HadSoc Flashcards
What is an adverse event?
-An injury caused by medical management which prolongs hospitalisation, produces a disability or both and cannot be avoided eg vomiting after chemo
What is a preventable adverse event?
-An adverse event that could have been prevented given current medical knowledge eg operations on wrong body part, wrong dose, failure to rescue
What is failure to rescue?
-A missed deterioration in a patient which should not have happened eg missed sepsis
How is it evident that there are problems with quality and safety within the NHS
-Direct evidence from patients being harmed or recieving substandard care-Variations in provision of healthcare nationally shows that not everyone is recieving the same amount of care -> eg variation in diabetic leg amputations depending on location, are some people receiving unnecessary leg amputations
Describe some ideas about why poor patient safety occurs
-Poorly designed systems which do not account for human error eg inadequate training, long hours, drugs with same packaging, different protocols between trusts-Culture and behaviour doesnt allow whistle blowing or admission of clinical weaknesses-Over-reliance on individual responsibilities as the individual gets blamed and not the system, system never changes
What is James Reasons Framework of error (swiss cheese)
-Active failures (acts which lead to harm) and latent conditions (predisposing conditions which mean active failures are more likely to occur) align and break several layers of barrier defences and safe guarding eg identical packaging and administering the wrong medication
Describe how a systems based approach can improve quality and safety
-Takes into account all factors which influence one another contributing to quality and safety eg hospital policies, patient characteristics, individual practitioner, work environment
State how human error factors can be reduced
-Avoid reliance on memory -> use signs and stickers-Make things visible-Use checklists-Standardise protocols-Review and simplify procedures
What is clinical governance?
-Legal duty to continuously monitor and improve quality, safety and effectiveness of services under the health and social care act 2012 which provides a framework through which NHS organisations are accountable
Describe some NHS policies and organisations which encourage safety within the NHS
-Financial incentives which work by payments based on results eg QOFs and Tariffs-Clinical audits-Disclosure of organisational performance and individual performance-Standard setting for quality care
What is a QOF?
-Quality and Outcome framework used in primary care which set national quality standards-Practices score points based on standards and receive payments based on this-Results published online
What is a tariff?
-A reward systems intended to provide consistent basis for comissioning services-Treatments which use similar levels of resources are grouped together in healthcare resource groupings (HRGs) and are designed as a unit of currency determining equitable reimbursement of healthcare-Longterm incentive as efficient trusts make more profit and inefficient trusts loose profit-Never-event deems no payment
Outline the steps in a clinical audit
1) Set standards (criteria and standards)2) Measure current practice 3) Compare results with standards (1st evaluation)4) Change practice (Implemant change)5)Re-audit (2nd evaluation)
What is care quality comission?
-An organisation which monitor quality (unannounced visits) and can impose conditions (warnings, fines, closure) if unsatisfied
Describe the functionalist approach to understanding the doctor-patient relationship
-Falling ill is a socio-cultural experience-lay people do not have the technical competence to remedy the situation and so the sick person is placed in a state of helplessness-Medicine and doctors restore health and therefore restores social equilibrium
Describe the rights and duties of a sick role in the functionalist approach to viewing the dr-pt relationship
-Sick person is freed of social responsibilities and obligations -Become dependant upon medical care-Should want to get well and not abuse exemption-Expected to seek out help
Describe the rights and duties of the doctor role in the functionalist approach to viewing the dr-pt relationship
-Tend to the sick in society-use skills for the benefits of patients-act for the welfare of the patient
Describe some criticisms to the functionalist approach to viewing the dr-pt relationship
-Sick role may never end ie chronic illness/illegitimate occupants-Assumes patient is incompetent and has a completely passive role-Assumes rationality and beneficence
Outline the conflict approach of assessing the dr-pt relationship
-Doctor has bureaucratic power and can exploit definitions of health and illness-Patient has to submit to institutionalised dominance of Dr-Lay ideas are discounted and social life pathologised-People become dependant of medicine and loose self reliance ie childbirth
Give some criticisms of the conflict approach of assessing dr-patient relationships
-Is the portrayal of Drs and pts in conflict inaccurate?-Patients can exert control over their care eg non-adherence-Patients seek to medicalise issues
Describe the interpretive/interactionalist approach to viewing the dr-pt relationship
-Focusses on the meaning to both parties give to the encounter-Interested in patients and what features of care are good/hinder care?
