FoPC Year 2 Tutorial 1 - Long-Term Conditions

Question 1

define person-centred care

Answer 1

Person-centered care places patient at center

Question 2

who decides what person-centered care means

Answer 2

Only the patient is in a position to decide this

Question 3

what makes care patient centered

Answer 3

if it is based on the principles and values that define patient-centeredness

Question 4

the principles and values of patient centered care are brought together by which organisation in what declaration?

Answer 4

International Alliance of Patients’ Organizations (IaPO)

Declaration on Patient- Centered Healthcare.

Question 5

Name the 5 principles outlined in the Declaration on Patient- Centered Healthcare by the IaPO

Answer 5

1. Respect.
2. Choice and empowerment.
3. Patient involvement in health policy.
4. Access and support.
5. Information.

Question 6

Long-term conditions now account for what proportion of GP appointments?

Answer 6

50%

Question 7

long-term conditions are more prevalent in what two groups of people?

Answer 7

older people

deprived groups

Question 8

what is equally as important as establishing the causes of a long term illness?

Answer 8

the consequences of such long-term illness

Question 9

define incidence

Answer 9

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

Question 10

define prevalence

Answer 10

the number of people in a population with a specific disease at a single point in time or in a defined period of time (existing cases)

Question 11

aetiology - name the 2 broad factors

Answer 11

genetic

environmental

Question 12

define vulnerability

Answer 12

an individuals ability/inability to resist disease, repair damage and restore physiological homeostasis

Question 13

describe 3 categories of natural history of diseases

Answer 13

acute onset

gradual onset

relapsing remitting

Question 14

what 2 things should any treatment aim to cure/allay ?

Answer 14

disease

effects of disease

Question 15

briefly define the burden of treatment

Answer 15

patients and caregivers are often put under enormous demands by healthcare systems

Question 16

give 4 examples of the burden of treatment

Answer 16

1. changing behaviour (of patient) or policing behaviour (doctor) of others (i.e. to adhere to lifestyle modifications)
2. monitoring + managing their symptoms at home
3. complex treatment regimens and multiple drugs (polypharmacy)
4. complex administrative systems - accessing, navigating + coping with uncoordinated health and social care systems

Question 17

define the process of biographical disruption

Answer 17

a long term condition leads to a loss of confidence in the body

there is then a loss of confidence in social interaction or self-identity

Question 18

define stigma

Answer 18

a mark of disgrace associated with a particular circumstance, quality, or person

Question 19

outline why stigma might exist for those with a chronic illness

Answer 19

having a chronic illness or condition subjects a person to possible stigmatization by those who do not have the illness

Question 20

what is the biggest decision in coping with the stigma of a condition?

Answer 20

the decision about whether to:

1) disclose the condition and suffer further stigma

or

2) attempt to conceal the condition and pass for normal

Question 21

the long term condition of a particular individual may impact what people/groups of people

Answer 21

patient

family

community

Question 22

discuss the impact of long term conditions on the individual

Answer 22

can be negative or positive

negative may be denial, self-pity, apathy

Question 23

an individual’s long-term condition can impact their family in what 3 broad ways?

Answer 23

financial

emotional

physical

Question 24

what might happen to an individual that has a long term condition with regards to their community

Answer 24

isolation of that individual

Question 25

an observation often made by doctors/nurses who care for people with some long term conditions is “my patient understands their disease better than I do” what is this concept known as?

Answer 25

the "**expert** patient"

Question 26

name 3 conditions that typically creates a lot of these "expert patients"

Answer 26

diabetes mellitus arthritis epilepsy

Question 27

describe the relevance of the "expert patient" in modern care

Answer 27

patient's **knowledge/experience** has long been **untapped** could greatly **benefit** patient care + quality of life research/experience shows today’s patients with **chronic conditions** need **not be mere recipients of care** they can become **key decision-makers** in treatment process

Question 28

the WHO definition of disability may be split into what 3 categories

Answer 28

1. Body and Structure Impairment 2. Activity Limitation 3. Participation Restrictions

Question 29

define "body and structure impairment"

Answer 29

**abnormalities** of structure, organ or system function (organ level)

Question 30

define "activity limitation"

Answer 30

changed **fuctional performance** and activity by the individual (personal level)

Question 31

define "participation restrictions"

Answer 31

**disadvantage** experienced by the individual as a result of **impairments and disabilities** (interaction at a social and environmental level)

Question 32

describe 4 concepts in the medical model of disability

Answer 32

▪**Personal cause** e.g. accident whilst drunk ▪Underlying **pathology** e.g. morbid obesity ▪Individual level **intervention** e.g. health professionals advise individually ▪Individual **change**/adjustment e.g. change in behaviour

Question 33

describe 4 concepts in the social model of disability

Answer 33

▪Societal cause e.g. low wages ▪Conditions relating to **housing** ▪Social/**Political** action needed e.g. facilities for disabled ▪Societal **attitude** change e.g. use of politically correct language.

Question 34

describe 2 legislations that have been drawn up to support those with a disability

Answer 34

disability discrimation acts 1995 and 2005 equality act 2010

Question 35

describe 3 roles of a doctor in the care of those with a disability

Answer 35

1. **assess** disability 2. **co-ordinate** MDT care 3. **intervention** with rehabilitation

Question 36

personal reaction to a disability depends on many factors give 10 examples

Answer 36

1. **nature** of disability 2. **information base** of individual, ie education, intelligence and access to information 3. **personality** 4. **coping** strategies 5. (previous) **role** of individual – loss of role, change of role 6. mood and emotional **reaction** 7. reaction of **others** around them 8. **support** network of individual 9. **additional resources** available to the individual? e.g. good local self-help group, socio-economic resources 10. **time** to adapt (how long they have had the disability?)

Question 37

consider 6 possible categories of “benefits” of illness

Answer 37

1. social 2. familial 3. psychological 4. financial 5. medications 6. responsibilities.

Question 38

outline the concept of the sick role

Answer 38

a concept that concerns the **social aspects** of becoming ill and the **privileges** and **obligations** that come with it

Question 39

describe 3 ways disability might cause disruption within a family

Answer 39

personal economic/financial social

Question 40

with regard to the epidemiology of disability: give 9 different causes worldwide

Answer 40

1. congenital 2. injury 3. communicable disease 4. non-communicable disease 5. drugs-iatrogenic and/or illicit use 6. mental Illness 7. alcohol 8. malnutrition 9. obesity

Question 41

in the uk, what proportion of those with a disability are in employment?

Answer 41

1/3rd

Question 42

what happens to the prevalence and severity of disability with age?

Answer 42

rises

Question 43

Wilson and Jungner criteria for screening **testing/examination** for a disease - 3 factors

Answer 43

1. **_suitable_ test** or examination. 2. test **_acceptable_** to population. 3. case finding should be **continuous** (not just a 'once and for all' project as there's limited evidence for single-ocasion screening).

Question 44

Wilson and Jungner criteria for screening **treatment** of disease - 3 factors

Answer 44

1. **Accepted treatment** for patients with recognised disease. 2. **Facilities** for diagnosis and treatment available. 3. Agreed **policy** concerning whom to treat as patients

Question 45

Wilson and Jungner criteria for screening: **knowledge** of the disease - list 3 factors

Answer 45

1. condition should be **important**. 2. must be a **early symptomatic stage** or **recognisable latent** stage 3. natural **history** should be adequately **understood**.