FOPC Updated Flashcards
1
Q
Describe patient-centred care
A
Focuses on the patient, only the patient can decide what this means to them
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
- Respect
- Choice and Empowerment
- Patient Involvement in Health Policy
- Access and Support
- Information
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
4
Q
Consequences of long term conditions
A
Can be physical, social or mental
5
Q
Incidence
A
number of new cases of a disease in a population over a specified period of time
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
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
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)
9
Q
Aetiology of long term conditions
A
Genetic and/or environmental
Could be neither
10
Q
Vulnerability
A
Individual’s capacity to resist disease, repair damage and restore physiological homeostasis
11
Q
What is important if no diagnosis or cure determined?
A
Acceptance of this fact will provide better management
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
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
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
15
Q
Define body and structure impairment
A
Abnormalities of structure, organ or system
16
Q
Define activity limitation
A
Altered functional performance and activity by the individual
17
Q
Define participation restrictions
A
Disadvantage experiences by individual as a result of impairments and disabilities
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
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
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
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
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
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
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
25
Define disease
Disorder of structure and function which can cause specific symptoms and signs, bio-medical perspective - diagnosis
26
Define illness
Symptoms or signs of disease, patient ideas and concerns
27
Factors affecting uptake of care
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
28
Define relative risk
This is the measure of the strength of an association between a suspected risk factor and the disease under study
29
Sources of epidemiological data for UK
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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
```
30
Define health literacy
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
31
Describe descriptive studies
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
32
Describe cross-sectional studies
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
33
Describe case control studies
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
34
Describe cohort studies
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
35
Describe trials
Experiments used to test ideas about aetiology or to evaluate interventions
"randomised controlled trial" is definitive method of assessing any new treatment in medicine
36
Describe results standardisation
Set of techniques to remove or adjust for effects of differences in age or other confounding variables when comparing two or more populations
37
Describe standardised mortality ratio
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
38
Describe quality of data
Ensuring data is trustworthy so as to know whether to believe it or not
39
Describe case definition
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
40
Describe coding and classification
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
41
Describe ascertainment
Is the data complete? Are any subjects missing?
42
Describe bias
Any trend in the collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth
43
Describe selection bias
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
Describe information bias
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
Describe follow up bias
Arises when one group of subjects is followed up more assiduously than another to measure disease incidence or relevant outcomes
46
Describe systematic error
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
What is a confounding factor?
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
What are criteria for causality?
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
Audit criteria and standards
Need to set
Could define own but time consuming and requires a lot of research
Could utilise others
50
Evidence based guidelines
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
Describe what is meant by multi-morbidity
the co-existance of two or more long-term conditions in an individual
52
Describe complications of caring for someone with multi-morbidity
Often results in polypharmacy
adds complexity to management as treatment for one condition may worsen another
Conflicting care needs
53
What options for care are available to the elderly population?
```
Own home with support from family
Own home with support from social services
Sheltered housing
Residential home
Nursing home care
```
54
Ways to alleviate burden of care on family caring for an elderly relative
Carers going into the home to help several times a day
| Meal delivery service
55
Describe anticipatory care planning
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
Demographic changes in populations globally
Ageing in both developed and developing areas
Increase in life expectancy across world with a decrease in fertility
57
Describe differences in population curves within scotland
Highlands has an older population whilst Edinburgh and Glasgow have younger populations; working age and student populations
58
Physiological challenges of ageing
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
Common causes of mortality
Globally heart disease, stroke, chronic lung disease
60
Elderly disease burden
Elderly carry a higher disease burden in lower and middle income countries than higher income countries
61
Changes required for ageing population (intersectoral)
Expanding housing options
Making buildings and transport accessible
Promoting age-diversity in working environments
62
Describe the GP partner
Most GPs are independent contractors to the NHS
Mostly responsible for providing own premises and employing own staff
63
Describe the role of the practice nurse
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
Describe the role of the district nurse
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
Describe the role of the midwife
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
Describe the role of the health visitor
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
Describe the role of a Macmillan nurse
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
Allied health professionals
```
Physiotherapy
OT
Diatetics
Podiatry
Pharmacy
Councelling
```
69
Describe the role of a pharmacist
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
Describe the role of a dietician
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
Describe the role of a physiotherapist
Help and treat people with physical problems
Manual therapy, therapeutic exercise and application of electro-physical modalities
72
Describe the role of an OT
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
Describe the role of a care manager
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
Describe political pressure on GP practices
Pressure to
- reduce cost of treatments
- provide more treatments closer to where patients live
75
Describe the principles of good team work
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
The Public Bodies Joint Working Act 2013
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
Integrated Joint Board (Body corporate) model
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
What is the WHO definition of health?
a state of complete mental, social and physical well-being and not merely the absence of infirmity or disease
79
What are the essential skills for interview?
Content
Perception
Processing
80
GP (in an exam)
co-ordinate care and review treatment and medication
81
Care manager (in an exam)
co-ordinate social care package
82
District nurse (in an exam)
co-ordinate at home care i.e. bloods, catheter care, attending to wounds etc
83
What are the areas of life affected by a diagnosis?
Personal
Social
Economic
84
Actual risk
The individual's own risk = the most important to consider
85
How can risk be communicated to a patient?
verbally, through fractions or illustrations
86
What are the stages of an audit?
A CYCLE
```
Identify problem or issue
Set criteria and standards
Observe practice/data collection
Compare performance with criteria and standards
Implement change
```
87
What are the types of studies?
```
descriptive
randomised controlled trials
cohort
case control
cross-sectional
```
88
What are audit headings?
```
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
Rights/obligations of sick role
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
What will the elderly population multiply by from 2000 to 2050?
4
91
What is included in an ACP?
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
pharmacist (in an exam)
assisting with provision of medication
93
Macmillan nurse (in an exam)
Cancer specialist nurse care
| Palliative care and support for family and carers
94
Factors affecting consultation
```
Site and environment
Adequacy of medical records
Time constraints
Patient status
Personal factors
```
95
Types of questions
```
Open ended
Closed
Leading
Reflected
Direct
```
96
Personal qualities of a good GP
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
Aims of consultation according to Calgary Cambridge model
```
Initiating the Session
Gathering Information
Providing Structure
Building Relationship
Explanation and Planning
Closing the Session
```
98
Form of problem solving used by GP to narrow down diagnoses?
Hypothetico-deductive reasoning
99
Ethical issues
Religious beliefs
| beliefs otherwise
100
Factors affecting likelihood of changing behaviour
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
Government strategies to improve health on a whole
```
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
Why might a person feel they are healthy?
```
no illness / long term condition (chronic disease)
exercises regularly
on no regular medication
manages to work, socialise
'Healthy diet'
```
103
The four ethical principles
Autonomy
Justice
Beneficence
Non-malefecince
104
Define hazard
Something with potential to cause harm
105
Define risk
likelihood of harm occurring
106
Types of hazards
```
Physical
Chemical
biological
Psychosocial
Mechanical
```
107
Coping mechanisms
Problem focussed
| Emotion focussed
