HaDSoc Flashcards
What is the function of the national tariff?
Incentivising efficiency and rewarding the best practice
What can the CQC do if a trust is not up to standards?
Can impose conditions of registration, issue warning notices, fines, prosecution, restriction on activity and close the trust
What are the components of a clinical audit?
Setting standards, measuring current practice, comparing results with standards (against the criteria), changing practice and improving practice
What is quality improvement in the healthcare setting?
Systematic efforts to make changes that lead to better patient experiences and outcomes as well as system performance improvements and professional development
Define clinical governance
Framework through which the NHS trusts are required to continuously improve quality of care. NHS trusts therefore have a legal duty to put systems in place to monitor and ensure quality care.
What was Cochrane’s role in the rise of evidence-based medicine?
He criticised the medical profession for failing to incorporate research into their practice. He called for a register of all randomised control trials.
What was Iain Chalmers role in the development of evidence based medicine?
Produced a register of all RCTs in obs and gynae and generated systematic reviews and meta-analyses of this data. This became the first Cochrane Centre.
What is evidence based practice?
Integration of individual clinical expertise with the best available external clinical evidence from systematic reviews.
What is the function of CQUIN?
CQUIN (commissioning for quality innovation) is a financial incentive. 1.5% of a trusts income depends on achieving measurable goals in three areas: safety, effectiveness and patient experience
Why are systematic reviews important?
Quality of the research is variable, helps address clinical uncertainty, can highlight gaps in research or poor quality research, offers quality control, offer generalisable and up to date conclusions, saves times for clinicians, help prevent biased views and are easily convertible into guidelines and recommendations
State some practical criticisms of evidence based practice
Hard to create and maintain systematic reviews across all specialities, expenses, RCTs aren’t always feasible, choice of outcomes are often biochemical thus limiting which interventions are trialled and funded and it also requires good faith in the pharmaceutical companies
State some philosophical criticisms of evidence based medicine
Doesn’t align with most doctors’ way of thinking, population level interventions might not be suited to individual problems, EBM could create unbreakable rules and thus unreflective rule followers, could undermine the patient-doctor relationship and removes professional autonomy and responsibility
State some of the problems in getting evidence based medicine into practice
Doctors being unaware of the evidence, doctors knowing about the evidence but not following it, organisational systems not being able to support innovative procedures, commissioning decisions, resource allocation issues and reluctance to fund things if the evidence is poor
Describe quantitative methods of research
Collection of numerical data. Begins with an idea/hypothesis and draws conclusions through deduction. It is repeatable and reliable.
Briefly state some advantages and disadvantages of quantitative research
Good at describing, measuring, finding relationships between things and therefore allowing comparisons to be made. Bad because it can force people into categories, doesn’t allow freedom of expression, may not access all the important information and might not be effective in establishing causality
Give examples of quantitative research designs
Experimental study designs (e.g. RCTs), cohort studies, case-control studies, cross-sectional surveys, secondary analysis of data from other sources and questionnaires.
Describe qualitative research
Aims to make sense of phenomena in terms of meanings people bring to them. Emphasises meaning, experience and views of the respondents. Analysis emphasises the researchers interpretations.
State some advantages and disadvantages of qualitative research designs
Can provide insight to behaviour, helps understanding perspectives and allows access to information not revealed in quantitative methods, explains relationships between variables. A major disadvantage is that they are not generalisable. They are also prone to bias and therefore make it hard to implement changes. It is also a labour intensive process
State some qualitative research methods
Observation and ethnography, interviews, focus groups and documentary/media style analysis
What is the function of the critical appraisal skills programme?
CASP offers a tool to appraise qualitative research; offers critical appraisal skills training, workshops and tools which help in reading and checking health resources for trustworthiness, results and relevance
Distinguish between inequality and inequity
Inequality - when things are different either in a group or between groups. Inequity - inequalities within a group of people that’s unfair and avoidable.
Describe the relationship between health and socioeconomic position
Generally poorer socioeconomic groups have poorer health. Can be measured by the NS-SEC which is calculated from census data.
What are the domains in the Index of Multiple Deprivation?
Income, employment, health and disability, education skills and training, barriers to housing and services, living environment and crime
Describe the relationship between health and ethnicity
Different ethnicities are at risk of different diseases. Also racial bias can play a role in treatment
Describe the relationship between health and gender
Men have a higher mortality rate, more suicides and more violent deaths. Women have a higher life expectancy, higher reported poor mental health and higher rates of disabilities and long standing illness. Gender is prescribed by social factors whereas biological sex is defined by hormonal and reproductive differences
Explain the artefact explanation about inequality and inequity within healthcare services
Health inequalities are evident due to the way stats are collected. Mostly discredited because data problems can lead to underestimation of inequalities
Explain social selection in terms of inequality and inequity within healthcare services
Direction of causation is from health to social position; sick people move down whereas healthy people move up. It is a plausible theory however most studies suggest that it only makes a minor contribution to differentials in health and morality
Explain the behavioural-cultural explanation about inequality and inequity within healthcare services
Ill health is due to people’s choices, decisions, knowledge and goals. States that people with a disadvantaged background are more likely to engage in health-damaging behaviours and vice versa. Limitations of this approach: behaviours are outcomes of societal pressures and not just individual choices and ‘good’ choices might be impossible to carry out
Explain the materialist explanation in terms of inequality and inequity within healthcare services
Inequalities in health arise from differential access to material resources e.g. low income, work environments etc. These factors then accumulate over life. Limitation of this approach is that further research is needed as to the precise methods through which ill health is caused by material deprivation
Explain the psychological explanations in terms of inequality and inequity within healthcare services
Psychological pathways act in addition to direct effects of absolute material living standards. There’s a social gradient of psychological factors. Stressors can impact health directly or indirectly
What is the function of the critical appraisal skills programme?
