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ESA 4 Steven > HaDSoc > Flashcards

HaDSoc Flashcards

0
Q

What is high quality healthcare?

A

Safe, effective, timely, efficient and equitable

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1
Q

Explain what clinical governance means

A

A framework through which NHS organisations are accountable for continuously improving the quality and safeguarding high standards of care

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2
Q

Define equity

A

Everyone with the same need gets the same care

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3
Q

What evidence is there that care isn’t optimal?

A

There is variation

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4
Q

In terms of harm, define adverse effect and preventable

A

Injury caused by medical management not the underlying disease - first time giving a drug and the patient reacts to it

Adverse effect which could be prevented given current medical knowledge - wrong operation/dose

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5
Q

Explain the Swiss cheese model

A

There are successive layers of defences/barriers/safeguards which have holes in due t active failures or latent conditions. If all the holes “line up” then harm may occur

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6
Q

What is the difference between an active failure and a latent condition?

A

Acts which lead to patient harm - wrong dose

Something which makes active failures more likely - poor training

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7
Q

What organisations and policies encourage quality in the NHS?

A

NHS outcomes framework - outcome goals linked to finance
NICE quality standards - markers of high quality, clinical, cost effective care
Clinical commissioning groups, commissioning outcomes framework, quality and outcomes framework, quality accounts, care quality commission, audit

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8
Q

Explain how a systems based approach can promote better healthcare

A

Remove human factors such as: avoid reliance on memory, visible things, simplify, standardise, checklists, less vigilance needed

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9
Q

What are some types of quantitative research?

A

RCT, cohort, case control study

Secondary statistics - census or other national/regionally collected statistics

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10
Q

What are the pros and cons of quantitative research?

A

Good - describing, measuring, finding relationships and comparing

Bad - forced into inappropriate category, don’t get all info and can’t establish causality

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11
Q

What is qualitative research?

A

Make sense of phenomena such as why people don’t stop smoking or what it’s like to have arthritis

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12
Q

How can qualitative research be collected?

A

Observation/ethnography
Interviews
Focus groups
Documentary/media analysis

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13
Q

What is qualitative research good and bad for?

A

Good - understand perspectives, access non quantitative information and explain relationship

Bad - finding relationships and can lead to generalisations as small groups

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14
Q

What is evidence based practise?

A

Integrate individual clinical expertise with best external evidence from research

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15
Q

What are some practical and philosophical criticisms of evidence based practise?

A

Can’t maintain all systemic reviews and can’t always use good RCTs

May not apply to individual patient, legitimise rationing leading to distrust, doctors become “rule followers”

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16
Q

What are the difficulties of establishing based practise?

A

Unavailable research
Doctors don’t know about or use research
System doesn’t support innovation
Patient wants something else

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17
Q

What five factors in regards to diversity affect health?

A

Ethnicity, gender, age, disability and homeless

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18
Q

Why might ethnicity affect health?

A

Health related behaviours
Discrimination in services
Genetics

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19
Q

What are the 6 explanations for inequalities in health?

A

Artefact-data collection
Social selection-sick people become more deprived
Behavioural/cultural-due to people’s choices based on background
Materialist-lack of resources or increased exposure to hazards
Psychosocial-deprived have more stressors
Income distribution-more inequality means more threat so more stress

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20
Q

What are lay beliefs?

A

Beliefs constructed by people with no specialised knowledge to understand health and illness

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21
Q

What is health behaviour?

A

Activity undertaken to maintain health/prevent illness

22
Q

What is illness behaviour?

A

Activity of ill person to define illness and seek solution

23
Q

What is the illness iceberg?

A

Most symptoms never get to a doctor

24
Q

What is the lay referral system?

A

Sick people contact other lay people prior to/instead of health professionals

25
Q

How can lay beliefs affect patients behaviour?

A

Impact on health/illness behaviour and compliance

Deniers/distancers, pragmatists, acceptors

26
Q

What are some determinants of disease?