Describe the patient-centred method to assessing the doctor-patient relationship
-Has an aspiration that the relationship could be less hierarchical and more cooperative -Patients views should be taken seriously and consultations should explore patients reasons for visits -> ICE-Holistic approach to medicine with a mutual agreement
Describe some challenges of shared decision making between doctors and patients
-Are the consequences of patient involvement always good?-Under what circumstances should patient power be limited?-Who has final responsibility?-Time
Why are patient views on healthcare important?
-Patient satisfaction is an outcome in its own right-Humanitarian and ethical reasons -> stop paternalism (limiting a persons autonomy becuase ‘its for their own good’)-Increasing external regulation of healthcare
Give 3 example of how patient views are accessed within the NHS
-NHS family and friends test-NHS choices -> allows service users to rate and comment-Healthwatch england-Patient Advice and Liason Service-Parlimentary and Health Service Ombudsman-Patient complaints
What is Healthwatch England?
-An organisation which puts consumers views to those who commision, deliver and regulate services-Each local authority has a healthwatch to seek views of local people regarding health and care services
What is the Patient Advice and Liason Service? (PALS)
-Trust-based organisation which offerd confidential advice, support and information-Resolves concerns/problems when using NHS and gives advice on complaints procedure and increasing own involvement in healthcare
Give 3 qualitative approaches to accessing patient views
-Interviews-Focus groups-Observation
What is the advantage to obtaining patient views in a qualitative manner?
-Can identify successfully how patients view their care and priorities
What is the main quantitative way in which patient views are accessed?
-Surverys
Give 4 reasons why surveys are used to quantifiably collect patient views?
-Cheap and easy-less staff training-Anonymity guaranteed-Standard responses make analysis easier
What are the main reasons patients are dissatisfied with care?
-Interpersonal skills eg lacking communication-Access and hygiene standards-Culturally inappropriate care
What are the main issues surrounding responding to patient dissatisfaction?
Who is accountable?Is every patient reasonable/rational?Is the resource diversion worth the complaint?
What is healthcare economics?
-Assumes resources are scarce and seeks to provide information to assist in the allocation of resources in an efficient and equitable way
What is opportunity cost?
-Once you have used a resource in one way it is no longer available to use in a different way. The opportunity cost of a tx is the value of the next best alternative use of those resources
when measuring the cost of a treatment, what factors are taken into account?
-Identify, quantity and value of resource needed-Cost of healthcare-Cost of patient time-Cost of care-giving-Economic cost by employers
What factors are taken into account when measuring the benefit of a treatment?
-Impact on health status-Savings in healthcare resources-Improved productivity of patient
What is cost minimisation analysis?
-Outcomes assumed to be equivalent regardless of tx chosen-Focusses on inputs of resources only ie chooses the cheapest option
What is cost effectiveness analysis?
-Getting most for your money-Compares interventions with common health outcomes eg lowering bp-compared in cost per unit outcome eg cost/5mmHG lowered-Is the extra benefit worth the extra cost?
What is cost benefit analysis?
-Compares everything in money by placing a price on how much it means to the patient-Compares outputs and inputs-Willingness to pay
What is the major difficulty of cost benefit analysis?
-Difficult to put a monetary value on non-monetary benefits eg saving lives
What is cost utility analysis?
-A type of cost effectiveness analysis-Focusses on the quality of health produced/benefits foregone-Measured in QALY = 1 perfect year of health or 10 years at 0.1 health or 6months of 1 health for 2 people
What is the advantage of using cost utility analysis?
-Using QALYs allows comparisons to be made across different programmes
How is quality of life assessed for QALYs?
-Using questionnaires such as EQ-5D
How is cost utility calculated?
-Cost per QALY gained-Work out QALY for each treatment-Work out QALYs gained-Work out how much it costs per QALY gained from total cost of treatment divided by QALYs gained
Give 3 alternatives to QALYs
-Health Year Equivalents (HYE)-Saved-Young-Livefe Equivalents (SAVEs)-Disability Adjusted Life Years (DALYs)
How does NICE use QALYs?
