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Primary Care > FOPC Updated > Flashcards

FOPC Updated Flashcards

1
Q

Describe patient-centred care

A

Focuses on the patient, only the patient can decide what this means to them

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2
Q

What principles define patient-centredness and where are they outlined?

A

5 principles outlined in the International Alliance of Patient’s Organisations Declaration on Patient-Centred Healthcare

  1. Respect
  2. Choice and Empowerment
  3. Patient Involvement in Health Policy
  4. Access and Support
  5. Information
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3
Q

Describe epidemiology of long term conditions

A

More prevalent in older and more deprived populations

Account for ~50% of GP appointments, 64% outpatient appointment and 70% inpatient bed days

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4
Q

Consequences of long term conditions

A

Can be physical, social or mental

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5
Q

Incidence

A

number of new cases of a disease in a population over a specified period of time

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6
Q

Prevalence

A

Number of people in a population with a specific disease at a single point in time or over a defined period of time

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7
Q

Burden of treatment

A

The impact of the demands of being a patient on functioning and well-being

Patient often have to change behaviour/police other’s behaviour

Monitor and manage symptoms at home

Complex treatment regimens and multiple drugs as well as complex administrative systems

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8
Q

Biographical disruption

A

a loss of confidence in social interaction or self-identity due to a loss of confidence in the body (caused by long term condition)

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9
Q

Aetiology of long term conditions

A

Genetic and/or environmental

Could be neither

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10
Q

Vulnerability

A

Individual’s capacity to resist disease, repair damage and restore physiological homeostasis

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11
Q

What is important if no diagnosis or cure determined?

A

Acceptance of this fact will provide better management

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12
Q

Describe stigma of long-term conditions

A

Some people are stigmatised by those who do not have the illness

As a result some people will disclose and some will not

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13
Q

Impact of long term conditions

A

On individual; negative or positive and include denial, self-pity, apathy

On family; financial, emotional, physical

Social life; may be unable to work, isolation can occur

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14
Q

WHO definition of disability

A

A person is considered to be disabled if they have a mental or physical impairment which impacts their ability to carry out normal daily activities

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15
Q

Define body and structure impairment

A

Abnormalities of structure, organ or system

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16
Q

Define activity limitation

A

Altered functional performance and activity by the individual

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17
Q

Define participation restrictions

A

Disadvantage experiences by individual as a result of impairments and disabilities

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18
Q

Describe the medical model of disability

A

Individual/personal cuase e.g. accident whilst drunk

Underlying pathology e.g. morbid obesity

Individual level intervention e.g. health professionals advising individually

Individual change/adjustment e.g. change in behaviour

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19
Q

Describe the social model of disability

A

Societal cause e.g. low wages

Conditions related to housing

Social/Political action needed e.g. facilities for disabled

Societal attitude change e.g. use of politically correct language

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20
Q

Describe reasons for different personal reactions to disability

A

Depends on

  • nature of disability
  • information base of individual
  • personality
  • coping strategies
  • role of individual i.e. loss of role/change of role
  • mood and emotional reaction
  • reaction of others
  • support network
  • additional resources available
  • time to adapt
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21
Q

Describe the sick role

A

Form of deviant behaviour by those who are ill within society due to them being seen as unable to partake in social norms and activities, thus deviating from these

Sort of accepted within society as they are ill

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22
Q

Describe different causes of disability

A 
Congenital
Injury
Communicable disease
Non-communicable disease
Alcohol
Drugs; iatrogenic and/or illicit use
Mental illness
Malnutrition
Obesity
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23
Q

Wilson’s Criteria for Screening

A

Knowledge of Diseae

  • condition should be important and have a recognisable latent or early symptomatic stage
  • natural course of condition should be adequately understood

Knowledge of test

  • suitable, acceptable test
  • continuous case finding

Treatment for disease

  • accepted treatment
  • facilities for diagnosis and treatment available
  • agreed policy for whom to treat as patients

Cost
- Cost of case-finding economically balanced in relation to possible expenditures

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24
Q

Why is understanding data relevant in primary care?

