Foundations of Primary Care Flashcards
What is person centred care?
Places the patient at the centre.
Only the patient is in a position to make a decision on what this means to them.
What does the declaration of patient centred care outline as their 5 principles?
- Respect
- Choice and empowerment
- Patient involvement in health policy
- Access and support
- Information
How prevalent are Long term conditions?
More prevalent in older people and in more deprived groups:
- 50% of all GP appointments
- 64% all outpatient appointments
- 70% all inpatient bed days.
What is incidence?
The number of new cases of a disease in a population in a specified period of time.
What is Prevalence?
The number of people in a population with a specific disease at a single point in time or in a defined period of time.
Aetiology of long term conditions
Usually the end result of a long term complex interaction of factors:
- Genetics
- Environmental
- Both or Neither.
What is vulnerability?
An individuals capacity to resist disease, repair damage and restore physiological homeostasis can be deemed vulnerability.
What is important to consider before treatment
Important to realise the chronic nature and come to terms with this.
Both patient and doctor must admit failure in diagnosis or cure, with the payoff being better management.
What is the Burden of Treatment?
- Changing behaviours or policing the behaviour of others to adhere to lifestyle modifications.
- Monitoring and managing their symptoms.
- Complex treatment regimens and multiple drugs contribute to the burden of treatment.
- Complex adminisrative systems, and accessing, navigating and coping with uncoordinated health and social care systems add to this.
What is Biological Disruption?
Loss of confidence in the body, loss of confidence in social interaction or self-identity.
What is the stigma behind Long term conditions?
Coping with stigma involves a variety of strategies including the decision about whether to disclose the condition and suffer further stigma, or attempt to conceal the condition or aspects of the condition and pass for normal.
Impacts of Long term conditions
- individual
- family
- Community/society
- On individual - Can be negative or positive. (denial, self-pity).
- On family - can be financial, emotional and physical.
- Community/Society - isolation of an individual.
What is the WHO definition of Disability?
- Body and Structure Impairment
- Activity limitation
- Participation Restrictions
Medical Disability
- Individual/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
Social disability
- Societal cause e.g. low wages
- Conditions relating to housing
- Social/political action needed
- Societal attitudes change (PC language)
What legislations have been drawn up in terms of disability
- Disability Discrimination Acts 1995 and 2005
2. Equality Act 2010
What are the responsibilities of the GP in terms of disability?
Your attitudes will pass on to your patients and this you teach
Listen to patient and learn
Your own age and culture affect your view
Can you truly empathises with a severe disability
What do doctors do in terms of disability?
- Assess disability
- Co-ordinate the MDT
- Intervene in the form of rehabilitation
What is the personal reaction to disability?
Depends on:
- Nature of the disability
- Information base of the individual
- Personality
- Coping strategies
- Role of individual - loss or change
- Mood or emotional reaction
- Reaction of others around
- Support network
- Additional resources available
- Time to adapt.
What causes disruption at different levels in disability?
Personal
Economic
Social
What are some of the different causes of disability worldwide?
- Congenital
- Injury
- Communicable disease
- Non-communicable disease
- Alcohol
- Drugs - illicit or iatrogenic effect
- Mental illness
- Malnutrition
- Obesity
What is the screening used for disability?
Wilson’s Criteria
What is GP in terms of link from primary to secondary care?
Interface between the public on the one hand and secondary care on the other hand.
How many GP consults are referred to hospital?
3%
Define disease
Symptoms, signs - diagnosis. Bio-medical perspective.
Define illness
Ideas, concerns and expectations - experience. Patients perspective.
What factors affect the uptake of care?
Concept of Lay referral
Sources of information - internet, family, newspaper.
Medical factors - new, visible symptoms
Non-medical factors - crisis, peer pressure, patient beliefs, social class, economic, age, gender.
What are the 3 aims of epidemiology?
Description - amount and distribution of the disease.
Explanation - To elucidate the natural history and identify etiological factors for disease - epidemiology data with other data.
Disease control - Preventative measures, public health practices.
What does epidemiology compare groups to detect?
Aetiological clues
The scope of prevention
The identification of high risk or priority groups in society.