-QALYs integrated with price to determine cost effectiveness-Below 20K per QALY accepted-20-30K/QALY judgement takes into account degree of uncertainty, if chalnge in HRQoL has been adequately captured by QALY, any benefits not captured by QALY-Above 30K needs to be a very strong case
Who is involved in NICE in decided the cost effectiveness of treatments?
-DoH, HCPs, patients, carers and public
What are the concerns of using NICE to decide the acceptance/rejection of treatments?
-Political interference -CCGs prioritise NICE-approved interventions with unintended consequences-May be represented by pharmaceutical companies and/or patient groups
Describe some criticisms of QALYs
-Controversy over values -Doesn’t distribute resources according to need but benefits per unit cost-Disadvantages common conditions-> not allocated a fair impact on health-Dont assess impact on carers and family
What role do CCGs have in commisioning services within NHS england?
-They commission services for secondary and community healthcare -Control 65% of NHS budget and trusts make money by CCGs commissioning services from them-Can also give money to private sectors
Who commissions services for primary care?
-NHS england
How does the commissioning of services in NHS England differ from the rest of the UK
-Commissioned by CCGs as opposed to trusts in the rest of the UK
Who has overall accountability for NHS England?
-Secretary of state for health
What is the role of a medical director?
-Overall responsibility for medical quality-Responsibility for care in hospitals-Communicate between board and staff
What is the role of clinical director?
-Overall responsibility for faculty-Provide continual education and training-Design/implement policies regarding jr doctor hours, supervision etc-Implement clinical audits
Define screening
-Systematic attempt to detect an unrecognised condition which can be done rapidly to distinguish those who are likely to have disease from those who haven’t
Does a positive screening test mean you have the disease?
-No, it means you are high risk and diagnostic tests must be performed.
With reference to test validity, what is sensitivity?
-Proportion of people with the disease who test positive (how good the test is at getting a positive result from those who have the disease)
With reference to test validity, what is specificity?
-The proportion of people who do not have the disease which test negative (how good the test is at getting a negative result if you do not have disease)
How do you calculate sensitivity of a screening test?
-Disease present +ve/ (disease present +ve and -ve)
How do you calculate the specificity of a screening test?
-Disease free -ve /(disease free +ve and -ve)
What is the positive predicted value? How do you work this out?
-How likely a person is to have the disease when they have tested positive -Disease +ve /(disease +ve + disease free +ve)
What is the negative predicted value? How do you work this out?
-How likely a person is to be disease free when they have tested negative-disease free -ve/(disease free -ve + diseased -ve)
What 3 groups of criteria are there when referring to screening criteria?
-The disease-The test-The treatment
Outline the screening criteria for the disease aspect
-Must be an important health problem-Epidemiology and natural history must be well understood-Must have an early detectable stage
Outline the screening criteria for the test aspect
-Simple and safe-Precise and valid with an agreed cut off-Acceptable to population being screened-Agreed policy on who to investigate further
Outline the screening criteria for the treatment aspect
-Effective evidence-based tx available-Early treatment is advantageous
Which aspect of test validity does prevalence effect and how?
-PPV-The higher the prevalence the higher and more accurate the PPV
State 2 advantages of screening
-Reduces number of deaths from a certain condition-Earlier detection of diesease prevents morbidity
What are the disadvantages of screening?
-Many people have to be screeded to sace 1 life -> costly, invasive and causes unneccesary worry and anxiety-Some people detected by screening die anyway-People diagnosed with disease without harm or symptoms may be subjected to reduced QoL due to checkups -Refers well people for investigation -> false positives-Fails to refer people who have the disease -> false negatives -> ess likely to present if symptoms occur as been told low risk-Overdiagnosis of diseases which wouldnt have caused harm
Explain how screening alters the dr-pt contract
-Normally patients self present asking for help-Screening targets apparently health people who have not sought help and offers help for something they havent thought about
Describe some limitations of screening
-Cannot guarantee protection-Always false +ves and -ves-Need for informed choice on whether to have screening or not-Always unneccessary investigations
What is lead time bias?
-Early diagnosis falsely appears to prolong survival as screened patients appear to survive longer but were only diagnosed earlier -Patients live the same length of time but a longer period knowing they have the disease
What is length time bias?
