GP Public healthy things Flashcards
What is a Health Needs assessment (HNA)?
Health needs assessment is a systematic method of reviewing health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities.
Where may a Health needs assessment be carried out?
- A population i.e. a GP practice
- A condition i.e. COPD
- An intervention i.e. angioplasty
What approaches to Health Needs assessments are there?
- Epidemiological
- Comparative
- Corporate
What is the epidemiological approach to HNA?
Much like a service evaluation:
- define problem -size of problem
- services available (Tx/prevention)
- evidence for Tx
- models of care (outcomes & QI)
- recommendations (met/unmet needs)
What is the comparative approach to HNA?
- Compares the services received by a population with another (geographical or demographic)
- could be health status, provision, utilisation, or health outcomes
What is the corporate approach to HNA?
corporate approach takes into account what political, press, patients, professionals, providers, commissioners and ‘opinion leaders’ have to say.
How does need differ from demand?
- Need is the ability a person/group/society has to benefit from an intervention
- Demand is what people ask for irrespective of need.
What are drawbacks to the epidemiological approach to HNA?
- data may not be available
- data may be of variable quality
- Evidence base may be inadequate
- doesn’t consider felt needs
What are drawbacks to the comparative approach to HNA?
- data may not be available
- data may be of variable quality
- may be difficult to find a comparative group
What are drawbacks to the corporate approach to HNA?
- difficult to distinguish need from demand
- groups may have vested interest
- Bias results of assessments driven by political agendas
What is health psychology?
The study of how psychological factors play a role in the cause, progression and consequences of health and illness.
3 main types of health behaviours
- Health behaviour
- illness behaviour
- Sick role behaviour
What are health behaviours?
behaviours that:
- prevent disease (exercise)
- seek remedy (seeing Dr)
- aim at getting well (resting/taking drugs)
What does NICE gotta say about behaviour changes?
- Work with your patient’s priorities
- Aim for easy changes over time
- Set and record goals
- Plan explicit coping strategies
- Review progress regularly (this really matters)
- Remember the public health impact of lots of you making small differences to individuals
What are some determinants of health?
- Age, sex & other genetic factors
- personal lifestyle factors
- social & community factors
- general culutural, socio-economic and environmental factors
What’s the difference between equity and equality?
Equity = what’s right and just
Equality = everyone get’s an equal share
Explain the difference between secondary and tertiary prevention
secondary is concerned with detecting a disease early to prevent disease progression.
Teritatry is concerned with trying to improve quality of life and reduce symtpoms of disease you already have
Explain the difference between horizontal and vertical health equity
Horizontal = equal Tx for equal need - All health needs are treated the same - i.e. all those with pneumonia have the same access to healthcare
Vertical = unequal Tx for unequal need - those with higher need have higher access to Tx - those in a deprived area need more expenditure than those in affluent area.
What are the 3 broad domains of Public health?
- health improvement
- health protection
- health care
Define the health improvement role of PHE.
societal interventions not necessarily through health services aimed at reducing health inequalities, promoting health and preventing disease
Define the health protection role of PHE.
Preventing the spread of infectious disease and spread of chemicals hazordous to health
Define the health care role of PHE.
concerned with the organising and delivering safe & high quality services - clinical effectiveness, efficacy, audit & evalluation
What are the health consequences of loneliness?
earlier death
more risk taking
harder to self regulate
physical changes which can bring on poor health
equivalent of 15 cigarettes a day
bigger problem than obesity
What’s the definition of social exclusion?
the dynamic process of being shit out, fully or partially, from any of the social, economical, political or cultural parts of society.
What are the 5 domains of social exclusion?
Material resources
civic activities
Basic Services
Neighbourhood
Social Relationships
What are some causes of social exclusion?
Poor health, Sensory impairment, poverty, fear of crime, transport issues, problems of the roads, discrimination (internalised - sexuality, gender, ethnicity, belief)
What are the 5 parts of Maslow’s heirarchy of needs?
Physiological need
Safety need
love/belonging need
Esteem needs
Self-actualisation need
What are barriers to healthcare for homeless people?
- accessability - appointment times, location of procedure, percieved or actual discrimination
- Lack of integration between primary care and other agencies
- Other things to think about - people don’t tend to prioritise health when there are more immediate survival issues
- people may not know where to find help
What are some barriers to health care for Gypsies?
- Reluctance of GPs to register Gypsies and visit sites
- poor reading and writing skills
- communication difficulties
- Too few permanent or transient sites
- Mistrust of professionals
- Lack of choice
What is the definition of an asyum seeker?
A person who has made an applicatio for refugee status
What is the definition of a Refugee?
A person granted asylum and refugee status. Usually means to to remain for 5 years then reapply.
What is the definition of Humanitarian Protection?
Fauled to demonstrate claim for asylum but face serious threat to life if returned. Usually 3 years then reapply.
What’s are population and high risk prevention approaches?
