Foundations of Primary Care COPY Flashcards
What are the three aims of SIGN
- 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
understand medical evidence
reduce variations in practice
improve healthcare
Give examples of sources/types of epidemiological data.
michael gove HIDES CHARM
Health and household surveys
ISD Scotland statistics
Drug misuse databases
Expenditure data from NHS Social security statistics
Cancer statistics
Hospital activity statistics
Accident statistics
Reproductive health statistics
Mortality data
Define 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 the exposure and disease.
List three common confounding factors
- Age
- Sex
- Social class
List Reasons not to do with healthcare why numbers of elderly population increasing
- Decrease in birth/fertility rates
- Improvements in housing
- Improvements in water supplies
- Improvements in sanitation/sewerage systems
- Improvements in nutrition
- Improved safety and reduction of injury
- Migration (some areas only)
- War/genocide (some areas only)
social implications associated with Scotland’s increasing elderly population
- Increasing dependence on families and/or carers who are also ageing and perhaps still working themselves
- Demand for home carers likely to increase
- Demand for Care home/nursing home places likely to increase
- Increasing emphasis on social activities for the elderly within communities
- Role of elderly as grandparents and carers of grandchildren likely to change e.g. may have fewer/no grandchildren, may still be in employment themselves
- Housing demands are likely to change as more elderly people live alone e.g. increased demand for one-bedroom flats, sheltered housing
- Elderly people remaining in employment for longer may lead to an increase in unemployment rates in the young (this point could equally well be made as an economic implication)
What are the different options for care when an elderly person becomes more ill?
• 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 an anticipatory care plan
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 or personal and practical aspects of care.
examples of legal issues which may be included in an Anticipatory Care Plan for any patient
• Welfare power of attorney • Financial power of attorney • Guardianship (POA = arranged with patient when has capacity, guardian is arranged through court when no POA made and person no longer has capacity).
examples of medical issues which may be included in an Anticipatory Care Plan for any patient
• Potential problems • Home care package • Wishes re DNA CPR • Scottish Palliative Care Guidelines • Communication which has occurred with other professionals • Details of “just-in-case” medicines • Electronic care summary • Assessment of capacity/competence • Current aids and appliances (helps assess current functional level)
examples of personal issues which may be included in an Anticipatory Care Plan for any patient
• Statement of wishes regarding treatment/advance directive • Next of kin • Consent to pass on information to relevant others • Preferences and priorities regarding treatment • Who else to consult/inform • Preferred place of death • Religious and cultural beliefs re death • Current level of support e.g. family/carers
Why is disability increasing?
Increased age of population Rise in injuries from car accidents, falls and violence, chronic diseases
What are descriptive studies and what are they used for?
Descriptive studies attempt to describe the amount and distribution of a disease in a given population This kind of study does not provide definitive conclusions about disease causation, but may give clues to possible risk factors and candidate aetiologies. Such studies are usually cheap, quick and give a valuable initial overview of a problem
What are cross sectional studies?
(disease frequency, survey, prevalence study) In cross-sectional studies, observations are made at a single point in time
What are case control studies?
two groups of people are compared: a group of individuals who have the disease of interest are identified (cases), a group of individuals who do not have the disease (controls).
What are cohort studies?
In cohort studies, 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 is meant by a trial? A randomised controlled trial?
Trials are experiments used to test ideas about aetiology or to evaluate interventions. The “randomised controlled trial” is the definitive method of assessing any new treatment in medicine.
What is standardisation?
A set of techniques used to remove (or adjust for) the effects of differences in age or other confounding variables, when comparing two or more populations. An age-sex standardised rate represents what the unstandardised (crude) rate would have been in the study population if that population had the same proportion of males and females, and of people in different age groups, as the standard population. Rates can be standardised for any other relevant confounding factor (eg, social class). Comparisons of incidence or mortality rates in a population over time, or between two different populations, or between population subgroups, should always be based on standardised rates, never on crude rates.
What is the Standardised Mortality Ratio (SMR)?
This is a special kind of standardisation which you may encounter in your reading. It is a standardised death rate converted into a ratio for easy comparison. The figure for a standard reference population (eg, Scotland) is taken to be 100 and the standardised death rates for the comparison (study) populations (eg, Grampian) are expressed as a proportion of 100. A figure below one hundred means fewer than expected deaths, and above 100 means more. For example, an SMR of 120 means that 20% more deaths occurred than expected in the study population, allowing for differences in the age and sex structure of the standard and study populations and an SMR of 83 means 17% fewer deaths occurred.
