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PPE > HaDSoc > Flashcards

HaDSoc Flashcards

1
Q

Qualities of good healthcare?

A

SETEE

safe, effective, timely, efficient, equitable

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2
Q

Why do pt safety problems occur? how to fix

A

human error or behaviour. Fix with checklists, avoid reliance on vigilance and memory, simplify and standardise processes and procedures

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3
Q

what policies encourage quality in the NHS

A

payment for high standard, clinical governance

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4
Q

what are the NHS 5 domains of national outcomes

A

PHEET

Prevent premature death, Help pt recovery, Ensure QoL for LTCs, Ensure pt has good exps, Treat in safe environment

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5
Q

What is purpose of the nhs national outcomes framewokr

A

make nhs accountable and increase quality

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6
Q

what mechanisms can be used to improve quality of nhs care

A

standard setting, clinical commissioning, financial incentives e.g. QoF, disclosure, regulation, clinical audit, professional regulation

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7
Q

what is cquin?

A

safety and pt exp = ££

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8
Q

benefits of a systematic review?

A

decrease time to guidelines, provides up to date conclusion for docs, identify gaps in research

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9
Q

pros and cons of quantitative research?

A

pros - greater no of subjects, comparable between studies, reliable and analysable
cons - doestn reflect how ppl really feel, limited results, forces ppl into categories

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10
Q

types of qualitative research

A

focus groups, interviews, ethnography and observe

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11
Q

what are focus groups good and bad for

A

good for participation but not good for sensitive topics and individual views

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12
Q

pros and cons of qualitative research

A

pros - explains relationships betwwen variables, info not revealed in quantitative
cons - not generalisable, labour intensive

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13
Q

what is evidence based practice?

A

integrating clinical expertise with best available evidence

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14
Q

critcism of evidence based practice? practical and philosophical

A

practical - RCT not always ethical, expensive, requires pharma companies to be honest
philosophical - rule followers, population guide may not apply to individual, professional autonomy

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15
Q

difficulties in getting evidence into practice

A

funding, doctors not aware of evidence or dont want to use it

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16
Q

diversity in health according to black report?

A

income diversity, artefact, behavioural cultural, social selection

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17
Q

define inequality and inequity

A

inequality - not equal

inequity - unfair and avoidable inequality

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18
Q

where do lay beliefs come from

A

social, cultural and personal knowledge

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19
Q

what is illness behaviour

A

activity done in ill health to define illness and seek solution

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20
Q

how are lay referrals useful

A

explains why and when pts present and the services they use

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21
Q

what are determinants of illness behaviour

A

culture, threshold for tolerance, visibility of symptoms, lay referral, disruption of life

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22
Q

purpose of health promotion

A

enable people to improve control over their own health

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23
Q

critiques of public health

A

sociological - surveillance critiques, consumption critiques (lifestyle choices are tied to identity)

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24
Q

what aproaches can be taken to promote health

A

MBEES

medical and preventative, Behavioural, Education, Empowerment, Social change

25
Q

what is primry, secondary, and tertiary prevention. give egs where relevant

A

primary - imunisation, decrease risk factors, decrease risk of health related behaviour
secondary - screening, treat BP
tertiary - minimise effects of disease

26
Q

dilemmas of health promotion?

A

ethics of interfering, victim blaming, prevention paradox, reinforces negative stereotypes

27
Q

why evaluate health promotion programmes

A

accountability, ethical obligation (ensure no harm), evidence based interventions

28
Q

how do you evaluate health promotion programmes? process, impact? Problems with evaluating outcomes?

A

process - quantitative
impact - assess immediate effects
outcomes - subject to delay, expensive, hard to measure confounders

29
Q

what is illness narratives

A

accounts of experiences of LTCs

30
Q

what is involved in chronic ilness work? explain

A

biographical work (loss of self and grief for former life), illness work, identity work, emotional work, everday life work

31
Q

what are the dilemmas of identity work

A

scrutinise others reactions, dependence on others, relationships harder to maintain, loss of social life

32
Q

define stigma

A

negatively defined thing that confers deviant status

33
Q

what is narrative reconstruction

A

identity reconstructed in ways that explain their illnes

34
Q

define impairment, disability, and handicap

A

impairment - abnormal function + structure of body
disability - loss of ability to participate
handicap - broader social and psych impacts of impairments e.g. cant get a job

35
Q

tools for measured HRQoL

A

morbidities, mortaility, patient based outcome

36
Q

what are patient based outcomes useful for?

