HaDSoc Flashcards
Qualities of good healthcare?
SETEE
safe, effective, timely, efficient, equitable
Why do pt safety problems occur? how to fix
human error or behaviour. Fix with checklists, avoid reliance on vigilance and memory, simplify and standardise processes and procedures
what policies encourage quality in the NHS
payment for high standard, clinical governance
what are the NHS 5 domains of national outcomes
PHEET
Prevent premature death, Help pt recovery, Ensure QoL for LTCs, Ensure pt has good exps, Treat in safe environment
What is purpose of the nhs national outcomes framewokr
make nhs accountable and increase quality
what mechanisms can be used to improve quality of nhs care
standard setting, clinical commissioning, financial incentives e.g. QoF, disclosure, regulation, clinical audit, professional regulation
what is cquin?
safety and pt exp = ££
benefits of a systematic review?
decrease time to guidelines, provides up to date conclusion for docs, identify gaps in research
pros and cons of quantitative research?
pros - greater no of subjects, comparable between studies, reliable and analysable
cons - doestn reflect how ppl really feel, limited results, forces ppl into categories
types of qualitative research
focus groups, interviews, ethnography and observe
what are focus groups good and bad for
good for participation but not good for sensitive topics and individual views
pros and cons of qualitative research
pros - explains relationships betwwen variables, info not revealed in quantitative
cons - not generalisable, labour intensive
what is evidence based practice?
integrating clinical expertise with best available evidence
critcism of evidence based practice? practical and philosophical
practical - RCT not always ethical, expensive, requires pharma companies to be honest
philosophical - rule followers, population guide may not apply to individual, professional autonomy
difficulties in getting evidence into practice
funding, doctors not aware of evidence or dont want to use it
diversity in health according to black report?
income diversity, artefact, behavioural cultural, social selection
define inequality and inequity
inequality - not equal
inequity - unfair and avoidable inequality
where do lay beliefs come from
social, cultural and personal knowledge
what is illness behaviour
activity done in ill health to define illness and seek solution
how are lay referrals useful
explains why and when pts present and the services they use
what are determinants of illness behaviour
culture, threshold for tolerance, visibility of symptoms, lay referral, disruption of life
purpose of health promotion
enable people to improve control over their own health
critiques of public health
sociological - surveillance critiques, consumption critiques (lifestyle choices are tied to identity)
what aproaches can be taken to promote health
MBEES
medical and preventative, Behavioural, Education, Empowerment, Social change
what is primry, secondary, and tertiary prevention. give egs where relevant
primary - imunisation, decrease risk factors, decrease risk of health related behaviour
secondary - screening, treat BP
tertiary - minimise effects of disease
dilemmas of health promotion?
ethics of interfering, victim blaming, prevention paradox, reinforces negative stereotypes
why evaluate health promotion programmes
accountability, ethical obligation (ensure no harm), evidence based interventions
how do you evaluate health promotion programmes? process, impact? Problems with evaluating outcomes?
process - quantitative
impact - assess immediate effects
outcomes - subject to delay, expensive, hard to measure confounders
what is illness narratives
accounts of experiences of LTCs
what is involved in chronic ilness work? explain
biographical work (loss of self and grief for former life), illness work, identity work, emotional work, everday life work
what are the dilemmas of identity work
scrutinise others reactions, dependence on others, relationships harder to maintain, loss of social life
define stigma
negatively defined thing that confers deviant status
what is narrative reconstruction
identity reconstructed in ways that explain their illnes
define impairment, disability, and handicap
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
tools for measured HRQoL
morbidities, mortaility, patient based outcome
what are patient based outcomes useful for?
clinical audits, measure service quality, assess benefits of treatment
what are the components of HRQoL
physical and cognitive function, symptoms, satisfaction
give eg of generic HRQoL
SF-36, EQ-5D
pros and cons of generic HRQoL
pros - broad range, assess health of whole population
cons - 2 general, less acceptable to pts
what is a specific HRQoL good for? pros and cons
good for disease, site specific, dimension specific e.g. pain
pros - sensitive to change, relevant
cons - must have disease, limited comparison
what are the 3 ways of detecting a disease
opportunistic, screening, spontaneous
what factors are needed to have a screening programme
disease - must be detectable, treatable, important
test - precise and valid, acceptable, cheap
treatment - early treatment must be useful and exist
define sensitivity, specificity, ppv, npv
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
what can false +ves and -ves lead to?
false + - anxiety, stress
false -ve - false assurance, delay diagnosis
cons of screening?
surveillance critique, victim blaming, lag time bias, length time bias, selection bias, false + and -ves
what is the health and social care act 2012
creates ccgs and gives GPs power to make commissioning decisions
what is explicit rationing? pros and cons
defined rules and systematic allocartion
pros - fair, transparent, open to debate
cons - pt distress, doesnt account for individual need, complex
implicit rationing pros and cons?
pros - sensitive to complexity of pt
cons - abuse, social deservingness, inequality
How does the NHS ration healthcare?
5Ds Deterrent (prescriptions), delay, deflection (referred to different institution), dilution (service offered but quality declines as cuts made), denial
what are healthcare resource groups?
payment by results. treatments put into a group that is similar and uses similar resources
define technical and allocative efficiency
technical - most efficient way to meet a need
allocative - choosing between many needs
what is cost minimilisation, utility, effectiveness, benefit analysis?
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
what is incremental cost effectiveness ratio?
cost per QALY
criticisms of QALY?
problems with calculation, resource not distributed according to need, may not embrace all dimensions of benefit
problems with complaints in nhs
no feedback, lack of confidence in a resolution, complex system
how are patients viewed investigated directly and indirectly
indirectly - ombudsman, pt complaints
directly - qualitative and quantitative
what can cause pt dissatisfaction
poor interpersonal skills, concerns not addressed
what are 4 approaches to pt doc relationship? criticise where necessary
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
what are the 2 types of regulation of doctors and criticisms?
self regulation - self serving, whistleblowing discouraged, fialure of regulation
managerial - less clinical autonomy