What is meant by case definition?
The purpose of case definition is to decide whether an individual has the condition of interest or not. It is important in because not all doctors or investigators mean the same thing when they use medical terms. Differences in incidence of disease over time or in different populations may be artefact, due to differences in case definition, rather than differences in true incidence.
What is meant by Coding and classification?
This is related to the issue of case definition. When data are being collected routinely (eg, death certificates), it is normal to convert disease information to a set of codes, to assist in data storage and analysis. Rules are drawn up to dictate how clinical information is converted to a code. If these rules change, it sometimes appears that a disease has become more common, or less common, when in fact it has just been coded under a new heading
Define bias?
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. There are very many types of bias which can creep into epidemiological studies. Four important types are described below.
Define Selection bias?
Occurs when the study sample is not truly representative of the whole study population about which conclusions are to be drawn. For example, in a randomised controlled trial of a new drug, subjects should be allocated to the intervention (study) group and control group using a random method. If certain types of people (eg, older, more ill) were deliberately allocated to one of these groups then the results of the trial would reflect these differences, not just the effect of the drug.
Define Information bias?
arises from systematic errors in measuring exposure or disease. For example, in a case control study, a researcher who was aware of whether the patient being interviewed was a ‘case’ or a ‘control’ might encourage cases more than controls to think hard about past exposures to the factors of interest. Any differences in exposure would then reflect the enthusiasm of the researcher as well as any true difference in exposure between the two groups.
Define follow up bias?
arises when one group of subjects is followed up more assiduously than another to measure disease incidence or other relevant outcome. For example, in cohort studies, subjects sometimes move address or fail to reply to questionnaires sent out by the researchers. If greater attempts are made to trace these missing subjects from the group with greater initial exposure to a factor of interest than from the group with less exposure, the resulting relative risk would be based on a (relative) underestimate of the incidence in the less exposed group compared with the more exposed group.
Define Systematic error?
A form of measurement bias where there is a tendency for measurements to always fall on one side of the true value. It may be because the instrument (eg, a blood pressure machine) is calibrated wrongly, or because of the way a person uses an instrument. This problem may occur with interviews, questionnaires etc, as well as with medical instruments.
Define Cofounding 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 the exposure and disease. In some cases the confounding factor may be the true causal factor, and not the exposure that is under consideration.
List two common cofounding factors
Age Sex
List how cofounding factors are dealt with in trials
depending on the particular study design: • In trials, the process of randomisation (in effect the play of chance leads to similar proportions of subjects with particular confounding in the intervention and control groups). • Restriction of eligibility criteria to only certain kinds of study subjects . • Subjects in different groups can be matched for likely confounding factors. • Results can be stratified according to confounding factors. • Results can be adjusted (using multivariate analysis techniques) to take account of suspected confounding factors.
Define multimorbidity
the co-existence of two or more long-term conditions in an individual (multi-morbidity often results in polypharmacy)
Define criteria for causality?
Criteria establishing epidemiologic evidence of a causal relationship between a presumed cause and an observed effect
What are the three main reasons for culturally competent healthcare?
1) eliminating misunderstandings in diagnosis or treatment planning 2) improve patient adherence with treatment 3) eliminate healthcare disparities
What are the components of the mental state exam? MSE - structured way of observing and describing a patients current state of mind
ASEPTIC - R Appearance - Age, sex, dress, unkempt? signs of self harm? and B- behaviour - alert? fidgeting? eye contact? inappropriate conduct? Speech Emotion (mood and affect - blunted, flat, labile) low, elated, anxious Perception - hallucinations Thought/ Thinking - Content (abnormal beliefs/delusions, obsessions) and Process - speed and fluency Insight and judgement - Do they think they have a problem? What do they think caused it? Do they want help? Cognition - orientation, attention and concentration
What is psychopathology? What is descriptive pathology? Define phenomenology? (phenomenon)
Psychopathology is concerned with abnormal experience, cognition and behaviour Descriptive pathology - describes and categorise the abnormal experience as described by the patient Phenomenology - in psychiatry refers to the observation and understanding of the psychological event or phenomenon so that the observer can as far as possible know what the patients experience feels like
What is the hypothetico- deductive process?
