Final revision Flashcards
Reasons for non Adherence
1) Language barrier
2) Low education level
3) Poor doctor-patient relationship
4) System related obstacles
Clinical approach steps
1) History
2) Examination
3) Investigation
4) diagnosis
5) Treatment/follow up
Tertiary care
- specialized consultative health care
- referral from a primary or secondary health professional
- has facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.
Secondary care is
Medical care that is provided by specialist
-upon referral by a primary care physician
-that requires more specialized knowledge,
skill than the primary care physician
Primary care is
-care provided by physicians trained for and
skilled in comprehensive first contact
-continuing care for persons with any health
concern
good physician treats the disease, but great physician treats…..
the patient who has the disease
Referral means
Referral does not mean transferring responsibility But it’s sharing responsibility in patient care.
How to write a referral letter?
1) Patient details
2) Name of physician
3) Reason for referral
4) Degree of urgency
5) Clinical points
6) Previous injury
7) Findings on physical exam/ investigations
8) Medication and drug sensitivity
9) Expected outcome and desirable follow up
4 levels of Referrals are
1st • From family physician primary health care to hospital specialist.
2nd • From specialist to another specialist.
3rd • From junior specialist to senior specialist.
4th • from general hospital to specialized hospital
disadvantages of teleconsultation
- No non-verbal cues, hidden agendas or fears
- No examination findings, No opportunity for near patient testing e.g. pregnancy test
- Deafness, language can be a big barrier to communication
- Reduced opportunity for health promotion
- Issues of confidentiality, who are you talking to and who may overhear?
Disadvantages of self medication
- Adverse Drug Reactions.
- Chances of using wrong medication.
- Drug & food interactions.
- Lack of knowledge about dose.
- Risk of disease aggravation.
History taking steps
1) Personal history: Full name, age, sex, marital status, occupation
2) Chief complaints: The main reason of visit. recorded in patients own words.
3) Present history: Elaborate on chief complaint in detail, describe each symptom in chronological order.
4) Past history: ask if they have any medical problems like past surgery/operation, history of trauma/accidents and drug history.
5) Family history: hereditary diseases
6) Social history: Smoking, drinking, occupation/education.
Other relevant history: Gynae history for female, immunization if small child and sexual/travel history if STI or infectious disease.
Top 5 reasons for consulting a doctor
- Reaching anxiety threshold
- Reaching symptom threshold
- For follow up
- For prevention “vaccine”
- For administrative reasons
Case 1: young healthy man has a low-grade fever. He may react to it by:
a) Neglect b)Taking time off work c) Self-medication d) Visiting his physician
Neglect
—-% of patients neglect their illness
20%
Case 2: A young healthy lady has a high fever. She may react to it by:
Self-medication
__% of the patients may try to help themselves by rest and self medication
75
Patient Agenda: model 6-Helman folk model 1981 suggest that patient comes to doctor to answer 6 questions:
1) What has happened 2) Why it has happened 3) Why now 4) Why me 5) What would happen if nothing done towards it 6) what should be done/who I should consult
Model-McWhinneys Disease-Illness model 1986 suggests
that the doctor weaves between his agenda and that of the patient’s in a formulated management plan that satisfies the patients expectations.
Good comunication skills consist of
- Greeting the patient
- Open ended questions, active listening
- Facilitating verbal and nonverbal cues
- Clarification of the problem: History of current problem
- Analysis of the problem
- Explore patient ideas
- effect of the problem on family
Patient centered case
1) Shared consultation and management with patient
2) Focus on the patient as a whole not the disease
Provides partnership with patient
Patients become active and consider medical decisions makers
enhance patient physician relationship
Understanding the whole process
Patient centered method
1) Explore both diseases and patients
2) Understanding the whole person
3) Finding common ground
4) Disease prevention and health promotion
- Health enhancement: detect areas in patients life that need improvement
- Risk reduction and early detection
- Complication reduction
5) Patient-Doctor relationship
- Caring and healing
- Trust and respect
- Different patient needs different approaches
6) Be realistic
- Time
- Resources
- Emotional and physical needs of doctor
Myths around patient centered care (PCC)
1) its the ‘softer medicine”
2) disables the doctor
3) Only applicable in certain types of visits
4) Only applicable in family medicine
5) time consuming
Benefits of patient centered care (PCC)
1) Greater level of patient satisfaction
2) Greater level of doctor satisfaction
3) Better patient adherence
4) Improves patient outcomes
5) positive impact on utilization costs
6) Fewer malpractice claims
7) Higher quality of self reporting
Complaince
The extent to which the person’s behavior coincides with medical advise. Important in chronic diseases.
The different dimensions of adherence are
1) Socio-economic
2) Health care system
3) Condition-related
4) Therapy related
5) Patient related
______ is the biggest and the most common threat to medical practices.
Non-adherence
Non adherence maybe:
1) Intentional= active patient decision
2) unintentional= passive: carless or forgetful
Reasons for not taking medication
1) Forgetful
2) Symptoms disappear
3) Save money
4) Considered drug ineffective
5) Don’t need
6) side effects
7) Prevent other activities
8) No Rx reminder
Average information retention of patient:
1) 80% forgotten immediately
2) 20% of this 20% half misunderstood (10% overall) and half remember accurately (10% overall)
Effects of Non adherence
1) increase hospital readmission
2) Increase complications
3) Increase cost
4) decrease quality of life
5) patient death worst case scenario
Methods to detect non adherence
1) Direct objective: Measure drug level in blood
2) Indirect objective: pill count, prescription refilling
3) Health outcome measures: BP control/ asthma severity
4) Utilization of health core services: clinical attendance/appointment
5) Indirect subjective: patient interview
External Factors affecting compliance
1) health care provider
2) pharmacist
3) product/packaging
4) News/media
5) Government/payers
Patient experience affecting compliance
1) Side effects
2) Phycological issues
3) cost/insurance
4) awareness
5) co-morbidities
6) Rx benefits not noticeable because of delayed onset.
To simplify therapeutic regimen you could
Minimize the complexity of the doses
When educating the patient about medication you must explain
Name of med Action Route of Administration Common side-effects Self monitoring Storage Drug interactions Action if does is missed Selection of Over the counter drugs
What are the vital signs
Reflect body physiological and homeostatic state which include Temperature Heart rate/pulse Respiratory rate Blood pressure
Purpose of the vital signs checking
Base line data bout condition
Diagnostic purpose
Therapeutic purpose
When should you check vitals
On admission
Change in health status=symptoms or signs
Nursing or medical order
Before and after medications that may affect CVS and respiratory system
Before and after surgeries or invasive procedures
Before and after nursing procedures
Hospital policy
Conditions of the room for vitals taking?
Must be quite and warm