Minor illnesses high have a high what? but low what?
High incidence
Low prevalence
Chronic illnesses might be what incidence and what prevalence?
Low incidence
High Prevalence
What is relative risk?
Measure of the strength of an association between a suspected risk factor and the disease under study.
RR = Incidence of disease in exposed group / Incidence of disease in unexposed group.
What are the sources of Epidemiological data?
Mortality data Hospital activity statistics Reproductive health stats Cancer stats Accident stats GP morbidity Health and household surveys Social security stats Drug misuse databases Expenditure data from NHS.
What is health literacy?
People having the knowledge, skills, understanding and confidence to use health information, to be active partners in their care, and to navigate health and social care systems.
What is the CHADS@ score?
Clinical prediction rules fro estimating the risk of stroke in patients with non-rheumatic AF. Score used to determine whether or not treatment is required.
What are SIGN guidelines intended to do?
- Help health and social care professionals and patients understand medical evidence and use it to make decisions about healthcare.
- Reduce unwarranted variations in practice and make sure patients get the best care available, no matter where they live.
- Improve healthcare across Scotland by focusing on patient - important outcomes.
What is a descriptive study?
Attempt to describe the amount and distribution of a disease in a given population.
Gives clues to possible risk factors and candidate aetiologies.
Cheap, quick and give a valuable initial overview of a problem.
What is an analytic study?
Cross-sectional (disease frequency, survey, prevalence study).
Observations made at a single point in time.
Quick results, usually impossible to infer causation.
What is a case control study?
2 groups of people compared:
a group of individuals who have the disease of interest identified (cases)
a group of individuals who do not have the disease (controls)
What is a cohort study?
Baseline data on exposure are collected from a group of people who do not have the disease under study.
The group is then followed through time until a sufficient number have developed the disease to allow analysis.
What are trials?
Experiments used to test ideas about aetiology or to evaluate interventions.
What is the randomised controlled trial?
The definitive method of assessing any new treatment in medicine
What factors need to be considered when interpreting results
Standardisation (remove confounding variables)
Standardised Mortality Ratio
Quality of Data
- What is Bias?
2. What different types of Bias are there?
- Bias is any trend in the collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth.
- Selection Bias
Information Bias
Follow up Bias
Systematic Error
What is a confounding factor and give examples?
Associated independently with both the disease and with the exposure under investigation and so distorts the relationship between exposure and disease.
Examples:
Age, sex, social class.
What is the criteria for Causality?
Strength of association Consistency Specificity TEMPORALITY - exposure before disease. Biological gradient Biological plausibility Coherence Analogy Experiment
What is multi morbidity?
The co-existence of two or more long-term conditions in an individual.
What causes complexity in patients?
Older patients many have more than one chronic health condition, preferred treatment for one condition may worsen another.
What can be seen in terms of life expectancy?
Life expectancy has increased by more years than healthy life expectancy and therefore the number of years lived in poor health has also increased slightly; in 2013 to 1015 it was 16.1 years for males and 19.0 years for females.
What is the difference between men and women in terms of life expectancy?
- 4 years more in poor health for women.
1. 5 years more in poor health for men
What is happening n terms of poor health and ageing together?
Combined effect of higher prevalence of long term conditions and population which is proportionately older and spending more years in poor health is placing pressure on health care and social care systems
How many carers are in the uk right now?
6.5 million and rising
3 in 5 people will be carers at some point in their life.
82% providing practical help.
What are the options for care for the elderly after GP?
Living in own home with support from family.
Living in own home with support from social services.
Sheltered housing
Residential home
Nursing home care
What is the Anticipatory Care Plans?
Advance and anticipatory care planning, as a philosophy, promotes discussion in which individuals, their care provides and often those close to them, make decisions with respect to their future health or personal and practical aspects of care.
When should a ACP be done?
Who should do it?
How should it be done?
Hello can it be shared?
- At any time in life that seems appropriate, continuously.
- By anyone with appropriate relationship.
- Thinking ahead and making plans. Write it down.
- KIS (Key Information summary), other communication
What are the different aspects of ACP?
Legal - power of attorney.
Personal - next of kin, preferred place of death.