Population = A preventive measure aimed at shifting the distribution curve of risk factors for a certain disease in a particular population to the left (reduce dietary salt with legislation decreases the population risk of HTN)
High risk = seeks to identify individuals that pass a chosen cut-off for a risk factor and treat them (screening BP and treating those higher than 140/90)
What are the beliefs an individual needs to hold in order to change according to the health belief model?
Belief’s that:
- they’re susceptible to a condition
- the condition will have serious consequences
- taking action reduces susceptibility
- benefits of takign action outweigh the costs
What are some critiques of the health belief model?
- doesn’t take into account the effect of emotions on behaviour
- doesn’t differentiate between first time and repeat behaviour
- cues to action often missing
- alternative factors may predict health behaviour - outcome expectancy, self efficacy
What is the prevention paradox?
A preventative measure which brings much benefit to the population often offers little to each participaitng individual
According to the theory of planned behaviour, What is the best predictor of changing in health behaviours?
Intention - determined by:
- attitude to behaviour
- preceieved social pressure
- percieved behavioural control
A PSP and a PBC are all about intentions ma G. = behaviour change
(the pencil faceway)
One down side of the planned behaviour model is that 47% of people don’t act on their intentions. What psychologically can help bridge that gap?
- precieved control
- anticipated regret
- preparartory actions
- implementation intentions
- relevance to self
What are some critiques to the theory of planned behaviour model?
- lack of temporal element
- lack of direction or causality
- doesn’t take into account emotions that may disrupt rational thinking
- doesn’t explain how attitudes, intentions and percieved behavioural control interact
- habits (procedural rationallity) - bypass cognitive deliberation that undermine a key assumption of the model
- assumes that attudes, subjective norms and percieved behavioural change can be measured
Summarise the theory of planned behaviour.
- rational choice model
- attitudes, subjective norms and percieved behavioural control are determinants of intentions
- TPB can predict intentions for a wide range of health behaviours
- useful for predicting intentions but not as a succesful for actual behaviours
What are the 5 stages of change in the trantheoretical model of changing health behaviours?
- precontemplation
- contemplation
- preparation
- action
- maintainence
What are the advantages of the transtheoretical model of behavioural change?
- Acknowledges individual stages of readiness
- accounts for relapse
- has a temporal element
what are some critiques of the transtheoretical model?
- not all people move through every stage
- change might operate on a continium instead of discrete changes
- doesn’t take into account values, habits, culture, social and economic factors
Give as many criteria for a screening test as you can remember, please and thank you. (there’s 12)
Condition:
- important health problem
- recognizable latent pahse
- known natural Hx + epidemiology
Test:
- suitable - sensitive, simple, inexpensive
- acceptable - clinically, socially, ethically
- suitably defined and agreed cut off value
- Benefit > psychological + physical harm
- agreed policy on Tx following +ve screen
Treatment:
- Effective treatment
- agreed policy on whom to treat
Cost Consideration:
- cost of screen < cost of possible expenditure on medical is not found early
- available facilities for Dx + Tx
Important – the condition should be an important one
Acceptable treatment for the disease
Treatment and diagnostic facilities should be available
Recognisable at an early stage of symptoms
Opinions on who to treat as patients must be agreed
Guaranteed safety e.g. low radiation exposure
Examination must be acceptable by the patient
Natural history of the disease must be known
Inexpensive test
Continuous screening i.e. not a one-off
What is the widely used health service evaluation model?
Donabedian model:
Structure
Process (output)
Outcome
What happens in the strucutre phase of the Donabedian model of health service evaluation?
Work out what there is:
- number of ICU beds per 1000
- number of vascular surgeons per 1000
- location swhere screening is provided
What happens in the Process phase of the Donabedian model of health service evaluation?
What is done:
- number of patients seen in A&E
- the process which pts go through in A&E - where do they go first, who triages, how is priority assessed.
- no. of operations performed
OUTCOME MAY BE INCLUDED IN THIS PHASE
What happens in the Outcome phase of the Donabedian model of health service evaluation?
This may be included in process phase
-classifies health outcomes:
~mortality
~morbidity
~QoL/PROMs
~patient satisfaction
5Ds - death, disease, disability, discomfort, dissatisfacation
What are some issues with health ouctomes?
- link between service provided and outcome may be difficult to establish
- tim lag between service provided and outcome may be long (healthy eating in childhood and T2DM in middle age)
- Large sample sizes needed to detect stat. sig. effects
- data may not be available
- there may be issues with data quality - CART - Completeness, Accuracy, Relevance, Timeliness
What is Maxwell’s dimension of Quality? What are it’s subheadings?
-Method of assessing quality of health care interventions
3Es and 3As
Effectiveness - does it have the desired effect?
Efficiency - is the output maximised for the input?
Equity - Are patients being treated fairly?
Acceptability - how acceptable is the service to the people being offered it?
Accessibility - Is the service provided? geographically; cost; information available; waiting times.
Appropriateness - is the right treatment being given to the right peopleat the right time?
What two methods can be used for Service evaluations? Breifly describe them both.
Qualitative - observation, interviews, focus groups, reviews of documents
Quantative - routinely collected data, reviews of records, surveys, other epidemilogical methodologies.