-Screening programmes are better at detecting slow growing, unthreatening cases vs fast agressive cases-Therefore diseases detected by screening are already more likely to have a favourable prognosis
What is selection bias?
-Skewed by ‘healthy volunteer’ effect. Those who attend screening are more likely to be doing other things to protect themselves from disease
Describe some structural sociological critiques of screening
-Victim blaming -> individuals encouraged to take responsibility for own health - can everyone do this?-Individualising pathology -> What about addressing underlying material causes of disease
Describe some surveillance sociological critiques of screening
-Individuals and populations increasingly subject to surveillance
Describe a social constructionist critique to screening
-Health and illness practices can be seen as moral - given meaning through particular social relationships
Describe a feminist critique of screening?
-Is screening aimed more at women than men?
Outline the aspects of the cervical screening programme
-Aims to decrease the number of invasive cervical cancers and deaths-Women aged 25-64 years -> 25-49 3 yearly: 50-64-> 5 yearly; 65+ only those who had recent abnormalities-under 25s not screened due to lots of false negatives as invasive cervical cancers rare under 25-normal results -> continue screening-Abnormal result -> analysed -> either no tx or laser ablation LLETZ-Incorporates HPV test -> +ve referred to colposcopy
What are patient reported outcomes and why is it important to use patient-based outcomes as a measure of health?
-PB outcomes are a measure of health and assess wellbeing from a patients point of view by assigning a score before and after treatment-Mortality not always accurately recorded and cannot access quality of care-Morbidity cannot get information about patient experience-Get more information then a biomedical test and provides the ability to look for iatrogenic factors of care
What is a HRQoL?
-Health related quality of life. A measure used in patient reported outcomes which takes the quality of life in clinical medicine and represents it as a functional effect on the life of a patient
In what situations can PROMs be used?
-Clinically, economically, audits, RCTs, service quality
Give 3 examples of treatments where PROMs are currently used
-Hip/knee replacement-Hernias-Varicose veins
What factors do HRQoL take into account?
-Physical function and symptoms, global judgements of healthm psychological well-being, cognitive function, personal constructs and satisfaction with care
What mathods are used to measure HRQoL? State the advantages and disadvantages of each method
-Qualitative and quantitative methods-Qual -> interviews are good for initial assessment and develeopment of quantitative methods, Resource hungry and not easy to evaluate -Quan -> questionnaires are easy to evaluate but force people into specific groups
Why are PROMs a valuable measure of health?
-Reliable -> accurate over time and internally consistent-Valid -> assesses one aspect at a time-Allows comparisons between different groups of patients using standardised measures
What are the differences between generic and specific instruments used to measure HRQoL?
-Generic provide tools used to assess any population and gain an overall perception of health as well as social, emotional and physical functioning-Specific instruments evaluate a series of diseases, sites or health dimensions
What are the advantages and disadvantages of generic instruments to measure HRQoL?
-Covers a broad range of health problems-Enables comparisons-Detect unexpected positive/megative effects-Less detailed-loss of relevance-less sensitive to change
What are the advantages and disadvantages of specific instruments to measure HRQoL?
-Relevant to particular areas-Sensitive to sudden changes-Detailed-Comparison limited as restricted to specific topic-limited use-not good at detecting unexpected outcomes
Give an example of a generic instrument used to measure HRQoL
-SF36 -> questionnaire with a 4 week recall period which is widely used in research and population surveys covering physical, mental, social, role, pain and generic health
Give an example of a specific HRQoL tool
-AIMS -> Arthritis Impact Measurement Scale-Oxford Hip Score-McGill Pain questionnaire
What does the sociological research of LTCs focus on?
-How LTCs impact on social interaction and role performance
What is an illness narrative?
-Patient’s story and account of their LTC which they use to make sense of it
What are the 5 concepts relating to sociological theory
-Illness work-Everyday life work-Emotional work-Biographical work-Identity work
What is illness work in sociological theory of LTCs?
-The concept of getting a diagnosis of a chronic illness and the associated feelings which come with waiting and receiving eg shock, relief-Also refers to body illness and involves managing the symptoms of illness via coping with the physical symptoms before the social
What is fveryday life work in sociological theory of LTCs?