1) Make 4 or 5 diagnostic hypotheses 2) rare but not immediately concerning diagnosis excluded at this stage 3) strengthen case for diagnosis through brief history and examination 4) extend the search thereafter if no diagnosis identified 5) not about common diagnosis, rather about likely diagnosis
List two coping mechanisms used to cope with stress and describe
1) Problem focused e.g. enlist friends and family help 2) emotion focused e.g. seek counselling/stress management (positive) alcohol or drug misuse (negative)
What are the individual variables in risk perception?
Previous experience attitudes towards risk values beliefs socioeconomic factors personality demographic factors
What are the three principles that govern the perception of risk?
Feeling in control Size of the possible harm Familiarity with the risk
List four ethical principles and their meanings
Respect for autonomy; promote right to self determination, confidentiality, informed consent, promote capacity. Can we promote autonomy? Justice ; fairness/equity, individual vs population (non discrimination, equal treatment for equal need, rationing) Beneficence; To do good, what are the benefits of giving treatment? Non maleficence; avoidance of harm (to do no harm) what are the *harms* of giving treatment?
What are the 4 options of decision making? When are they used?
1) degree of certainty 2) speed of change Pattern recognition (both 1+2 high) if speed of clinical change is high and complexity or ambiguity is high (ie A and E/ ITU) Algorithms Speed of clinical change is high, complexity or ambiguity is low = childbirth Pathways Speed of clinical change is low and complexity is low. e.g. elective hernia surgery Scenario/option planning Speed of clinical change is low but complexity is high e.g. GP caring for patient at home with co-morbidity
Blaxter (1995) identified factors which influence lay beliefs around health (list 4)
Age - if older - see health as functioning, young people see health as fitness social class /difficult economic and social circumstances - more likely to think in terms of being able to work/care for others ie. functional Gender - women of higher social class or educational equlifications have a more multidimentional view of health. women include social aspects of health, find concept of health more interesting. Culture- e.g. Afro-Caribbean patients hypertension regarded as normal and less likely to take medication
List actions a government might take to promote health in the population as a whole (5 actions)
legislation/policies on smoking/alcohol (minimum age to buy products, licencing laws, taxation) improvements in housing provision of health education health and safety laws traffic/transport legislation/policies
List 5 reasons why people may feel they are in good health
1) no diagnosed long term conditions 2) not on medication 3) able to work/socialise 4) able to have children (fertile) 5) on a ‘healthy diet’ 6) ‘exercise regularly’
Define: Hazard and Risk Risk factor Protective factor Susceptibility
Hazard: something with potential to cause harm Risk: the likelihood of harm occurring Risk factor: something that increases the risk of harm Protective factor: something that decreases the risk of harm Susceptibility: influences the likelihood that something will cause harm
List some examples in disparities in disease outcomes between people who are different races (3) Disease prevalence? (3)
- Lung cancer death rates are higher in black men than white men - Ethnic minority women with breast cancer have a poorer survival rate than white women (even with similar access to care) - Racial disparities in uptake of joint replacement for knee osteoarthritis not explained by prevalence -Diabetes 5 x higher amoung pakistani and bangladeshi women than in general population - all male minority groups (except chinese) have higher rates of heart attacks - black Caribbean men have higher rates of stroke
List 5 duties of a doctor registered with the GMC
make the care of your patient your first concern treat every patient politely and considerately respect a patients privacy and dignity give patients information in a way they can understand recognise the limits of your professional competence be honest and trustworthy avoid abusing your position as a doctor.
What factors make GPs appropriate HCPs to sort out a problem for a patient? List types of questions
Awareness of current and past medical history Awareness of social circumstances A GP has a knowledge of a broad range of illnesses and health conditions Trusted HCP ho is likely to be known by the patient/family for some time/lifelong GP local to patients home 1) direct (specific) 2) closed (yes/no) 3) leading 4) reflected (doctor asks patient to think of the answer)
List five questions for practising Realistic medicine
Is this test, treatment or procedure really needed? What are the potential benefits and risks? What are the possible side effects? Are there simpler, safer or alternative treatment options? What would happen if I did nothing?
Needed?
risk/benefits?
side effects?
alternative treatments?
do nothing?
