GP Flashcards
Defintion: equity
Abscence of unfair and avoidable differences in health among the population - “creating an even playing field” i.e adjusting for disadvantages groups
Definition: equality
Equal access for all patients
Three domains of public heath
- Healthcare improvement - reducing inequalities
- Health protection - minimise and control disease risk
- Health care - delivering safe services
Examples of health improvement
Improving:
-education
-housing
-lifestyles e.g diet, exercise
Examples of health protection
Minimising issues to do with
-chemicals
-radiation
-environamental health
-emergency response
What is primary prevention in public health
Trying to avoid or remove the cause of a health problem before it arises
e.g recreational substance misuse give education
What is secondary prevention for public health
Preventing progression of health problem at an early stage
e.g substance abuse providing needles that are safe
What is tertiary prevention public health
Preventing worst outcome or complications from a health problem
E.g diabetes check insulin regularly and check feet for ulcers
Difference between horizontal and vertical equity
Horizontal -people with equal needs should be treated the same
Vertical - people with greater clinical needs should have more intervention
What are the three approaches to health assessment
Epidemiological
Corporate
Comparative
What is an epidemiological approach to health needs
Considering the illness in terms of things like incidence, prvelance and mortality
What is a corporate approach to health needs
Getting a Systematic collection of knowledge and views from people working in health e.g GPs
What is a comparative approach to health needs
comparing health performance across or between communities, disease groups + service providers.
Definition: domestic abuse
incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are:
intimate partners
family members
Regardless of sexuality or gender
What the framework questions for domestic abuse
HARK - in the last year have you been?
Humiliation: humiliated or emotionally abused in other ways by your partner?
•Afraid: “In the last year have you been afraid of your partner or ex-partner?
•Rape: “In the last year have you been raped by your partner or forced to have any kind of sexual activity?”
•Kick: In the last year have you been physically hurt by your partner?
What is the health belief model
A model that claims people will change if:
• Believe they are susceptible to the condition in question
• Believe that it has serious consequences
• Believe that taking action reduces susceptibility
• Believe that the benefits of taking action outweigh the cost
Cons of the health belief model
- alternative factors may predict health behaviour such as a persons own belief in their ability to carry out preventative measure
-model doesnt take into account emotional or behavioural influence
-model doesnt differentiate between first time and repeat behaviour
What this theory of planned behaviour
A model that proposes that the Best predictor of behaviour is INTENTION which is determined by :
-persons attitude
-perceived social presssure/ subjective norm
-persons belief in their own ability to perform the behaviour
Cons of theory of planned behaviour
-lack of temporal element and causality
-doesnt take into account emotions such as fear which may disrupt rational decision making
-doesnt take into account habits and routine which bypass cognitive deliberation
-you cant measure or assume subjective norms
Stages of trans theoretical model
• Precontemplation– no intention of giving up smoking
• Contemplation – beginning to consider giving up, probably at some
ill-defined time in the future
• Preparation – getting ready to quit in the near future
• Action – engaged in giving up smoking now
• Maintenance – steady non-smoker,
i.e. state of change reached
Advantages of trans theoretical model
• Acknowledges individual stages
of readiness (tailored
interventions)
• Accounts for relapse
• Temporal element
Cons of trans theoretical model
-Not all people go through very stage, some people move backwards and forwards or miss
some stages out completely
• Change might operate on a
continuum rather than in discrete
stages
• Doesn’t take in to account values,
habits, emotions, culture, social
and economic factors
• People often change their
behaviour in the absence of
planning/ intentions can change
over a very short time period
What are the three health behaviours
Health behaviours - prevention
Illness behaviours - seek remedy
Sick role behaviours - behaviour in order to get better e.g rest and fluid
Equation for specificity
Total negative results / (total negative + false positives)
Validity meaning
whether a test accurately measures what it is supposed to measure.
Reliability meaning
Reliability is used in statistics to imply consistency of a measure.
Determinant of health examples
PROGRESS
P- place of residence
R- race
O- occupation
G- gender
R- religion
E- education
S- sociocapital status
S- socioeconomic status
What is maxwells dimensions of the quality of healthcare
Used to assess the quality of healthcare
3As and 3Es
A-acceptability
A-accessibility
A-appropriateness
E- effectiveness
E-efficiency
E- equity
What is the donabedian framework of health service evaluation
Assessment of wether a service achieve sits outcome
Structure - what actually is the service
Process - how does this process work
Outcome - 5Ds death, disease, disability, discomfort, dissatisfaction
What is a need
The ability to benefit from an intervention
What is a demand
What is a supply
Demand -What people ask for
Supply -What is provided
4 types of need in health need assessment
Felt need -individual perceptions of variation from normal health
Expressed need - individual seeks helps to overcome variation in normal health
Normative need - professional defines intervention appropriate for the expressed need
Comparative need - comparison between severity, range of interventions and cost
List from bottom to top mallows hierarchy of needs
- -physiological - e.g food and water
- -safety - e.g security of body/ employment
- -love/belonging - e.g friendship, sexual intimacy
- -esteem - e.g self esteem, confidence, respect of others
- -self actualisation - e.g morality, creativity, problem solving
What is a egalitarian method of resource allocation
Provides all the care that is necessary and required to everyone
Advantage - equal for all
Disadvantages - economically restricted
What is a maximising resource allocation method
Allocation Based solely on consequence
Advantage - people who need it most, most likely to benefit
Disadvantage - those with ‘less need’ receive nothing
What is libertarian resource allocation
Each individual is responsible for own health
Advantage -onus on patient therefore may be more engaged
Disadvantage -not all diseases are self inflicted
Definition of epidemiology
The study of the frequency, distribution and
determinants of diseases and health-related states in populations in order to prevent and control disease.