-The concept of coping and strategic management of daily life including the cognitive processes in dealing with illness as well as actions
What is normalisation in chronic illness?
-The redesignation of new life as ‘normal life’
What is emotional work in sociological theory of LTCs? What roles and relationships can be effected by emotional work?
-The part of chronic illness which involves working to protect emotional well-being of others by aiming to maintain normal attitude and activities -Friendships can be disrupted as patient may strategically withdraw from groups -> cannot downplay symptoms to appear cheery self any more-Impact on role can be devastating, especially if involves dependancy
What is biographical work in sociological theory of LTCs
-The part of chronic illness which refers to loss of self as former identity disappears without the development of an equally valued new one-Reconstruction of biography and a taken-for-granted life feeling
What is identity work in sociological theory of LTCs?
-Part of chronic illness which refers to how people see themselves and how other see them as illness can become defining aspect of their life
Which area of sociological illness does self management fall under?
-Illness work
Why is optimum self management difficult to achieve in long term illness?
-Adherence to LT treatment-Reduced quality of life-poor psychological well being
Give 2 examples of interventions which aim to help with self-management of longterm diseases
-DESMOND -> diabetes education and Self Management for Ongoing and Newly Diagnosed-Expert-Patient Programme -> focusses on coping and condition management to reduce hospital admissions and increase responsibility for own health
Which section of sociological theory does stigma fall under?
-Identity work
What is stigma?
-Negatively defined condition, attitude, trait or behaviour conferring deviant status
What is discreditable stigma?
-Stigma which occurs when the disease is found out but it is not seen
What is discredited stigma?
-Stigma is caused by the physical characteristics of disease
What is enacted stigma?
-The real experience of predjudice when stigma is acted upon
What is felt stigma?
-The fear of enacted stigma and feeling as though stigma is present even though it might not be
Describe the medical concept of disability
-Deviation from the medical norms with disadvantage as a direct consequence. Requires medical intervention
Describe the social concept of disability
-Problems are a product of environment and failure of environment to adjust - social oppression produced by government and society
Describe some critiques of the medical model of disability
-Lack of recognition of social and psychological factors-Uses stereotyping and stigmatizing language
Describe some critiques of social model
-Body is left out-Overly drawn view of society-Failure to recognise body realities and the extent to which they are solvable socially
According to the international classification of impairment, disabilities and handicaps, what is impairment?
-Impairment is the abnormality in structure or function of body
According to the international classification of impairment, disabilities and handicaps, what is disability?
-Disabilty refers to the performance of activity
According to the international classification of impairment, disabilities and handicaps, what is handicap?
-Social and psychological consequences of impairment and disability
What are the limitations of the IC of impairment, disability or handicaps?
-Problematic use of word handicap-Implies problems are intrisic and inevitable
What is the IC of function, disability and health?
-WHO national standard which attempts to integrate the medical and social concept of disability -Involves body structure and functions, activities, participation in life and personal and environmental factors
What is the aim of health promotion?
-To enable people to increase control over and improve their health
What are the 5 approaches to health promotion?
-Medical/prevantative measures-Behavioural change-Education-Empowerment -Social change
What is primary prevention? Give an example
-Aims to prevent the onset of disease or injury by reducing exposure to risk factor eg immunisation, reducing poor health behaviours eg smoking
What is secondary pevention? Give an example
-Detects or treats a disease (or risk factor) at an early stage to prevent progression or disabilityeg screening and monitoring
What is tertiary prevention? Give an example
-Minimises the effects of established diseaseeg rehab programmes
State 6 dilemmas of health promotion
-Ethical-Victim blaming-Fallacy of empowerment-Reinforcing negative stereotypes-Unequal distribution of responsibility-Prevention paradox
What is the ethical dilemma of health promotion?
-Ethics of interfering in peoples lives-Potential psychological impact of health promotion messages eg anxiety-Nanny state -> overprotectibe or interfering with personal choice
What is the victim blaming dilemma of health promotion?
-Constraints in which people live are not recognised-Downplays the impact of wider socioeconomic and envronmental determinants of health eg housing conditions by focussing on individuals
What is the fallacy of empowerment dilemma of health promotion?