Medical - Potential problems, wishes re DNA, CPR.
What should be discussed in an interview with patient and carer?
Issues for the carer.
Find out how the patient feels about being dependent on others for care needs.
Who is part of the traditional primary health care team?
GP partners GP assistants and other salaried doctors GP registrars Practice nurses Practice managers Receptionists Community nurses Midwives Health visitor Nurse practitioners
What does a practice nurse do?
They can work as part of PHCT, with other practice nurses and might work on their own. involved in: Obtaining blood samples ECG's minor and complex wound management Vaccinations Cervical smears.
What do GPs do?
Deal with problems that often combine physical, psychological and social components.
What does a District nurse do?
Visit people in their own homes or residential care homes. Direct care and teaching and support role.
What does a midwife do?
Provides care during all stages of pregnancy, labour and early postnatal period.
Homes, local clinics, GP and children centres, hospital based.
What does a health visitor do?
Lead and deliver child and family health services (pregnancy through to 5 years)
MDT contribution to safeguarding and protecting children. Vulnerable children.
What does a macmillan nurse do?
Specialise in cancer and palliative care, providing support and information to people and families.
Who are the allied health professionals?
Physiotherapy OT Dietetics Podiatry Pharmacy Counselling
What does a pharmacist do?
Expert in medicines and their use. Hospital, community, and primary care. Advise medical and nursing staff on selection of appropriate medications.
What do dietetics do?
Interpretation and communication of nutrition science to enable people to make informed and practical choices about food and lifestyle. Hospital and community.
What do Physiotherapists do?
Treat and help people with physical problems. Manual therapy, therapeutic exercise.
What do OT’s do?
Assessment and treatment of physical and psychiatric conditions using specific activity to prevent disability. Work with all ages: - Mental health - Physical rehabilitation - Primary care - care management
What are the selected secondary care services?
Hospital consultants
Diagnostic imaging
Operating services
What does a care manager do?
Work with individuals to identify their goals and locate the specific support services.
What changes are affecting the PHCT?
Economic factors - Many too small so many bigger properties and private GPs coming into play.
Political pressure - reduce cost and provide treatments closer to where patients live.
Going number of ageing patients - more long term conditions
Development of new and extended professional roles.
What should an effective team do?
Recognise and include the patient, carer and an essential member of the team.
Set objectives and monitor progress
Ensure that each team member understands and acknowledges the skills of colleagues.
Promote teamwork across health and social care.
Ensure sharing patient information within team is in accordance with current legal and professional requirements.
What is the WHO definition of health?
State of complete physical, mental and social well bring and not just the absence of disease or infirmity
What is the audit cycle?
Set standards
Measure current practice
Compare results of practice to standards set
Reflect, plan and change and implement change
Re-audit
How many times do you do an audit?
At least once every 5 years
Effects of disability on 1. Parents 2. Siblings 3. Peers
4. Teachers
- Financial and physiological strain
- Resentment and may become carer
- Teasing and friend stigmatised too
- Lack of understanding / training, personalising education
What is the expert patient?
Patient / carer has an in-depth knowledge of their condition, sometimes exceeding that of the health professional.
Utilising this knowledge is likely to benefit the patients care.
6 different sources of information used by general public influencing uptake of medical care
- Peers / family
- Internet
- T.V.
- GP practice leaflet
- Adverts in public places
- Posters in pharmacies
What are 5 social implications with Scotland’s increasing elderly population?
- Increasing dependence on families and carers
- Increasing emphasis on social activities for the elderly
- Demand for home carers likely to increase
- Elderly people remaining in employment for longer, increase unemployment rate in young
- Demand for care homes / nursing homes increase.
What are some of the financial implications of being a carer?
- Large numbers of carers said financial circumstances affected their health.
- Large numbers missed out on financial support
- Third of carers had cut backs on essentials like food and heating.
Headings of an audit?
Reason for audit Criteria Standard set Preparation and planning Results and date of data collection one Description of change implemented Results and date of data collection two Reflections
What are the rights of patients on sick role?
Exempts an individual from normal social roles
Not responsible for his / her condition
Should try get well
Seek competent help and co-operated with the doctor / health professional to get better.
