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Phase 3a - Arun&Erin > GP > Flashcards

GP Flashcards

1
Q

Defintion: equity

A

Abscence of unfair and avoidable differences in health among the population - “creating an even playing field” i.e adjusting for disadvantages groups

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2
Q

Definition: equality

A

Equal access for all patients

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3
Q

Three domains of public heath

A
  1. Healthcare improvement - reducing inequalities
  2. Health protection - minimise and control disease risk
  3. Health care - delivering safe services
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4
Q

Examples of health improvement

A

Improving:
-education
-housing
-lifestyles e.g diet, exercise

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5
Q

Examples of health protection

A

Minimising issues to do with
-chemicals
-radiation
-environamental health
-emergency response

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6
Q

What is primary prevention in public health

A

Trying to avoid or remove the cause of a health problem before it arises
e.g recreational substance misuse give education

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7
Q

What is secondary prevention for public health

A

Preventing progression of health problem at an early stage
e.g substance abuse providing needles that are safe

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8
Q

What is tertiary prevention public health

A

Preventing worst outcome or complications from a health problem

E.g diabetes check insulin regularly and check feet for ulcers

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9
Q

Difference between horizontal and vertical equity

A

Horizontal -people with equal needs should be treated the same

Vertical - people with greater clinical needs should have more intervention

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10
Q

What are the three approaches to health assessment

A

Epidemiological

Corporate

Comparative

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11
Q

What is an epidemiological approach to health needs

A

Considering the illness in terms of things like incidence, prvelance and mortality

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12
Q

What is a corporate approach to health needs

A

Getting a Systematic collection of knowledge and views from people working in health e.g GPs

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13
Q

What is a comparative approach to health needs

A

comparing health performance across or between communities, disease groups + service providers.

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14
Q

Definition: domestic abuse

A

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

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15
Q

What the framework questions for domestic abuse

A

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?

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16
Q

What is the health belief model

A

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

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17
Q

Cons of the health belief model

A
  • 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

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18
Q

What this theory of planned behaviour

A

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

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19
Q

Cons of theory of planned behaviour

A

-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

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20
Q

Stages of trans theoretical model

A

• 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

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21
Q

Advantages of trans theoretical model

A

• Acknowledges individual stages
of readiness (tailored
interventions)

• Accounts for relapse

• Temporal element

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22
Q

Cons of trans theoretical model

A

-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

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23
Q

What are the three health behaviours

A

Health behaviours - prevention
Illness behaviours - seek remedy
Sick role behaviours - behaviour in order to get better e.g rest and fluid

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24
Q

Equation for specificity

A

Total negative results / (total negative + false positives)

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25
Q

Validity meaning

A

whether a test accurately measures what it is supposed to measure.

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26
Q

Reliability meaning

A

Reliability is used in statistics to imply consistency of a measure.

27
Q

Determinant of health examples

A

PROGRESS

P- place of residence
R- race
O- occupation
G- gender
R- religion
E- education
S- sociocapital status
S- socioeconomic status

28
Q

What is maxwells dimensions of the quality of healthcare

A

Used to assess the quality of healthcare

3As and 3Es

A-acceptability
A-accessibility
A-appropriateness

E- effectiveness
E-efficiency
E- equity

29
Q

What is the donabedian framework of health service evaluation

A

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

30
Q

What is a need

A

The ability to benefit from an intervention

31
Q

What is a demand
What is a supply

A

Demand -What people ask for

Supply -What is provided

32
Q

4 types of need in health need assessment

A

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

33
Q

List from bottom to top mallows hierarchy of needs

A
  1. -physiological - e.g food and water
  2. -safety - e.g security of body/ employment
  3. -love/belonging - e.g friendship, sexual intimacy
  4. -esteem - e.g self esteem, confidence, respect of others
  5. -self actualisation - e.g morality, creativity, problem solving
34
Q

What is a egalitarian method of resource allocation

A

Provides all the care that is necessary and required to everyone

Advantage - equal for all

Disadvantages - economically restricted

35
Q

What is a maximising resource allocation method

A

Allocation Based solely on consequence

Advantage - people who need it most, most likely to benefit

Disadvantage - those with ‘less need’ receive nothing

36
Q

What is libertarian resource allocation

A

Each individual is responsible for own health

Advantage -onus on patient therefore may be more engaged

Disadvantage -not all diseases are self inflicted

37
Q

Definition of epidemiology

A

The study of the frequency, distribution and
determinants of diseases and health-related states in populations in order to prevent and control disease.

38
Q

What is the definition of incidence

A

Number of new cases in population in period of time

39
Q

Definition: prevalence

A

Number of existing cases in a population at a point in time

40
Q

Difference between absolute and relative risk

A

Absolute risk – gives a feel for actual numbers involved and has units

Relative risk – risk in one category relative to another with no units

41
Q

What is attributable risk

A

Attributable risk – rate of disease in the exposed that may be attributed to exposure

42
Q

Defintion for bias

A

a systemic deviation from the true estimation of the associated between exposure
and outcome (it is an example of a systematic error)

43
Q

What is selection bias

A

An error in Selection of study participants
Or Error Allocation of study participants to different study groups

E.g lost to follow up

44
Q

Information bias definition

A

Error in observer’s recall and reporting, participant, instrument wrongLy calibrated

45
Q

What is publication bias

A

Trials with negative results are less likely to be published

46
Q

What is length time bias

A

disease that progresses more slowly/ are benign are more likely to be picked up by screening which makes it appear that screening lengthens life

47
Q

What is lead time bias

A

Early identification doesn’t alter the outcome but appears to increase survival as the patient has the disease identified earlier than normal

48
Q

What is is the Bradford hill criteria (9)

A

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
49
Q

What is prevention paradox

A

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

50
Q

What is Wilson and junger criteria for screening

A
  1. The condition
    - an important condition
    - knowledge on the condition
  2. Screening programme
    - should be cost effective
    - ongoing not just one off
  3. 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

51
Q

Equation for positive predictive value

A

TP/ TP+FP
Proportion of people with positive test that actually have disease

52
Q

Equation for sensitivity

A

TP/TP+FN

proportion of people with the disease who are correctly idenitified by screening test

53
Q

Bolam rule

A

Would a doctor do the same

54
Q

Bolitho rule

A

Would that be reasonable

55
Q

What age can never consent to sex legally

A

Under 13s

56
Q

Fours dimensions of food insecurity

A

Availability/affordability

Access

Utilisation - can they prepare the food

Stability of the above three over time

57
Q

Defintion of food insecurity

A

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.

58
Q

What is malnutrition

A

deficiencies, excesses or imbalances in a person’s
intake of energy and/ or nutrient

59
Q

What is triple burden for malnutrition

A

Overweight
Underweight
Micronutrient deficiencies

60
Q

Benefits of breastfeeding

A

-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

61
Q

What is colostrum, fore milk and hind milk

A

Colostrum - 3 dy after birth
Foremilk beginning of a feed (watery)
Hindmilk end of a feed (> energy dense)

62
Q

Why do you not stop statins

A

associated with a 33% increased risk of admission for a cardiovascular event in 75-year-old primary prevention patients

63
Q

Problems of polypharmacy

A

•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

Phase 3a - Arun&Erin (15 decks)

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