FoPC 1 Flashcards
What are the features of primary care?
It is where the illness first presents, where most illnesses are managed and allows for the gatekeeper and prevention roles of the GP
What is meant by the “Gatekeeper”?
The person who decides who gets access to secondary care
What is meant by secondary care?
Hospital care
What is meant by tertiary care?
Specialised care that only takes place in regional centres e.g. transplant centre
Which services bridge primary and secondary care?
Public health, occupational medicine, some hospital specialties (e.g. psychiatry and palliative care), management of long term conditions (e.g. asthma) and community hospitals
Name the members of the primary care team?
GPs, dentists, NHS Direct/24 staff, nurses, midwives, pharmacists, allied health professionals e.g. physiotherapists and OT, PAs, practice staff e.g. receptionists, opticians and social care professionals
For every 1000 people, how many will report symptoms per month?
750
For every 1000 people, how many will see their GP per month?
250
For every 1000 people, how many will be admitted to hospital per month?
9 (3.5% of those seen in primary care)
For every 1000 people, how many will be referred to another doctor per month?
6
What are content skills?
What the doctors communicate - the substance of their questions and responses, the information they gather and give and the treatments
What are perceptual skills?
What they are thinking and feeling - their internal decision making, clinical reasoning, awareness of their own biases, attitudes and distractions
What are process skills?
How they do it - the way doctors communicate with patients; how they go about discovering the history or providing information; the verbal and non-verbal skills they use; the way they structure and organise communication
What types of factors influence the consultation?
Physical and personal factors
What are the physical factors?
Site and environment, adequacy of medical records, time constraints and patient status
What are the personal factors?
Sex, backgrounds and origins, knowledge and skills, beliefs and the illness
What are the types of doctor-patient relationships?
Authoritarian/Paternalistic: the patient does not actively participate in their own treatment
Guidance/Co-operation: physician still exercises authority but the patient is much more involved with their own care
Mutual Participation: the patient is an active participant and feels responsible for part of the outcome
What are the types of interviewing techniques?
Open ended question
Listening and Silence
Facilitation: encourages communication by using manner, gesture or words that do not specify the kind of information that is sought
What are the types of questions?
Open-ended: is not seeking a particular answer but simply signals the patient to tell their story
Direct: asks about a specific item
Closed: can only be answered yes or no
Leading: presumes the answer and is best avoided
Reflected: allows the doctor to avoid answering a direct question
What are the types of non-verbal communication?
Instinctive, learned (from life experiences and training) and clinical observation
What are the factors of body language?
Culture, context, gesture clusters, congruence, gaze behaviour (eye contact), posture and specific gestures (folded arms fidgeting etc.)
What are the top risks factors in Scotland?
Exceeding drink guidelines, smoking, not eating enough fruit/veg, not being active enough and overweight/obese
What diseases are smoking a risk factor for?
CVS diseases (hypertension, CHD and stroke), COPD and some cancers
What diseases are being overweight/obese a risk factor for?
CVS diseases, type 2 diabetes and some cancers
What diseases are lack of physical activity a risk factor for?
Obesity, type 2 diabetes, CVS disease, osteoporosis, back pain and some cancers
What disease are excessive alcohol consumption a risk factor for ?
Obesity, liver disease, CVS disease, some cancers, diabetes, osteoporosis, pancreatitis and psychiatric disorders
What are the factors of behaviour change theory?
Personal: beliefs, knowledge, attitudes and self-efficacy
Environmental/Social: culture, location and income
Behavioural: habit or pattern of behaviour
What are the factors of social cognitive theory?
Observational learning/modelling (learned behaviours)
Outcome Expectations
Self-efficacy (belief about capabilities)
Goal Setting
Self Regulation
What qualities does the knowledge/information need to have when helping someone to change?
Relevant to current goals
Easily understood and remembered
Readily available at the moment of the decision/action
What are the behaviour change recommendations (NICE, 2007) ?
Take account of the circumstances in which people live, especially socioeconomic/cultural context and any potential barriers
Develop and build on peoples strengths and skills
Tailor interventions to tackle the individual beliefs, attitudes, intentions, skills and knowledge associated with the target behaviours
What is the definition of health (WHO, 1948) ?
A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
What are the 5 major characteristics of health (Seedhouse)?
Health as an ideal state Health as a commodity Health as physical and mental strength Health as personal strength or ability Health as the basis for personal potential
What are the two types of normality?
