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3a > GP > Flashcards

GP Flashcards

1
Q

Maxwell’s dimensions of the quality of health care

A

Acceptability
Accessibility
Appropriateness
Effectiveness
Efficiency
Equity

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2
Q

Benefits of teaching diversity

A

better outcomes for patients
more satisfying patient encounters

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3
Q

Negligence (4)

A

was there a duty of care?
was there a breach in that duty?
was the patient harmed?
was the harm due to the breach in care?

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4
Q

Negligence -> Bolam test

A

would a group of reasonable doctors do the same?

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5
Q

Negligence -> Bolitho test

A

would that be reasonable?
(defines the ‘reasonable’ part of Bolam -> logical basis)

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6
Q

Determinants of health (8)

A

PROGRESS
Place of residence
Race
Occupation
Gender
Religion
Education
Socio-economic
Social capital

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7
Q

Transtheoretical model - smoking

A

5 stages of change
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance

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8
Q

Advantages and disadvantages of the trans theoretical model

A

+ acknowledges differing stages of readiness, allows relapse
- people may skip stages, doesn’t take cultural views into account

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9
Q

Theory of planned behaviour change

A

the best predictor of behaviour is ‘intention’ e.g. I intend to give up smoking

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10
Q

Motivational interviewing

A

attempts initiating behaviour change by resolving ambivalence

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11
Q

epidemiology

A

the study of the frequency, determinants and distributions of diseases and health related states in populations in order to prevent and control disease

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12
Q

domestic abuse

A

any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between current or former partners or family members in a person > 16

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13
Q

child abuse

A

same as domestic abuse but <16yo (any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between current or former partners or family members in a person)

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14
Q

toxic triangle for child abuse

A
  • parents mental health issues
  • alcohol and drug abuse
  • domestic abuse
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15
Q

effect of abuse on health

A

physical trauma, psychological trauma, somatic problems

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16
Q

role of doctor in dealing with domestic abuse

A

display helpline posters, give contact cards
- ensure records are kept
- vocally acknowledge it is not acceptable, be non-judgemental
- refer when appropriate
- break confidentiality if their health is in danger
- don’t speak about abuse when family members are present

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17
Q

DASH assessment

A

determines whether a patient is low, medium, or high risk in abuse

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18
Q

DASH low, medium and high risk

A

serious harm unlikely

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19
Q

DASH medium risk

A

serious harm likely without change in circumstances -> give domestic abuse helpline contact details

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20
Q

DASH high risk

A

risk of imminent harm
-> refer for Marac (multi-agency risk assessment conference) / IDVAS (independent domestic violence advocacy service)

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21
Q

health behaviour

A

a behaviour aimed to prevent diseases (e.g. healthy eating)

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22
Q

sick role behaviour

A

any activity aimed at getting well (e.g. taking medications)

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23
Q

illness behaviour

A

a behaviour aimed to seek remedy (e.g. going to the doctor)

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24
Q

health belief model

A

chance of an action being carried out is associated with persons belief that it will work + cues to action

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25
Q

health

A

a state of complete physical, mental and social wellbeing. Not merely the absence of disease or infirmity

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26
Q

public health

A

the science and art of preventing disease, prolonging life and improving health through organised efforts of society

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27
Q

equity

A

what is fair and just

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28
Q

equality

A

having equal shares (not always equitable)

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29
Q

horizontal equity

A

equal treatment for equal need

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30
Q

vertical equity

A

unequal treatment for unequal need
(e.g. poor area requires more services than rich area; simple cold vs pneumonia need unequal treatment)

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31
Q

inverse care law

A

availability of health care tends to vary inversely with its need

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32
Q

three domains of public health practice

A

health improvement, health protection, improving services

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33
Q

health improvement

A

societal interventions aimed at preventing disease, promoting health, reducing inequalities

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34
Q

health protection

A

measures to control infections disease and environmental hazards

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35
Q

improving services

A

organisation and delivery of safe, high quality care

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36
Q

5 stages of grief

A

denial; anger; bargaining; depression; acceptance
(think haunting of hill house)

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37
Q

health needs assessment

A

a systematic approach for reviewing health issues affecting a population in order to enable agreed priorities and resource allocation to improve health and reduce inequalities
-> should be carried out before designing an intervention

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38
Q

needs assessment cycle

A

needs assessment -> planning -> implementation -> evaluation

39
Q

perspectives a health needs assessment are based on: (3)

A

epidemiological, comparative, coporate

40
Q

epidemiological perspective of health needs assessment

A

informs health need based on size of problem (incidence, prevalence), services available (prevention, treatment), evidence base (effectiveness, cost-effectiveness)
+> uses existing data
-> doesn’t consider felt need, data quality varies

41
Q

comparative perspective of health needs assessment

A

compares the services received by a population with others
+> indicates if better/worse than comparable areas
-> difficult to find comparable population

42
Q

corporate perspective of health needs assessment

A

asks the local population what their health needs are (focus groups, surveys, etc)
+> based on felt and assessed needs
-> difficult to distinguish ‘need’ from ‘demand’

43
Q

need

A

ability to benefit from an intervention

44
Q

demand

A

what people ask for

45
Q

supply

A

what is provided

46
Q

supplied but not demanded or needed e.g.

A

routine C section for people with previous C sections

47
Q

supplied and demanded but not needed e.g.