CASP offers a tool to appraise qualitative research; offers critical appraisal skills training, workshops and tools which help in reading and checking health resources for trustworthiness, results and relevance
Distinguish between inequality and inequity
Inequality - when things are different either in a group or between groups. Inequity - inequalities within a group of people that’s unfair and avoidable.
Describe the relationship between health and socioeconomic position
Generally poorer socioeconomic groups have poorer health. Can be measured by the NS-SEC which is calculated from census data.
What are the domains in the Index of Multiple Deprivation?
Income, employment, health and disability, education skills and training, barriers to housing and services, living environment and crime
Describe the relationship between health and ethnicity
Different ethnicities are at risk of different diseases. Also racial bias can play a role in treatment
Describe the relationship between health and gender
Men have a higher mortality rate, more suicides and more violent deaths. Women have a higher life expectancy, higher reported poor mental health and higher rates of disabilities and long standing illness. Gender is prescribed by social factors whereas biological sex is defined by hormonal and reproductive differences
Explain the artefact explanation about inequality and inequity within healthcare services
Health inequalities are evident due to the way stats are collected. Mostly discredited because data problems can lead to underestimation of inequalities
Explain social selection in terms of inequality and inequity within healthcare services
Direction of causation is from health to social position; sick people move down whereas healthy people move up. It is a plausible theory however most studies suggest that it only makes a minor contribution to differentials in health and morality
Explain the behavioural-cultural explanation about inequality and inequity within healthcare services
Ill health is due to people’s choices, decisions, knowledge and goals. States that people with a disadvantaged background are more likely to engage in health-damaging behaviours and vice versa. Limitations of this approach: behaviours are outcomes of societal pressures and not just individual choices and ‘good’ choices might be impossible to carry out
Explain the materialist explanation in terms of inequality and inequity within healthcare services
Inequalities in health arise from differential access to material resources e.g. low income, work environments etc. These factors then accumulate over life. Limitation of this approach is that further research is needed as to the precise methods through which ill health is caused by material deprivation
Explain the psychological explanations in terms of inequality and inequity within healthcare services
Psychological pathways act in addition to direct effects of absolute material living standards. There’s a social gradient of psychological factors. Stressors can impact health directly or indirectly
Explain income distribution and its effect on inequality and inequity within healthcare services
Relative income distribution effects health - countries with greater income inequalities have greater health inequalities. The psychosocial element associated with this is as follows: greater social-evaluative threat, greater stress and therefore poorer health.
Suggest why deprived groups might have higher rates of GP use and emergency services as opposed to preventative and specialist services
Tendency for them to manage health as a series of crises. They may have normalised ill health. They may not want to present unless there is an obvious symptom. Might not have access or be aware that they have access to health services
Why is it important to understand lay beliefs?
There can be a gap between lay concepts and medical knowledge which a practitioner should notice and fill in. Lay beliefs impact adherence and compliance with treatments and can change the way a patient understands medical advice or explanations
Define the negative definition of health
Health equates to absence of illness. This view is commonly held by those from lower socioeconomic groups
Define the functional definition of health
Health is the ability to do certain things; these things vary from person to person. This view is commonly held by the elderly population
Define the positive definition of health
Health is a state of wellbeing and fitness. This view is usually held by those in higher socioeconomic groups
State some factors that influence illness behaviours
Cultural attitudes, visibility of symptoms, extent to which symptoms disrupt life, frequency and persistence of symptoms, tolerance threshold, information available, resources available and lay referral
What is lay referral and why is it important?
Lay referral is the action of a patient asking a lay person (family, friend etc) if they should go to the doctors. It’s important because it helps in understanding why people may delay seeking help, our role as doctors, use of health services and medication and use of alternative medications
Explain the relevance of lay beliefs to health promotion
Medical information might be rejected if it doesn’t align with the patients lay beliefs (e.g. lay understandings of inheritance often differ to the medical understanding)
What two concepts is lay epidemiology based on?
Understanding why and how illness affects people
Understanding why it happened to a particular person at a particular time
Why might lay epidemiology be problematic?
Because it is based on observations from collective experiences. This means that if there are exceptions to a rule then patients can justify poor health related behaviours by using these examples e.g. smokers living a long time and not getting cancer