A

Good patient-centred care requires knowledge of data and risk, and the ability to present these to patients

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25
Q

Define disease

A

Disorder of structure and function which can cause specific symptoms and signs, bio-medical perspective - diagnosis

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26
Q

Define illness

A

Symptoms or signs of disease, patient ideas and concerns

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27
Q

Factors affecting uptake of care

A

Lay referral “granny knows best”, new symptoms, visible symptoms, severity, duration, peer pressure “wife made me”, patient beliefs, expectations, social class, culture, ethnicity, age, gender, media, newspaper health pages, looking up internet

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28
Q

Define relative risk

A

This is the measure of the strength of an association between a suspected risk factor and the disease under study

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29
Q

Sources of epidemiological data for UK

A 
Mortality data
Hospital activity stats
Reproductive health stats
Cancer stats
Accident stats
General practice morbidity
Health and household surveys
Social security stats
Drug misuse database
Expenditure data from NHS
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30
Q

Define health literacy

A

Is about people having the knowledge, skills, understanding and confidence to use health info, be active partners in their care and navigate health and social care systems

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31
Q

Describe descriptive studies

A

These attempt to describe the amount and distribution of a disease in a given population

  • does not provide definitive conclusions about causation, but may give clues as to risk factors and candidate aetiologies
  • follow time, place, person framework
  • usually cheap, quick and give valuable initial overview
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32
Q

Describe cross-sectional studies

A

Observations are made at a single point in time and conclusions drawn about relationship between diseases and other variables

  • quick, but usually impossible to infer causation
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33
Q

Describe case control studies

A

Two groups of people are compared; a group of individuals who have the disease (cases) and a group who do not (controls)

Data is then gathered to determine who in each group has had exposure to the suspected aetiological factors, and comparisons between the two groups are made

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34
Q

Describe cohort studies

A

Baseline data on exposure are collected from a group who do not have the disease under study

The group is then followed through time until a significant number have developed the disease to allow analysis

The original group is split into subgroups determined by exposure status and these subgroups are compared to determine incidence of disease according to exposure

Results usually expressed as relative risks with confidence intervals or p intervals

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35
Q

Describe trials

A

Experiments used to test ideas about aetiology or to evaluate interventions

“randomised controlled trial” is definitive method of assessing any new treatment in medicine

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36
Q

Describe results standardisation

A

Set of techniques to remove or adjust for effects of differences in age or other confounding variables when comparing two or more populations

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37
Q

Describe standardised mortality ratio

A

Special kind of standardisation which compares mortality in group with disease under study and mortality expected in general population, converted to ratio for easy comparison

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38
Q

Describe quality of data

A

Ensuring data is trustworthy so as to know whether to believe it or not

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39
Q

Describe case definition

A

To decide whether or not an individual has the condition of interest or not

Important bc not all doctors or investigators mean the same thing when they use medical terms

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40
Q

Describe coding and classification

A

Related to case definition

When data are being collected routinely it is usual to convert this info to codes

Rules are drawn up to dictate how clinical data is converted to a code

If these rules change, a disease can appear more/less comon when in reality it is just coded under a new heading

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41
Q

Describe ascertainment

A

Is the data complete? Are any subjects missing?

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42
Q

Describe bias

A

Any trend in the collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth

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43
Q

Describe selection bias

A

Occurs when study sample not truly representative of the whole study population e.g. if certain types of people are allocated to a group in a randomised control trial, rather than randomly

44
Q

Describe information bias

A

Arises from systematic errors in measuring exposure or disease e.g. in case control if researcher knows patient being interviewed is “case/control” they might encourage cases to think harder about previous exposure

45
Q

Describe follow up bias

A

Arises when one group of subjects is followed up more assiduously than another to measure disease incidence or relevant outcomes

46
Q

Describe systematic error

A

Form of measurement bias where there is a tendency for measurements to always fall on one side of the true value

Could be instrument calibrated wrongly or because of the way a person is using the instrument

47
Q

What is a confounding factor?

A

A confounding factor is one which is associated independently with both the disease and with the exposure under investigation and so distorts the relationship between exposure and disease

Age, sex, social class are common confounders

48
Q

What are criteria for causality?

A

Strength of association; as measured by relative risk or odds ratio

Consistency; repeated observation of association in different populations under different circumstances

Specificity; single exposure leading to single disease

Temporality (the only absolute criterion); exposure comes before disease

Biological gradient; dose-response relationship, as exposure rises, so does risk of disease

Biological plausibility; association agrees with what is known about the biology of the disease

Coherence; association does not conflict with what is known about disease biology

Analogy; another exposure-disease relationship exists which can act as a model

Experiment; suitably controlled experiment to prove association as causal

49
Q

Audit criteria and standards

A

Need to set

Could define own but time consuming and requires a lot of research

Could utilise others

50
Q

Evidence based guidelines

A

Based on systematic review of scientific literature

Aimed at aiding translation of knowledge into action

Help healthy pros and patients understand medical evidence and make decisions about healthcare

Reduce unwarranted variation in practice and make sure patients get the best care available

51
Q

Describe what is meant by multi-morbidity

A

the co-existance of two or more long-term conditions in an individual

52
Q

Describe complications of caring for someone with multi-morbidity

A

Often results in polypharmacy

adds complexity to management as treatment for one condition may worsen another

Conflicting care needs

53
Q

What options for care are available to the elderly population?