A

antibiotics for mild infection

48
Q

health need

A

ability to benefit from an intervention measured using mortality, morbidit

49
Q

health care need

A

need for health care / ability to benefit from health care

50
Q

felt need

A

individual perceptions of variation from normal health

51
Q

expressed need

A

individual seeks help to overcome variation in normal health (demand)

52
Q

normative need

A

professional defines intervention for the expressed need

53
Q

comparative need

A

comparison between severity, range of interventions and cost

54
Q

principles of resource allocation

A

egalitarian
maximising
libertarian

55
Q

egalitarian resource allocation

A

provide all care that is necessary and required for everyone
+> equal for all
-> economically restricted

56
Q

maximising resource allocation

A

act evaluated in terms of its consequences - will it be beneficial?
+> resources allocated to those most likely to benefit
-> those with less need receive nothing

57
Q

libertarian resource allocation

A

each is responsible for their own health
+> promotes patient engagement
-> most diseases are not self-inflicted

58
Q

primary prevention

A

preventing disease occurring -> vaccine (=no disease)

59
Q

secondary prevention

A

early identification of disease to alter disease course -> screening (=pre-clinical disease)

60
Q

tertiary prevention

A

limit consequences of established disease (=clinical disease)

61
Q

population approach to prevention

A

prevention delivered to everyone aimed to shift the risk factor distribution curve (e.g. sugar tax)

62
Q

high risk approach to prevention

A

seeks to identify individuals above a chosen cut-off and treat them (e.g. screening for people with high BP & treating them)

63
Q

Wilson Jungner criteria for screening INASEP

A

Important disease
Natural history of disease understood (e.g. known disease marker)
Acceptable to population (not too invasive)
Simple, safe precise test
Effective treatment (early detection has better outcomes than late detection)
Policy agreed on who to treat

64
Q

sensitivity

A

ability to detect people with disease
(true positive results / true positive + false negative)

65
Q

specificity

A

excluding those without disease correctly (true negatives / true negatives + false positives)

66
Q

positive predictive value

A

proportion of people who test positive who actually have the disease (true positives / true positives + false positives)

67
Q

negative predictive value

A

proportion of people who test negative who don’t have the disease (true negative / true negative + false negative)

68
Q

ecological study design

A

observational; looks at the prevalence of the disease over time (population)
> can show prevalence and association but NOT causation

69
Q

cross sectional study

A

observational; collects data from a population and a specific point in time (snapshot)
+> large sample size
-> no time reference

70
Q

cohort study

A

longitudinal study in similar groups but with different risk factors/ treatments. follows up over time to measure who gets disease
+> can follow up rare exposure that would be unethical in RCT; causation
-> long time; high drop out rate

71
Q

case control study

A

observational; looks at cause of diseases by comparing similar participants with and without disease. Looks retrospectively for cause
+> quick, good for rare disease causes
-> hard to find similar control group, prone to selection and information bias

72
Q

RCT

A

gold; randomised participants, one group gets treatment, other is control
+> low risk of bias/confounding, can infer causality
-> time consuming, expensive, can be unreliable if population not representative (volunteer bias)

73
Q

odds

A

probability / 1- probability

74
Q

odds ratio

A

the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure

75
Q

addiction

A

craving, tolerance, compulsive drug seeking behaviour, physiological withdrawal state

76
Q

positive conditioning in addiction

A

increases desire to use drug

77
Q

negative conditioning in addiction

A

people don’t quit due to unpleasant withdrawal

78
Q

physical complications of drug use

A

injection complications (DVT, abscess, endocarditis, blood borne virus); overdose; side effects (constipation in opiates)

79
Q

social complications of drug use

A

criminal acts; social exclusion; poverty

80
Q

psychological complications of drug use

A

guilt; cravings; fear of withdrawal

81
Q

what can you offer a newly presenting drug user?

A

-screening for blood viruses
-health check
-contraception/smear
-sexual health advice
-check immunisation history
-info on drug services (e.g. needle exchange service)

82
Q

opiate detoxification drugs

A

methadone; buprenorphine
naltrexone to prevent relapse

83
Q

improving services

A

organisation and delivery of safe, high quality care

84
Q

Maslow’s hierarchy of needs

A
  1. physiological (air, water, food)
  2. safety (security of body and resources)
  3. love/belonging (friends, family, intimacy)
  4. esteem (confidence, achievement, respect)
  5. self actualisation (morality, creativity, problem solving)
85
Q

asylum seeker

A

someone who is applying for refugee status

86
Q

asylum seekers receive

A

-vouchers to live off
-NASS support package
-access to NHS
BUT not allowed to work & have no choice where they go

87
Q

refugee

A

someone who has been granted asylum status -> lasts 5y

88
Q

humanitarian protection

A

failed to get asylum but serious threat of returning -> can stay for 3y

89
Q

health problems for refugees

A

injury/illness from war/travelling
communicable disease
lack of health screening and immunisation
malnutrition
untreated chronic disease
mental illness (PTSD, depression, anxiety, post migratory stress)

90
Q

barriers to health for migrants

A

reluctance of GPs to register them
illiteracy
communication difficulties
lack of permanent site
mistrust of professionals

91
Q

alcohol unit calculation

A

ABV (%) x volume (ml) / 1000

92
Q

drugs for alcohol dependance

A

acamprosate -> reduces cravings
naltrexone -> reduces pleasure gained
disulfiram -> causes unpleasant reaction if you drink

93
Q

drugs for alcohol dependance

A

acamprosate -> reduces cravings
naltrexone -> reduces pleasure gained
disulfiram -> causes unpleasant reaction if you drink

94
Q

alcohol withdrawal treatment

A

chlordiazepoxide inpatient regime
(lorazepam in hepatic failure)
CIWA score
carbamazepine -> anti-convulsive

3a (8 decks)

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