A

Physical, social and economic environment, genetics and behaviour

27
Q

What are the three types of prevention in regards to health promotion?

A

Primary - prevent onset (immunise, prevent contact, reduce risk factors)
Secondary - detect and treat disease early (screening, monitoring and treating)
Tertiary - minimise effects (steroids and renal transplants)

28
Q

What are the 5 types of health prevention strategies?

A 
Medical/preventive
Behaviour
Educational
Empowerment
Social change
29
Q

What are the dilemmas for health promotion?

A

Interfere in people’s lives
Victim blaming - play down environment
Fallacy of empowerment - knowledge not same as power
Reinforce negative stereotypes
Unequal distribution if responsibility
Prevention paradox - may affect population, not individual

30
Q

What are some difficulties with evaluating?

A

Design of intervention
Time lag
Confounders
Cost

31
Q

What “work” has to be done if you have a chronic illness?

A

Illness work - symptom management
Everyday life work
Emotional work
Identity work

32
Q

What are the four types of stigma?

A

Discreditable - not seen
Discredited - visible/known
Enacted - experience prejudice
Felt - fear of enacted

33
Q

Why do we need to measure patient health?

A

Indicate need
Target resources
Assess effectiveness
Evaluate quality

34
Q

Define screening

A

Detect a patient who probably has an undiagnosed condition before they present with symptoms

35
Q

What are the four criteria for implementing a screening

A

Disease/condition
Test
Treatment
Programme

36
Q

Explain what factors a disease/condition should have for screening to be implemented

A

Important disease (prevalent)
Well understood
Early detectable stage
Primary prevention has been considered first

37
Q

Explain what criteria a screening test must have for it to be implemented

A

Simple
Safe
Precise/valid
Accepted by the public

38
Q

What criteria must a treatment have for screening to be implemented?

A

Effective

Advantageous to treat early

39
Q

What criteria must the programme have for screening to be implemented?

A

Benefit outweighs the harm

More effective than other options such as improving treatment

40
Q

What erroneous results may a screening test produce? Why are they bad?

A

False positives - don’t actually have the disease
Unnecessary stress and costs

False negatives - do actually have the disease
Inappropriate reassurance

41
Q

Define sensitivity. What is the formula for it?

A

Probability a case of the disease will test positive when screened

a/a+c

42
Q

Define specificity and give the formula for it

A

Probability a non case will test negatively when screened

b/b+d

43
Q

What is the positive predictive value and what is the formula?

A

Probability a positive test has the disease

a/a+b

44
Q

What is negative predictive value and the formula to calculate it?

A

Probability a negative test doesn’t have the disease

d/c+d

45
Q

What are the advantages of screening?

A

Early detection improves outcome

True negative reassures patient

46
Q

What are the disadvantages of screening?

A

False positives are invasive
False negatives falsely reassure and people don’t get the tests they need
Money is taken from treatment

47
Q

Explain lead time bias and length time bias

A

Appear to survive longer but only because it was detected earlier

Detects slower and less threatening cases

48
Q

Why has the cost of healthcare risen so much?

A

Ageing population
New technology - expensive and available to more patients
Treatments prolong lives but don’t cure

49
Q

What is the difference between explicit and implicit rationing?

A

Explicit is based on rules. Implicit is based on an individual’s judgement and isn’t public knowledge

50
Q

What is the opportunity cost?

A

The loss of other uses of that money

51
Q

What is cost minimisation/effectiveness/benefit/utility analysis?

A

Minimisation - output is the same so whatever’s cheapest
Effectiveness - similar outcomes. Cheapest per unit
Benefit - input and output given monetary values and compared
Utility - cost per QALY

52
Q

What are the disadvantages of QALYs?

A

Whether they value the right things
Distribute cording to benefit, not need
Trials may be incorrect

53
Q

Why use QALYs?

A

Measure cost effectiveness against life and quality gained

ESA 4 Steven (3 decks)

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