FPC2 Tutorial 1 Long Term Conditions Flashcards
What is Person Centred Care?
Person-centered care places the patient at the centre
Only the patient is in a position to make a decision on what this means to them
Care can be said to be patient-centered if it is based on the principles and values that define patient-centeredness
the provision of care that places the patient at the centre ensuring that the healthcare system is designed to meet the needs and preferences of patients as defined by patients themselves
The Declaration outlines five principles of person centered healthcare, what are they?
- Respect
- Choice and empowerment
- Patient involvement in health policy
- Access and support
- Information
What are possible impacts of someone living with a long term illness?
Sufferers may endure multiple handicaps that affect physical, social and psychological well-being
Constraints on family life
failure to re-establish the functional capacity to work and unremitting physical discomfort (often chronic pain)
all commonplace facts of life for patients with long-term conditions
In what groups are long term conditions more common in?
Long-term conditions are more prevalent in older people and in more deprived groups
How many appointments do patients with long term illnesses take up
50 per cent of all GP appointments
64 per cent of all outpatient appointments and over
70 per cent of all inpatient bed days
Whata re some examples of degenerative chronic disorders?
Parkinson’s disease, M.S, Arthritis
What does incidence mean?
the number of new cases of a disease in a population in a specified period of time
What does prevalence mean?
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)
What is the aetiology of long term conditions?
Long-term conditions (chronic diseases) are usually the end result of a long term complex interaction of factors:
There may be genetic factors
There may be environmental factors
There might be both or neither
What is an individuals vulnerability to long term illnesses?
An individuals capacity to resist disease, repair damage and restore physiological homeostasis can be deemed vulnerability
Even certain organs can vary – to an extent the liver repairs well, whereas the brain does not
What is the natural history of a long term ilness?
Diseases vary:
● Some may have an acute onset such as stroke or MI
● Some may be gradual with a slow or more rapid deterioration (e.g. angina)
There may on the other hand be relapse and remission e.g. cancer
What is the treatment of a long term condition like?
This may be aimed at the disease, or the effect of the disease
In order to treat a disease, it is 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 may be the burden of treatment on patients and caregivers as they are often put under enormous demands by healthcare system?
Changing behaviour or policing the behaviour of others to adhere to lifestyle modifications
Monitoring and managing their symptoms at home
Complex treatment regimens and multiple drugs (polypharmacy) contribute to the burden of treatment
Complex administrative systems, and accessing, navigating, and coping with uncoordinated health and social care systems add to this
What is Biographical Disruption?
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; this process is termed ‘biographical disruption’
What are the ffects of biographical disruption?
It may involve `re-negotiating’ existing relationships at work and at home
The chronically ill and disabled person also needs to be able to make some sense of their condition before they can begin the process of `adjusting’ to it
Involves redefining ideas of what is good' and bad’, such that the positive aspects of their lives are emphasised, and the negative impact of the illness lessened
Are long term conditions always visable to others?
Some are visibile and some are invisable and some are both
Having a condition may subject osmeone to stigma so how can this be delt with?
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
Who can long term conditons impact and what may thta impact be?
On the individual - can be negative or positive. Can include denial, self pity and apathy
On Family - can be financial, emotional and physical
Other family members may become ill as a result
Community/society - Isolation of an individual may result
What is the expert patient?
“my patient understands their disease better than I do.”
What are the effects of an expert patient?
It is something that could greatly benefit the quality of patients’ care and ultimately their quality of life, but which has been largely ignored in the past
They can become key decision-makers in the treatment process
What factors come under WHOs defnition of disability?
Body and Structure Impairment
Abnormalities of structure, organ or system function (organ level)
Activity Limitation
Changed functional performance and activity by the individual (personal level)
Participation Restrictions
Disadvantage experienced by the individual as a result of impairments and disabilities (interaction at a social and environmental level)
What is the medical model of 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 e.g. change in behaviour
What is the social model of disability?
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.
What is a doctors role in dealing with a patient with a long term disability and not simply being a spectator?
We assess disability
We co-ordinate the multi-disciplinary care team
We intervene in the form of rehabilitation
How is a disability often managed?
A multidisciplinary approach is often required
Is everyone reaction to disability the same?
no everyone is different and depends on multiple factors
The nature of the disability
The information base of the individual, i.e. education, intelligence and access to information
The personality of the individual
The coping strategies of the individual
The role of the individual – loss of role, change of role
The mood and emotional reaction of the individual
The reaction of others around them
The support network of the individual
Additional resources available to the individual e.g. good local self-help group, socio-economic resources
Time to adapt i.e. how long they have had the disability
How can disability affect the fmaily?
It can cause distruption at different levels:
personal
economic
social
What is the epidemiology of disability?
Different causes worldwide:
Congenital
Injury
Communicable Disease
Non-Communicable Disease
Alcohol
Drugs-iatrogenic effect and/or illicit use
Mental Illness
Malnutrition
Obesity
What is the prevelance of diability like in the UK?
In the UK the prevalence and severity of disability rise with age
One third of those with a disability are in employment
What is the criteria for screening?
Wilsons criteria:
knowledge of disease
knowledge of test
treatment for disease
cost considerations