What is the definition of incidence
Number of new cases in population in period of time
Definition: prevalence
Number of existing cases in a population at a point in time
Difference between absolute and relative risk
Absolute risk – gives a feel for actual numbers involved and has units
Relative risk – risk in one category relative to another with no units
What is attributable risk
Attributable risk – rate of disease in the exposed that may be attributed to exposure
Defintion for bias
a systemic deviation from the true estimation of the associated between exposure
and outcome (it is an example of a systematic error)
What is selection bias
- type of bias that results from improper selection of a cohort that does not closely represent the greater population for which the study aims to be applicable.
- It can also result from inadequate randomization into separate study groups
E.g lost to follow up
Information bias definition
Error in observer’s recall and reporting, participant, instrument wrongLy calibrated
What is publication bias
Trials with negative results are less likely to be published
What is length time bias
disease that progresses more slowly/ are benign are more likely to be picked up by screening which makes it appear that screening lengthens life
What is lead time bias
Early identification doesn’t alter the outcome but appears to increase survival as the patient has the disease identified earlier than normal
What is is the Bradford hill criteria (9)
Assesses causality between two things based on 9 criteria
-Strength - The strength of the association
- Dose-response – does a higher exposure produce higher incidence?
- Consistency – similar results in different studies and populations
- Temporality – does the exposure precede the outcome
- Reversibility – removing exposure reduced risk of disease
- Biological plausibility – does it make sense biologically
- Coherence – logical consistency with lab information e.g. incidence of lung cancer
with increased smoking is consistent with lab evidence that tobacco is carcinogenic - Analogy – similarity with other established cause-effect relationships in the past e.g.
thalidomide in pregnancy, not other teratogenic drugs show similar effects - Specificity – Relationship is specific to the outcome of interest e.g. introducing
helmets reduced head injuries specifically, it wasn’t that there has been an overall
lower injury rate
What is prevention paradox
A preventative measure which brings much benefit to the population but offers little to
each participating individual
” E.g. If all wore their car seat belts on every journey throughout their working lives, would save lives as a population
What is Wilson and junger criteria for screening
- The condition
- an important condition
- knowledge on the condition - Screening programme
- should be cost effective
- ongoing not just one off - The test
-simple, safe and precise screening test
-people should be willing to do it population wide
-agreed policy on further diagnostic procedures done with positive test result
4.the treatment
- disease has an accepted treatment
-enough facilities
-agreed threshold on who to treat
Equation for positive predictive value
TP/ TP+FP
Proportion of people with positive test that actually have disease
Equation for sensitivity
TP/TP+FN
proportion of people with the disease who are correctly idenitified by screening test
Bolam rule
Would a doctor do the same
Bolitho rule
Would that be reasonable
What age can never consent to sex legally
Under 13s
Fours dimensions of food insecurity
Availability/affordability
Access
Utilisation - can they prepare the food
Stability of the above three over time
Defintion of food insecurity
experiencing one or more of the following:
-Having smaller meals than usual or skipping meals
-Being hungry but not eating
-Not eating for a whole day
due to being unable to afford or get access to food.
What is malnutrition
deficiencies, excesses or imbalances in a person’s
intake of energy and/ or nutrient
What is triple burden for malnutrition
Overweight
Underweight
Micronutrient deficiencies
Benefits of breastfeeding
-Acceptance of novel foods during weaning
-Evidence to suggest that children who were breastfed are less picky eaters
in childhood
-Have a diet richer in fruit and vegetables if BF > 3 months
What is colostrum, fore milk and hind milk
Colostrum - 3 dy after birth
Foremilk beginning of a feed (watery)
Hindmilk end of a feed (> energy dense)
Why do you not stop statins
associated with a 33% increased risk of admission for a cardiovascular event in 75-year-old primary prevention patients
Problems of polypharmacy
•The drug combination is hazardous because of interactions
•The overall demands of medicine-taking, or ‘pill burden’, are unacceptable to the patient
•These demands make it difficult to achieve clinically useful medication adherence (reducing the ‘pill burden’ to the most essential medicines is likely to be more beneficial)
•Medicines are being prescribed to treat the side effects of other medicines