A 
Own home with support from family
Own home with support from social services
Sheltered housing
Residential home
Nursing home care
54
Q

Ways to alleviate burden of care on family caring for an elderly relative

A

Carers going into the home to help several times a day

Meal delivery service

55
Q

Describe anticipatory care planning

A

Advance and anticipatory care planning promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health as well as personal and practical aspects of care

56
Q

Demographic changes in populations globally

A

Ageing in both developed and developing areas

Increase in life expectancy across world with a decrease in fertility

57
Q

Describe differences in population curves within scotland

A

Highlands has an older population whilst Edinburgh and Glasgow have younger populations; working age and student populations

58
Q

Physiological challenges of ageing

A

Reduced capacity for movement; makes independence more difficult, results in less socialisation, may find it difficult to take care of themselves

Cognitive decline can cause difficulty planning, solving problems at home etc.

59
Q

Common causes of mortality

A

Globally heart disease, stroke, chronic lung disease

60
Q

Elderly disease burden

A

Elderly carry a higher disease burden in lower and middle income countries than higher income countries

61
Q

Changes required for ageing population (intersectoral)

A

Expanding housing options
Making buildings and transport accessible
Promoting age-diversity in working environments

62
Q

Describe the GP partner

A

Most GPs are independent contractors to the NHS

Mostly responsible for providing own premises and employing own staff

63
Q

Describe the role of the practice nurse

A

Many aspects of patient care

  • bloods
  • ECGs
  • minor and complex wound management
  • travel health advice and vaccinations
  • child immunisations and advice
  • family planning and women’s health incl cervical smears
  • men’s health screening
  • sexual health services
  • smoking cessation
64
Q

Describe the role of the district nurse

A

Visit people in own homes/residential care homes

Teaching and support; helping patients and family members to care for themselves

Play a role in keeping hospital admissions and readmissions to a min, ensuring patients return to own home asap

65
Q

Describe the role of the midwife

A

Provide care during all stages of pregnancy, labour and early post-natal period

Many now work in community, providing services in women’s homes, local clinics, children’s centres and GP surgeries

66
Q

Describe the role of the health visitor

A

Lead and deliver child and family health services (pregnancy - age 5)

Ongoing additional services for vulnerable children and families

Contribute to MD services in safeguarding and protecting children

67
Q

Describe the role of a Macmillan nurse

A

Specialise in cancer and palliative care

Provide support and information to people with cancer and those around them

  • specialised pain and symptom control
  • emotional support
  • care in variety of settings
  • information about cancer treatments and side effects
  • advice to other members of caring team
  • co-ordinated care between hospital and patient’s home
  • advice on other forms of support
68
Q

Allied health professionals

A 
Physiotherapy
OT
Diatetics
Podiatry
Pharmacy
Councelling
69
Q

Describe the role of a pharmacist

A

Expert in medicines and their use

Majority practice in hospital pharmacy, community or primary care

Advise med and nursing staff on selection and use of medicines to ensure optimal treatment

Able to undertake additional training to prescribe for certain conditions

70
Q

Describe the role of a dietician

A

Interpretation and communication of nutritional science

  • work with people with special dietary needs
  • informing general public about nutrition
  • offering unbiased advice
  • evaluating and improving treatments
  • educating patients, other healthcare professionals and community groups
71
Q

Describe the role of a physiotherapist

A

Help and treat people with physical problems

Manual therapy, therapeutic exercise and application of electro-physical modalities

72
Q

Describe the role of an OT

A

Assessment and treatment of physical and psychiatric conditions using specific activity to prevent disability and promote independent function

  • physical rehab
  • mental health services
  • learning disability
  • primary care
  • paediatrics
  • environmental adaptation
  • care management
  • equipment for daily living
73
Q

Describe the role of a care manager

A

Experts in working with individuals to identify their goals and locate support required

Care managers provide support to find the best solution when there are many choices and challenges

Highly trained social workers who advise the patient on social and financial support services

74
Q

Describe political pressure on GP practices

A

Pressure to

  • reduce cost of treatments
  • provide more treatments closer to where patients live
75
Q

Describe the principles of good team work

A

Recognise and include patient as essential member of PHCT

Establish a common agreed purpose

Agree set objectives and monitor progress toward them

Ensure that each member understands and acknowledges skills and knowledge of colleagues

Pay particular attention to the importance of comm between members including patient

Take active steps to ensure practice population understands and accepts way team works in community

Select leader for their leadership skills and include in team all relevant professions

Promote teamwork across health and social care

Evaluate teamworking initiatives

Ensure sharing of patient information within team is legal

Take steps to facilitate inter-professional collaboration

76
Q

The Public Bodies Joint Working Act 2013

A

Essentially aims to integrate health and social care to improve quality and consistency of care for patients and families

Created a number of new public organisations known as integration authorities

Requires NHS boards and local authorities to integrate governance planning and resourcing of adult servoces as well as jointly submitting an integration scheme

77
Q

Integrated Joint Board (Body corporate) model

A

An integration joint bord is set up

NHS board and local authorities delegate responsibility for planning adult services to the IJB

The NHS and local authorities also delegate budgets to IJB which then decides how to use the resources

78
Q

What is the WHO definition of health?

