HaDSoc Flashcards
What is high quality healthcare?
Safe, effective, timely, efficient and equitable
Explain what clinical governance means
A framework through which NHS organisations are accountable for continuously improving the quality and safeguarding high standards of care
Define equity
Everyone with the same need gets the same care
What evidence is there that care isn’t optimal?
There is variation
In terms of harm, define adverse effect and preventable
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
Explain the Swiss cheese model
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
What is the difference between an active failure and a latent condition?
Acts which lead to patient harm - wrong dose
Something which makes active failures more likely - poor training
What organisations and policies encourage quality in the NHS?
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
Explain how a systems based approach can promote better healthcare
Remove human factors such as: avoid reliance on memory, visible things, simplify, standardise, checklists, less vigilance needed
What are some types of quantitative research?
RCT, cohort, case control study
Secondary statistics - census or other national/regionally collected statistics
What are the pros and cons of quantitative research?
Good - describing, measuring, finding relationships and comparing
Bad - forced into inappropriate category, don’t get all info and can’t establish causality
What is qualitative research?
Make sense of phenomena such as why people don’t stop smoking or what it’s like to have arthritis
How can qualitative research be collected?
Observation/ethnography
Interviews
Focus groups
Documentary/media analysis
What is qualitative research good and bad for?
Good - understand perspectives, access non quantitative information and explain relationship
Bad - finding relationships and can lead to generalisations as small groups
What is evidence based practise?
Integrate individual clinical expertise with best external evidence from research
What are some practical and philosophical criticisms of evidence based practise?
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”
What are the difficulties of establishing based practise?
Unavailable research
Doctors don’t know about or use research
System doesn’t support innovation
Patient wants something else
What five factors in regards to diversity affect health?
Ethnicity, gender, age, disability and homeless
Why might ethnicity affect health?
Health related behaviours
Discrimination in services
Genetics
What are the 6 explanations for inequalities in health?
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
What are lay beliefs?
Beliefs constructed by people with no specialised knowledge to understand health and illness
What is health behaviour?
Activity undertaken to maintain health/prevent illness
What is illness behaviour?
Activity of ill person to define illness and seek solution
What is the illness iceberg?
Most symptoms never get to a doctor
What is the lay referral system?
Sick people contact other lay people prior to/instead of health professionals
How can lay beliefs affect patients behaviour?
Impact on health/illness behaviour and compliance
Deniers/distancers, pragmatists, acceptors
What are some determinants of disease?
Physical, social and economic environment, genetics and behaviour
What are the three types of prevention in regards to health promotion?
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)
What are the 5 types of health prevention strategies?
Medical/preventive Behaviour Educational Empowerment Social change
What are the dilemmas for health promotion?
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
What are some difficulties with evaluating?
Design of intervention
Time lag
Confounders
Cost
What “work” has to be done if you have a chronic illness?
Illness work - symptom management
Everyday life work
Emotional work
Identity work
What are the four types of stigma?
Discreditable - not seen
Discredited - visible/known
Enacted - experience prejudice
Felt - fear of enacted
Why do we need to measure patient health?
Indicate need
Target resources
Assess effectiveness
Evaluate quality
Define screening
Detect a patient who probably has an undiagnosed condition before they present with symptoms
What are the four criteria for implementing a screening
Disease/condition
Test
Treatment
Programme
Explain what factors a disease/condition should have for screening to be implemented
Important disease (prevalent)
Well understood
Early detectable stage
Primary prevention has been considered first
Explain what criteria a screening test must have for it to be implemented
Simple
Safe
Precise/valid
Accepted by the public
What criteria must a treatment have for screening to be implemented?
Effective
Advantageous to treat early
What criteria must the programme have for screening to be implemented?
Benefit outweighs the harm
More effective than other options such as improving treatment
What erroneous results may a screening test produce? Why are they bad?
False positives - don’t actually have the disease
Unnecessary stress and costs
False negatives - do actually have the disease
Inappropriate reassurance
Define sensitivity. What is the formula for it?
Probability a case of the disease will test positive when screened
a/a+c
Define specificity and give the formula for it
Probability a non case will test negatively when screened
b/b+d
What is the positive predictive value and what is the formula?
Probability a positive test has the disease
a/a+b
What is negative predictive value and the formula to calculate it?
Probability a negative test doesn’t have the disease
d/c+d
What are the advantages of screening?
Early detection improves outcome
True negative reassures patient
What are the disadvantages of screening?
False positives are invasive
False negatives falsely reassure and people don’t get the tests they need
Money is taken from treatment
Explain lead time bias and length time bias
Appear to survive longer but only because it was detected earlier
Detects slower and less threatening cases
Why has the cost of healthcare risen so much?
Ageing population
New technology - expensive and available to more patients
Treatments prolong lives but don’t cure
What is the difference between explicit and implicit rationing?
Explicit is based on rules. Implicit is based on an individual’s judgement and isn’t public knowledge
What is the opportunity cost?
The loss of other uses of that money
What is cost minimisation/effectiveness/benefit/utility analysis?
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
What are the disadvantages of QALYs?
Whether they value the right things
Distribute cording to benefit, not need
Trials may be incorrect
Why use QALYs?
Measure cost effectiveness against life and quality gained
