FOPC Updated Flashcards
Describe patient-centred care
Focuses on the patient, only the patient can decide what this means to them
What principles define patient-centredness and where are they outlined?
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
Describe epidemiology of long term conditions
More prevalent in older and more deprived populations
Account for ~50% of GP appointments, 64% outpatient appointment and 70% inpatient bed days
Consequences of long term conditions
Can be physical, social or mental
Incidence
number of new cases of a disease in a population over a specified period of time
Prevalence
Number of people in a population with a specific disease at a single point in time or over a defined period of time
Burden of treatment
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
Biographical disruption
a loss of confidence in social interaction or self-identity due to a loss of confidence in the body (caused by long term condition)
Aetiology of long term conditions
Genetic and/or environmental
Could be neither
Vulnerability
Individual’s capacity to resist disease, repair damage and restore physiological homeostasis
What is important if no diagnosis or cure determined?
Acceptance of this fact will provide better management
Describe stigma of long-term conditions
Some people are stigmatised by those who do not have the illness
As a result some people will disclose and some will not
Impact of long term conditions
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
WHO definition of disability
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
Define body and structure impairment
Abnormalities of structure, organ or system
Define activity limitation
Altered functional performance and activity by the individual
Define participation restrictions
Disadvantage experiences by individual as a result of impairments and disabilities
Describe the medical model of disability
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
Describe the social model of disability
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
Describe reasons for different personal reactions to disability
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
Describe the sick role
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
Describe different causes of disability
Congenital Injury Communicable disease Non-communicable disease Alcohol Drugs; iatrogenic and/or illicit use Mental illness Malnutrition Obesity
Wilson’s Criteria for Screening
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
Why is understanding data relevant in primary care?
Good patient-centred care requires knowledge of data and risk, and the ability to present these to patients
Define disease
Disorder of structure and function which can cause specific symptoms and signs, bio-medical perspective - diagnosis
Define illness
Symptoms or signs of disease, patient ideas and concerns
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
Define relative risk
This is the measure of the strength of an association between a suspected risk factor and the disease under study
Sources of epidemiological data for UK
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
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
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
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
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
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
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
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
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
Describe quality of data
Ensuring data is trustworthy so as to know whether to believe it or not
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
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
Describe ascertainment
Is the data complete? Are any subjects missing?
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
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
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
Describe follow up bias
Arises when one group of subjects is followed up more assiduously than another to measure disease incidence or relevant outcomes
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
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
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
Audit criteria and standards
Need to set
Could define own but time consuming and requires a lot of research
Could utilise others
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
Describe what is meant by multi-morbidity
the co-existance of two or more long-term conditions in an individual
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
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
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
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
Demographic changes in populations globally
Ageing in both developed and developing areas
Increase in life expectancy across world with a decrease in fertility
Describe differences in population curves within scotland
Highlands has an older population whilst Edinburgh and Glasgow have younger populations; working age and student populations
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.
Common causes of mortality
Globally heart disease, stroke, chronic lung disease
Elderly disease burden
Elderly carry a higher disease burden in lower and middle income countries than higher income countries
Changes required for ageing population (intersectoral)
Expanding housing options
Making buildings and transport accessible
Promoting age-diversity in working environments
Describe the GP partner
Most GPs are independent contractors to the NHS
Mostly responsible for providing own premises and employing own staff
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
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
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
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
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
Allied health professionals
Physiotherapy OT Diatetics Podiatry Pharmacy Councelling
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
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
Describe the role of a physiotherapist
Help and treat people with physical problems
Manual therapy, therapeutic exercise and application of electro-physical modalities
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
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
Describe political pressure on GP practices
Pressure to
- reduce cost of treatments
- provide more treatments closer to where patients live
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
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
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
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
What are the essential skills for interview?
Content
Perception
Processing
GP (in an exam)
co-ordinate care and review treatment and medication
Care manager (in an exam)
co-ordinate social care package
District nurse (in an exam)
co-ordinate at home care i.e. bloods, catheter care, attending to wounds etc
What are the areas of life affected by a diagnosis?
Personal
Social
Economic
Actual risk
The individual’s own risk = the most important to consider
How can risk be communicated to a patient?
verbally, through fractions or illustrations
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
What are the types of studies?
descriptive randomised controlled trials cohort case control cross-sectional
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
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
What will the elderly population multiply by from 2000 to 2050?
4
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.
pharmacist (in an exam)
assisting with provision of medication
Macmillan nurse (in an exam)
Cancer specialist nurse care
Palliative care and support for family and carers
Factors affecting consultation
Site and environment Adequacy of medical records Time constraints Patient status Personal factors
Types of questions
Open ended Closed Leading Reflected Direct
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
Aims of consultation according to Calgary Cambridge model
Initiating the Session Gathering Information Providing Structure Building Relationship Explanation and Planning Closing the Session
Form of problem solving used by GP to narrow down diagnoses?
Hypothetico-deductive reasoning
Ethical issues
Religious beliefs
beliefs otherwise
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
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
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'
The four ethical principles
Autonomy
Justice
Beneficence
Non-malefecince
Define hazard
Something with potential to cause harm
Define risk
likelihood of harm occurring
Types of hazards
Physical Chemical biological Psychosocial Mechanical
Coping mechanisms
Problem focussed
Emotion focussed