A

a state of complete mental, social and physical well-being and not merely the absence of infirmity or disease

79
Q

What are the essential skills for interview?

A

Content
Perception
Processing

80
Q

GP (in an exam)

A

co-ordinate care and review treatment and medication

81
Q

Care manager (in an exam)

A

co-ordinate social care package

82
Q

District nurse (in an exam)

A

co-ordinate at home care i.e. bloods, catheter care, attending to wounds etc

83
Q

What are the areas of life affected by a diagnosis?

A

Personal
Social
Economic

84
Q

Actual risk

A

The individual’s own risk = the most important to consider

85
Q

How can risk be communicated to a patient?

A

verbally, through fractions or illustrations

86
Q

What are the stages of an audit?

A

A CYCLE

Identify problem or issue
Set criteria and standards
Observe practice/data collection
Compare performance with criteria and standards
Implement change
87
Q

What are the types of studies?

A 
descriptive
randomised controlled trials
cohort
case control
cross-sectional
88
Q

What are audit headings?

A 
Reason for audit
Criteria to be met
Standard's set
Prep and planning
Results and data of collection one
Description changes implemented
Results and data of collection two
Reflections
89
Q

Rights/obligations of sick role

A

Person is not responsible for their condition
Exempt from “normal social roles”
Should try to get well
Should seek competent help with health professional to get better

90
Q

What will the elderly population multiply by from 2000 to 2050?

A

4

91
Q

What is included in an ACP?

A

legal details
resuscitation status
advance statements
contact details for close friends and family
strategy for managing illness without admission
details for out of hours team i.e. treatment plans etc.

92
Q

pharmacist (in an exam)

A

assisting with provision of medication

93
Q

Macmillan nurse (in an exam)

A

Cancer specialist nurse care

Palliative care and support for family and carers

94
Q

Factors affecting consultation

A 
Site and environment
Adequacy of medical records
Time constraints
Patient status
Personal factors
95
Q

Types of questions

A 
Open ended
Closed
Leading
Reflected
Direct
96
Q

Personal qualities of a good GP

A

Ability to care about patients and their relatives
A commitment to providing high quality care
An awareness of one’s own limitations
An ability to seek help when appropriate
Commitment to keeping up to date and improving quality of one’s own performance
Appreciation of the value of team work
Good interpersonal and communication skills
Clinical competence
Organisational ability
Ability to manage oneself
Ability to work with others
Maintaining good practice
Relating to the public
Ability to deal with uncertainty

97
Q

Aims of consultation according to Calgary Cambridge model

A 
Initiating the Session
Gathering Information
Providing Structure
Building Relationship
Explanation and Planning
Closing the Session
98
Q

Form of problem solving used by GP to narrow down diagnoses?

A

Hypothetico-deductive reasoning

99
Q

Ethical issues

A

Religious beliefs

beliefs otherwise

100
Q

Factors affecting likelihood of changing behaviour

A

You think the advantages of change outweigh the disadvantages
You anticipate a positive response from others to your behaviour change
There is social pressure for you to change
You perceive the new behaviour to be consistent with your self-image
You believe you are able to carry out the new behaviour in a range of circumstances

101
Q

Government strategies to improve health on a whole

A 
Legislation/policies on smoking/alcohol (e.g. minimum age to buy products, licensing laws, taxation)
Improvements in housing
Provision of health education
Health and safety laws
Traffic/transport legislation/policies
102
Q

Why might a person feel they are healthy?

A 
no illness / long term condition (chronic disease)
exercises regularly
on no regular medication
manages to work, socialise
'Healthy diet'
103
Q

The four ethical principles

A

Autonomy
Justice
Beneficence
Non-malefecince

104
Q

Define hazard

A

Something with potential to cause harm

105
Q

Define risk

A

likelihood of harm occurring

106
Q

Types of hazards

A 
Physical
Chemical
biological
Psychosocial
Mechanical
107
Q

Coping mechanisms

A

Problem focussed

Emotion focussed

Primary Care (2 decks)

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