A

clinical audits, measure service quality, assess benefits of treatment

37
Q

what are the components of HRQoL

A

physical and cognitive function, symptoms, satisfaction

38
Q

give eg of generic HRQoL

A

SF-36, EQ-5D

39
Q

pros and cons of generic HRQoL

A

pros - broad range, assess health of whole population

cons - 2 general, less acceptable to pts

40
Q

what is a specific HRQoL good for? pros and cons

A

good for disease, site specific, dimension specific e.g. pain
pros - sensitive to change, relevant
cons - must have disease, limited comparison

41
Q

what are the 3 ways of detecting a disease

A

opportunistic, screening, spontaneous

42
Q

what factors are needed to have a screening programme

A

disease - must be detectable, treatable, important
test - precise and valid, acceptable, cheap
treatment - early treatment must be useful and exist

43
Q

define sensitivity, specificity, ppv, npv

A

sensitivity - if ur +ve, chances test says +
specificity - if ur -ve, chances test says -ve
ppv - if test is +ve, chances u r +
npv - if test is -ve, chances u r -ve

44
Q

what can false +ves and -ves lead to?

A

false + - anxiety, stress

false -ve - false assurance, delay diagnosis

45
Q

cons of screening?

A

surveillance critique, victim blaming, lag time bias, length time bias, selection bias, false + and -ves

46
Q

what is the health and social care act 2012

A

creates ccgs and gives GPs power to make commissioning decisions

47
Q

what is explicit rationing? pros and cons

A

defined rules and systematic allocartion
pros - fair, transparent, open to debate
cons - pt distress, doesnt account for individual need, complex

48
Q

implicit rationing pros and cons?

A

pros - sensitive to complexity of pt

cons - abuse, social deservingness, inequality

49
Q

How does the NHS ration healthcare?

A 
5Ds
Deterrent (prescriptions), delay, deflection (referred to different institution), dilution (service offered but quality declines as cuts made), denial
50
Q

what are healthcare resource groups?

A

payment by results. treatments put into a group that is similar and uses similar resources

51
Q

define technical and allocative efficiency

A

technical - most efficient way to meet a need

allocative - choosing between many needs

52
Q

what is cost minimilisation, utility, effectiveness, benefit analysis?

A

minimilisation - choose cheapest of 2 treatments with similar outcomes
effectiveness - cost per health unit outcome e.g. cost to reduce 10 mmHg of BP
benefit - incomes and outcomes in £s
utility - focussed on quality of health outcome produced e.g. QALY

53
Q

what is incremental cost effectiveness ratio?

A

cost per QALY

54
Q

criticisms of QALY?

A

problems with calculation, resource not distributed according to need, may not embrace all dimensions of benefit

55
Q

problems with complaints in nhs

A

no feedback, lack of confidence in a resolution, complex system

56
Q

how are patients viewed investigated directly and indirectly

A

indirectly - ombudsman, pt complaints

directly - qualitative and quantitative

57
Q

what can cause pt dissatisfaction

A

poor interpersonal skills, concerns not addressed

58
Q

what are 4 approaches to pt doc relationship? criticise where necessary

A

functionalism - powerful vs vulnerable. Crit - some pts cant get better, assumes passive role of pt and beneficence of medicine
conflict - Crit - pts can exert control via non adherence, inaccurate
interpretism - emphasises meaning given to social situation
patient-centred partnership

59
Q

what are the 2 types of regulation of doctors and criticisms?

A

self regulation - self serving, whistleblowing discouraged, fialure of regulation
managerial - less clinical autonomy

PPE (18 decks)

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