Define terminal care
The last phase of care When the patient is deteriorating And is near death
List 6 points to consider when breaking bad news
Setting - Listen to patient and the carers Set the scene Check whether patient wants to speak alone or with a relative Perception - Find out what the patient already understands Invitation - Find out how much the patient wants to know Knowledge - Share the information with a common language/avoid jargon review and summarise the information Empathising -allow opportunities for questions Strategy and summary - agree follow up and support
List 5 actions that are taken because of anticipatory care plans
Preferred place of death noted and organised
patient put on palliative care register and discussed at MDT meeting Information on social and financial support given to patients and families
- appropriate referrals completed
Assessment of symptoms and partnerships with specialist palliative care team to customise care to patient needs
Dies in preferred place,
family bereavement and support
GP and district nurse phone calls and visits
Define sustainability
The ability to be able to continue over a period of time
List 4 positive factors that might contribute to a sustainable career in medicine
Autonomy work
life balance
manageable work load
flexibility of role
good job security good
financial security
Give 2 reasons why there are differences between two population pyramids one from 1800s and one from 2031
increased life expectancy decrease in birth rates migration greater availability in contraception improved housing conditions
Give three ways the change in population pyramids will affect healthcare services give three social issues that could arise due to these population changes
Heath increased number of Geriatricians Increased numbers of people with long term conditions such as diabetes Promotion campaigns aimed at the elderly Social increasing dependence on families/carers demand for home carers/nursing home places likely to increase housing demands change as more elderly people living on their own increasing emphasis on social activities for elderly within communities
Give a description of a case controlled study
two groups of people are compared a group of people who have the disease of interest are identified (cases) and a group that do not (controls) Data is then gathered to see if each individual has been exposed to the suspected aetiological factors Then whether a conclusion can be drawn as to whether that factor caused the disease
Give a description of a cohort study
a group of people are selected who do not have the disease yet They are then followed through time until a sufficient number of the cohort have developed the disease to allow analysis
List 6 possible sources of epidemiological data which provide information on IHD
Mortality data hospital activity statistics General practice disease registers NHS expenditure data Household surveys social security statistics
List five psychological issues that may be affecting a patient who works offshore and is from russia
drug/alcohol abuse being away from home (if not from scotland) and anxiety towards travelling anxiety from job insecurity pressure to maintain standard of living shift work stress
List ten potential difficulties during a consultation as a result of cultural differences
lack of knowledge about health issues fear and distrust racism bias and ethnocentrism stereotyping language barriers presence of third party translator in room differences in perceptions and expectations examination taboos religious beliefs
List 5 ways a role as a carer may affect a patient
poor mental health due to stress/anxiety may have to give up work/ work part time financial implications lack of privacy for patient and family (if live with person caring for) less time for hobbies adaptations to patients home e.g. stair lift
suggest 5 ways that issues with being a carer can be alleviated
sitter services (crossroads) home carers to assist with personal care day care centre respite care benefits - carers allowance psychological support - counselling
List 5 aspects in a patients history that could indicate that they are a suitable patient to receive palliative care if a respiratory patient
not expected to be alive in 6-12 months breathless on rest/minimal exertion spends more than 50% of day in chair long term oxygen therapy three acute exacerbation hospital admissions in past year symptomatic right heart failure BMI below 21 FEV less than 30%
List two emotional reactions to receiving bad news
shock - news completely unexpected, patient may be tearful anger - anger with themselves for previously unhealthy habits or behaviour denial - patient does not believe it can be true bargaining- perhaps if I change something in my life things will be better sadness/depression fear/anxiety - distressed about end of life/death/ issues surrounding dying shock anger denial = SAD
List ten factors that should be taken into consideration before starting a screening programme
will the test detect changes at an early preclinical stage? Is the disease an important public health problem? is the natural history of the disease understood? is a test available for this condition? Is the test sensitive? (low false negatives) is the test specific? (low false positives) Is the test safe? Is the cost of the test reasonable? Is the method of the test acceptable to the public and GPs carrying it out? Are facilities for diagnosis and treatment available?