Statistical - normality derived from the statistical distribution of the population
Cultural - normality dependent on the expectations and standards of the society, and thus on the political and economic as well as social factors
How do different age groups view health?
Older people concentrated on functional ability
Younger people tended to speak of health in terms of physical strength and fitness
How do people of different social classes view health?
People living in difficult economic or social circumstances regarded health as functional - the ability to be productive, to cope and take care of others Women of higher social class or educational qualifications have a more multidimensional view of health
How do those of different gender view health?
Women may find the concept of health more interesting and include a social aspect to health
How do cultural differences effect a person’s view on health?
White and Afro-Caribbean patients attached different meanings to high blood pressure
Afro-Caribbean’s tended to view it as normal and were less likely to take their medication
What is culture?
The learned and shared values of a particular group that guides thinking, actions, behaviours and emotional reactions to daily living.
The sum of beliefs, practices, habits, likes and dislikes.
The norms and customs that are learned
What is cultural sensitivity?
The ability to be open to learning about and accepting of different cultural groups
What is multiculturalism?
The recognition and acknowledgement that society is pluralistic. In addition to the dominant cultural, there exists many other cultures based around ethnicity, sexual orientation, geography, religion, gender and class
What are the barriers to communication?
Lack of knowledge, fear and distrust, bias and ethnocentrism, stereotyping, language barriers, differences in perceptions and expectations and situation
What is cultural competence?
The understanding of diverse attitudes, beliefs, behaviours, practices and communication patterns attributable to a variety of factors (such as race, ethnicity, religion, SES, historical and social context, physical or mental ability, age, gender, sexual orientation, or generational and acculturation status)
What is a hazard?
Something with the potential to cause harm
What is a risk?
The likelihood of the harm occurring
What is a risk factor?
Something that increases the risk of harm
What is a protective factor?
Something which decreases the risk of harm
What is susceptibility?
Something that influences the likelihood that something will cause harm
What are the main types of hazards?
Physical, chemical, mechanical, biological and psychosocial
What are the routes of exposure?
Skin, blood/sexual, inhalation and ingestion
What are the factors that influence the degree of risk?
How much a person is exposed, how the person is exposed and the conditions of exposure
What are the factors that influence the perception of risk?
Feeling in control: involuntary risks are perceived as having a greater risk
Size of the possible harm: risks that involve greater possible harm are perceived as greater
Familiarity with the Risk: risk that are less familiar are perceived as greater
What are the individual variables in risk perception?
Previous experience, attitudes towards risk, values, beliefs, socio-economic factors, personality and demographic factors
What are the direct effects of the environment?
Physical e.g. radiation
Chemical e.g. pesticides
Biological e.g. infectious agents
What are the indirect effects of the environment?
Housing e.g. overcrowding
Transport e.g. encouraging walking
Town Planning e.g. access to amenities and social networks
Income/Welfare/Welfare Distribution
What are three types of hazardous exposure/
Diet, inhalation and dermal
What are the factors of global health and sustainability
Inequalities in health within and between countries
Local problems may be generated/have consequences globally
Effective use of limited resources
Technology
Managing expectations and facilitating behavioural change
Politics/Human Rights/Gender Issues
What is ethics?
The body of moral principles or values governing or distinctive of a particular culture or group
What is morality?
Our attitudes, behaviours and relations to one another
What are the ethical principles?
Autonomy - the right to self determination
Non-maleficence -the avoidance of harm
Beneficence - to do good
Justice - fairness/equality and individual vs population
What is duty of candour?
You must be open and honest when something goes wrong with a patient’s treatment or care which causes, or has the potential to cause, harm or distress
What are Neighbour’s tasks of a consultation?
To connect with the patient
To summarise and verbally check that the reasons for attendance are clear
To hand over and bring the consultation to a close
To ensure that a safety net exists in that no serious possibilities have been missed
To deal with the housekeeping of recovery and reflection
What are the key points of safety netting?
The patient must know what to look out for, how to seek help if needed and the time course
What are the reasons for the social and economic gradient of health?
Access to healthcare (affordability, accessability and acceptability), environmental exposure, health behaviours and life course factors
What are the physiological response to psychological distress?
Increased BP, impaired glucose tolerance, immune dysregulation and oxidative stress with accelerated aging
What are the chronic diseases of lifestyle?
Obesity, high BP, diabetes and CVS disease
What childhood influences can have an impact on adult health?
Nutrition, trauma, nurture, optimism and education
What is the role of the Government in reducing exposure to health risks?
Legislation, regulation and taxation