-Giving people information does not give them power-Unhealthy lifestyles not due to ignorance but incontrollable determinants of health
What is the Reinforcing negative stereotypes dilemma of health promotion?
-Targets specific groups which can reinforce negative stereotypes eg leaflets for HIV prevention in drug users
What is the unequal distribution of responsibility dilemma of health promotion?
-Implementing healthy behaviours in the family often left up to the woman eg change4life
What is the prevention paradox dilemma of health promotion?
-Interventions which can effect at a population level may not effect an individual Eg people may not see themselves as a candidate for disease and thus health message ignored
Why is there an ethical obligation to evaluate health promotion?
-To ensure no harm is being done
What 3 types of evaluation occur after health promotion?
-Process evaluation -> assess process of implementation-Impact evaluation -> assess immediate effect-Outcome evaluation -> measures long-term consequences
Why can the timing of health promotion evaluation effect the outcome?
-Delay -> effect may take a long time to become apparent-Decay -> effects of a promotion may wear off quickly
Why can health promotion be difficult to evaluate?
-Lagtime of outcome-Confounding factors of outcome -> if person is undertaking this health behaviour then more likely doing others too-Intervention designs can be difficult to evaluate-Costly
Why are lay beliefs important to clinicians?
-Patients use lay beliefs to understand health and illness, it is important clinicians understand these as they impact on health behaviour and compliance, in addition to health promotion-Medical information may be rejected if it is incompatible with people ideas and beliefs -Lay understandings may construct a family history eg heart disease
What is the negative perception of health?
-Health equates to the absence of illness-Often the opinion of low socioeconomic groups
What is the functional perception of health?
-Health is the ability to do certain things-Common belief of the elderly
What is the positive perception of health
-Health is a state of wellbeing and fitness-Often the view of higher socioeconomic groups
What are lay theories?
-Theories about health and illness drawn on social, cultural and personal knowledge and/or experience
What is health behaviour?
-Activity undertaken for the purpose of maintaining health and preventing illness
What is illness behaviour?
-Activity of ill person to define illness and seek solution
What is sick role behaviour?
-Formal response to symptoms including seeking formal help and action of person as pathient
What is the illness iceberg?
-Most symptoms never get to a doctor and are treated with laycare eg otc medication
What are lay beliefs
-Ideas and beliefs constructed be a person with no specialised knowledge which helps them to understand health and illness
List some factors which influence illness behaviour
-Culture eg stoical attitude-Visibility of symptoms-Extent of disruption-Frequency/persistence-Tolerance threshold
What is lay referral?
-Symptoms discussed with others and a chain of advice-seeking contacts which the sick make with other lay people prior to, or instead of, seeking help from HCPs
Why may people delay consultation with a doctor?
-Experience of, and attitudes towards health professionals-Symptom evaluation-May have developed explanations for symptoms (lay beliefs) -> recognition that the explanation inadequate may prompt consultation-Lay beliefs about what things are supposed to present like
How do lay beliefs effect compliance?
-Beliefs about treatment influence patient decisions to take medication eg denial of disease and/or treatment, acceptance
What is meant by social patterning of health in the UK?
-Variations between regions of the UK based on differences in socioeconomic classeg lower socioeconomic class correlates to lower life expectancy and poorer health status
According the the black report by DoH, state the 4 reasons for health inequality (and an additional 2 not in the black report)
-Artefact-Social selection-Behavioral-cultural-Materialistic(Psychosocial and income distribution)
What is the artefect explanation of health inequality?
-Health inequalities evident from the way statistics were collected due to cocerns over quality and method-Most discredited explanation
What is the social selection explanation of health inequality?
-Direction of causation is from health to social status not the otherway around ie sick individuals move down the social hierachy and healthy move up-Chronically disabled are more likely to be disadvantaged
What are the criticisms of the social selection explanation of health inequality?
-It is plausible but only a minor contribution to health inequality
What is the behavioural-cultural explanation of health inequality?
-ill health is due to peoples choices, decisions, knowledge and goals-Those from disadvantaged backgrounds are more likely to engage in health damaging behaviours and vice versa
What are the limitations to the behavioural-cultural explanation of health inequalities?
-Behaviours are outcomes of social processes not simply choice-‘Choices’ difficult to exercise in adverse conditions
What is the materialise explanation of health inequality?