List 5 factors that may contribute to tiredness in a child that aren’t physical illness
poor diet inadequate sleep excess screen time lack of exercise/too much exercise academic issues home/relationship difficulties bullying loneliness
List 5 aspects in a patients history that could indicate that they are a suitable patient to receive palliative care if a dementia patient
unable to dress, walk or eat without assistance, unable to communicate meaningfully worsening eating problems (dysphagia) or needing pureed diet recurrent febrile episodes/aspiration pneumonia urinary and faecal incontinence
List 5 aspects in a patients history that could indicate that they are a suitable patient to receive palliative care if a liver patient
advanced cirrhosis with: intractable ascites hepatic encephalopathy recurrent variceal bleeds bacterial peritonitis low serum albumin prolongued INR over 2 not fit for liver transplant hepatocellular carcinoma
List 5 aspects in a patients history that could indicate that they are a suitable patient to receive palliative care if a kidney disease patient
stage 4/5 chronic kidney disease (eGFR under 30ml/min) deteriorating on renal replacement therapy/dialysis or with persistent symptoms
List 5 aspects in a patients history that could indicate that they are a suitable patient to receive palliative care if a cardiac patient
NYHA class III or IV heart failure, extensive valve disease, or coronary heart disease breathless or chest pain at rest or on exertion cardiac cachexia renal impairement (eGFR under 30 ml/min) two or more acute episodes needing hospital care in last 6 months
What scale can be used in palliative care to assess patients function
Palliative performance scale
What are the WHO aims for palliative care
provide relief from pain and other distressing symptoms affirms life and regards death as a natural process intends neither to hasten or postpone death integrates the psychosocial and spiritual aspects of patient care offers a support system to allow patients to live as fully as possible until they die offers a support system for the patient and family during the patients illness and for bereavement uses a team approach to address the needs of the patients and family
What specialists can be involved in a palliative patients care?
marie curie nurse macmillan nurse CLAN religious groups
What are the main components of a ‘good death’
pain free death open acknowledgement of iminent death death at preferred place surrounded by family and friends personal conflicts and practical matters settled death as personal growth person centred and tailored to the patients individual wishes and individuality
Where is most peoples preferred place of death? what percentage of people achieve this?
Home 25%
What framework offers tools to support palliative care patients at home?
The golden standards framework including - setting up a cancer register -reviewing these patients - reflective practice (e.g. significant event audits)
Define: voluntary euthanasia non voluntary euthanasia physician assisted suicide
voluntary euthanasia = patients request non voluntary euthanasia = no request physician assisted suicide = physician provides the means and advice for suicide
List three reasons people may request euthanasia
1) depression - 60% of patients that request are depressed 2) fear of unrelieved symptoms and dread of further suffering
Define sociology
the development, structure and functioning of human society
List the characteristics of a ‘profession’
1) systematic theory (has a theoretical basis) 2) authority recognised by its clientele (patients and government come to it for help) 3) broader community sanction (no one is allowed to practice without a licence) 4) code of ethics 5) professional culture sustained by professional sanctions
What are the social/socio-economic influences on our health?
gender ethnicity housing education employment financial security health system environment
List five reasons why employment is a social factor
Provides income and financial security; this obviously varies and relates in part to the previous slide on social class. (Deprivation is a major determinant of health inequalities) Provides social contacts Provides status in society Provides a purpose in life Unemployment is associated with increased morbidity and premature mortality
Define health inequalities according to WHO definition
The WHO states that health inequalities can be defined as the differences in health status or in the distribution of health determinants between different population groups
List some main health inequalities in scottish children
Birthweight Dental health breastfeeding obesity/overweight teenage pregnancy
What health inequalities are present for the homeless population?
Average age of death of longer-term homeless is 47 years for men and 43 years for women Death by unnatural causes has been found to be four times more common than average amongst rough sleepers, and suicide 35 times more likely Rough sleepers are more likely to be assaulted than the average person Alcohol and drug problems are very high amongst rough sleepers, and people being resettled from the streets are more likely to face problems sustaining a tenancy if they have these problems The prevalence of infectious diseases, such as tuberculosis, HIV and hepatitis C, is significantly higher than in the general populations This population experiences poorer oral health than the general population. Access to health care for this population is different to that of the general population: one third of rough sleepers are not registered with a GP; attendance at accident and emergency is at least eight times higher than the housed population.
List barriers that prevent people with a learning disability accessing healthcare
a lack of accessible transport links patients not being identified as having a learning disability staff having little understanding about learning disability failure to recognise that a person with a learning disability is unwell failure to make a correct diagnosis anxiety or a lack of confidence for people with a learning disability lack of joint working from different care providers not enough involvement allowed from carers inadequate aftercare or follow-up care
What challenges do refugees face in accessing healthcare?
Family integrity and social adjustments trump medical issues for most arriving refugees Competing demands of distinct services such as: social welfare, education, housing, transportation, public health, mental health, primary care, and specialty care encountered by refugees may overwhelm them and limited resources Language barriers impede the adjustment process Some refugees with urgent and complex medical conditions are unable to establish care and specialty referrals in a timely manner Underdeveloped or eroding health care systems in the countries of origin or first asylum leave many refugees with poorly controlled or undiagnosed chronic medical conditions Most refugees are unfamiliar with the biomedical practice of preventive medicine and primary health care Public health’s infectious disease screening results are not communicated to those providing ongoing medical care Exposure to violence, torture, warfare, and internment is common, even among children Loss upon loss is the nature of refugee life and so depression, PTSD, and anxiety are prevalent and often unrecognized Anti-immigrant sentiments further burden refugee life in the U.S.
