example

A

Defined by experts. A need endorsed by professional(s) – should be related to evidence base.

`I saw your patient today in my clinic… She has severe osteoarthritis of the hip and would benefit from a total hip replacement….’

May involve assessment of severity. Cultural influences may still be important. Serving gatekeeper function

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14
Q

Explain comparative need with example

A

Need compared between populations. e.g. Population A has total hip replacement rate of 10/1000/year. In Population B, rate is 6/1000/year - therefore Population B has an unmet need of 4/1000/year….. Is this a reasonable assumption?

This type of need is based on concepts of fairness/equity. May or may not link closely to felt need and expressed need in the individual

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15
Q

Need vs demand vs supply in healthcare

A

Need: defined on basis of what health care people can benefit from (i.e. is effective)
Demand: treatment which people would wish to use (or be prepared to pay for)
Supply: treatment actually provided

These do not always match in practice

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16
Q

Define health needs assessment

A

Systematic method for reviewing health issues facing a population, leading to agreed priorities + resource allocation that will improve health + reduce inequalities

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17
Q

What are the 3 elements of a health needs assessment?

A
  1. Epidemiological: which interventionsare helpful?Which patient groupsdo intervention work in?
  2. Comparative: compare service use to use in other comparable areas
  3. Corporate: consults to assess local public priorities & expert opinion
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18
Q

At least one proper RCT = Type __ evidence

A

1

19
Q

Who is involved in a corporate needs assessment?

A 
Purchaser
Provider
Professionals (hospital, community, GPs)
Patients 
Press
Public                             
Politicians
20
Q

What are the reasons why total hip replacement (or general treatment) provision could vary between locations? 5 points

A

DIFFERENCES IN:

  1. Data quality in different settings, so reliability + completeness differ
  2. Disease prevalence, reflecting differences in population age + sex structure
  3. Case ascertainment, diagnosis, criteria for operation in different settings
  4. Resource availability (staff, beds, theatres)
  5. Healthcare priorities (high/low rates of other conditions
21
Q

How does data quality affect provision of treatment X in 2 different locations?

A

Differences in data quality about treatment X in different settings means that reliability + completeness differ

22
Q

How does disease prevalence affect provision of treatment X in 2 different locations?

A

Differences in disease prevalence in 2 locations, reflecting differences in population age + sex structure = differences in how many people get treatment X in each location

23
Q

How does diagnosis affect provision of treatment X in 2 different locations?

A

Differences in case ascertainment, diagnosis and criteria for operation in different settings will causes differences in numbers of people receiving treatment X

24
Q

How does resource availability affect provision of treatment X in 2 different locations?

A

Diffeerences in resource availability (staff, beds, theatres) in 2 locations affect the number of people getting treatment X

25
Q

How do other conditions affect the availability of treatment X in 2 different locations?

A

Different healthcare priorities as a result of comparatively high or low rates of other conditions

26
Q

Give 4 reasons why imbalances occur in need/supply/demand

A

→ ageing population
→ medical progress
→ new technologies
→ rising expectations

27
Q

What has been the coventional NHS approach to rationing?

A

Waiting lists

28
Q

Give examples of implicit rationing

A

Waiting lists

Delaying referral based on criteria

29
Q

Give examples of explicit rationing

A

Do not provide service at all on basis of criteria

NICE/local NHS agencies

30
Q

Describe rational rationing

A

Remove ineffective treatments
Apply criteria consistently
Treat all patients who will benefit

31
Q

Describe irrational rationing

A

Rationing on criteria other than effectiveness and cost effectiveness e.g. pt criteria unrelated to outcome.
Locally defined criteria, conflicting with evidence

32
Q

Describe inequalities in health

A

Systematic differences in health of groups of people according to:

→ social position
→ place of residence
→ ethnicity
→ sex        
→ other characteristics

Health differences by age not usually referred to as inequalities

33
Q

How do we measure social status? 5 points

A 
Wealth 
Occupation 
Income 
Housing 
Amenities (e.g. car ownership)
34
Q

5 key points about the social gradient in disease (that disease and morbidity decrease with higher social standing)

A
  1. Large enough to have appreciable effect on life expectancy
  2. Applies to women + men
  3. Differences in mortality occur across life course (perinatal, infant, child, adult)
  4. Gradient in morbidity as well as mortality
  5. Apply to wide range of serious chronic diseases + risk factors for diseases
35
Q

How are geographic inequalities the same as social inequalities in health?

A
  1. Affect men and women, impact on life expectancy
  2. Tend to apply across life course (perinatal, infant mortality onwards)
  3. Major chronic diseases affected (CVD, cancers, respiratory disease)
  4. Reverse pattern for breast, skin cancer - ?due to starting family later, increased skin exposure in affluent areas
  5. Affect morbidity as well as mortality
36
Q

What are the 6 possible explanations for inequalities in health?

A
  1. artefact
  2. social selection
  3. differences in behaviour/`lifestyle’
  4. psychosocial pathways
  5. differences in material circumstances
  6. differences in health service provision + use
37
Q

How could differences in social class be an artefact to health inequality?

A 
Error in ascertaining social class
Selection of occupations into social class groups is arbitrary. 
This is not actually the case - similar mortality seen when comparing housing to mortality.
38
Q

Describe how feelings of inequality can lead to adverse health conditions

A

Leads to feelings of inferiority and unfairness or injustice. These give rise to emotional distress + negative feelings, which in turn have physiological effects, usually via neuroendocrine pathways.

Particularly implicated:

  • Work-related stress
  • Societal level stresses

Some evidence supporting psychosocial factors but overall remains inconclusive

39
Q

What is the inverse care law?

A

Health services tend to worsen in locations where it is needed more

40
Q

Does poor health lead to reduced social class?

A

Very limited.

a. There is some evidence e.g.mental illness often have a decline in social position
b. Generally a decline in health does NOT cause a decline in social position

41
Q

What accounts for most of the health inequalities between social classes?

A

Difference in material circumstances- different employment and living conditions

42
Q

4 explanations for health differences in ethnic minorites

A

i) Biological - genetic/hormonal differences
ii) Employment differences
iii) Behavioural differences(smoking + alcohol)
iv) Differences in health service use

43
Q

How can inequalities in health be reduced?

A

Most actions lie outside remit of health services. Limited evidence base to guide interventions

Key NHS actions include:

  • Establishing equitable access to effective care as a priority
  • Reallocating funds to reflect needs of socially deprived population groups
  • Improving monitoring of social, geographic + ethnic differences in health

CPH PPD 2 (11 decks)

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