What health inequalities do prisoners face?
more likely to smoke more likely to use illicit drugs more likely to have mental health conditions more likely to be involved in violence, accidents and higher suicide rate
What health inequalities do LBGTX people face?
higher suicide rate more likely to have mental health condition depression/anxiety
What factors can reduce health inequalities?
Effective partnership across a range of sectors and organisations e.g. to promote health, improve patient education about health Evaluate and refine integration of health and social care Government policies and legislation e.g. smoking ban, Keep Well campaign Time to invest in the more vulnerable patient groups Improve access to health and social care services and professionals Reduction in poverty Social inclusion policies Improved employment opportunities for all Ensuring equal access to education in all areas Improved housing in deprived areas
What is the difference between equality and equity?
What are the benefits of volunteering
gain confidence
learn a new skill
meet people
take on a challenge
Why is global sustainability important to healthcare?
Material Inequality
- Population and Consumption
- Resource Depletion
- Climate Change
- Loss of Biodiversity
- Crisis in Healthcare
List some actions that could be taken to slow global warming
Increase use of renewable energy resources ( that is any natural energy resource that can be replenished with the passage of time)
Modifying human behaviour, being more active
Move back to more plant based diet
Educate on carbon literacy and numeracy
Promote patient resilience
Teach healthcare students that as well as human anatomical systems we are also part of a wider ecological system
List some ways the NHS could improve sustainability
Prioritise Environmental Health Substitute harmful chemicals with safer alternatives.
Reduce and safely dispose of waste
Use energy efficiently and switch to renewable energy.
Reduce water consumption Improve travel strategies
Purchase and serve sustainably grown food
Safely manage and dispose of pharmaceuticals
Adopt greener building design and construction.
Purchase safer more sustainable products
What questions should you ask in an occupational history?
A description of the present and previous jobs from leaving school. Identifying any exposure to chemicals or other hazards ( may need to see confirmation from labels). Did the symptoms improve when not exposed e.g. at weekends, holidays? Determine the duration and intensity of exposure e.g. was it so noisy it was impossible to communicate Is personal protection used e.g. what kind of mask? What maintenance is in place for the protection measures? Do others suffer similar symptoms? Are there known environmental hazards in use? Any hobbies, pets, worked overseas, moonlighting?
Describe the components of the Fit Note
It’s purpose is to facilitate earlier discussion about returning to work and about rehabilitation.
It now includes items of consideration for employers when signing a patient’s return to work.
It can only be completed by a Doctor
It is advice to patients as employees, is not binding on the employer and does not affect Statutory Sick Pay
It is required if the patient has been off more than 7 consecutive days ( including non working days)
What are the aims of realistic medicine?
●Build a personalised approach to care
●Change our style to shared decision-making
●Reduce unnecessary variation in practice and outcomes
●Reduce harm and waste
●Manage risk better
●Become improvers and innovators
What areas of health are affected by health promotion?
access
environment
lifestyle
Define health promotion
an overarching principle which enhances health.
It includes health education, disease prevention and health protection
It may be opportunistic or planned
Define health education
An activity involving communication with individuals or groups aimed at changing knowledge, beliefs, attitudes and behaviour in a direction which is conducive to improvements in health.
Define health protection
involves collective activities directed at factors which are beyond the control of the individual.
Health protection activities tend to be regulations or policies, or voluntary codes of practice aimed at the prevention of ill health or the positive enhancement of well-being.
What are the benefits of empowerment?
An ability to resist social pressure.
An ability to utilise effective coping strategies when faced by an unhealthy environment.
A heightened consciousness of action.
Draw out the circle of change
Give some examples of health promotion in
1) primary care
2) governmental level
Primary Care : Planned or Opportunistic
Government : Legislation, Economic, Education
Define primary prevention and give an example
Measures taken to prevent onset of illness or injury
Reduces probability and/or severity of illness or injury
vaccinations
Define secondary prevention
Detection of a disease at an early (preclinical) stage in order to cure, prevent, or lessen symptomatology”
Define tertiary prevention
measures to limit distress or disability
caused by disease