-The most plausible explanation-Inequalties arise from differential access to material resources eg low income, unemployment, work environment,-Lack of choice in exposure to hazards adverse conditions eg poor housing-Accumulation of factors
What is the psychosocial explanation of health inequality?
-Stress impact on health-Act in addition to materialist explanation
What is the income distribution explanation of health inequality?
-Relative income affects health-Contries with greater income inequalities have greater health inequalities (egalitarian societies have least health inequalities)
What is inequity?
-Inequalities between healthcare which are unfair and avoidable
Which areas have the highest rates of GP and emergency services vs preventative and specialist services?
-Most deprived areas
Why may deprived areas have a decreased utilisation of healthcare?
-Normalise ill-health-Tendancy to manage health as a series of crises-Lack of cultural alignment between health services and socioeconomic services
How is access to healthcare measured? Why is thie problematic?
-Through utilisation-Do not know anything about those people who are not/cant access healthcare
How can ethnicity contribute to health inequalities?
-Culture can influence ways of doing /being-Access to/exclusion from services and resources-Genetic/biological factors
How does gender influence health inequalities?
-Males have higher mortality rates and more rates of suicide and violent deaths-Females have a higher life expectancy, higher reported mental health issures and higher rates of disability and longstanding illness
Why is social research important?
-Increases confidence in answering questions about social life and patients
Give some examples of quantitative research methods
-RCTs, Case-control, cohort studies-Questionnaires
Give 3 advantages of quantitative research methods
-Repeatable-Good at measuring/defining causality and allowing comparisions-Easy to analyse
State 3 disadvantages of quantitative research methods
-May force people into inappropriate categories-Doesnt allow for individual expression-May not access all the important information
What is the focus of quantitative research methods?
-Prove/disprove a hypothesis
What is the focus of qualitative research methods?
-Emphasise meaning, experience and views of the population
What is Observation and ethnography?
-A form of qualitative research which studies human behaviour in its natural context to observe their actions over what they say
What is the major disadvantage of observation and ethnography?
-Labour intensive
What type of research method are interviews?
-Qualitative
What are the advatages of interviews?
-Semi-structured with a clear agenda-Participants perspective is explored-Gains detailed focussed accouts
What is a disadvantage of interviews?
-Can get biased veiws-Risk of not obtaining accurate information
Why are focus groups a good qualitative research method?
-Quick and flexible-Access to collective understanding-May encourage people to participate
What are the disadvatages of focus groups?
-Difficult to arrange-Some topics too sensitive-Not very useful for individual experiences -> may get those who dominate the group
What are the advantages of qualitative research methods?
-Understand patient perspective-Gain more information
What are the disadvantages of qualitative research methods?
-Difficult to find consistent relationships between variables-May not bet statistically representative of whole population if small sample size used-Analysis is labour intensive
What is evidence-based practice?
-The integration of individual clinical expertise with the best available clinical evidence from systematic research
Why is evidence-based practice important?
-Ineffective/inappropriate interventions waste money and resources-Variations on treatment when decided solely by clinician creates inequity-Without evidence new intervention could be harmful-EBM results in the most effective interventions being used which is fair to all
What is the alternative to evidence based practice?
-Practice based on professional opinion, clinical fashion, historical president and social culture
Why is it good to use systematic reviews in EBM?
-Primary literature can be biased-Quality of review can be poor-address clinical uncertainti and quality control by surverying all the literature-Highlights gaps in research
Describe some practical criticisms of EBM
-Impossible task to create and maintain systematic reviews across all specialities-Challanging and expensive to disseminate and implement findings -RCTs not always ethical -Limits interventions trialled to biomedical ones
Describe some philosophical criticisms of evidence based medicine
-Population-level outcomes do not always work for individuals-Potential for EBM to crease unreflective rule followers out of clinicians with the potential to undermine the dr-pt relationship
Describe some problems of implementing EBM in pratice
-Ineffective dissemination can leave some doctors unaware -Doctors may choose not to follow EBM out of habit/judgement-Some organisations cannot support innovation
State how some NHS policies encourage EBP
-Clinical governance and quality care commission leagally olblige NHS organisations to follow NICE guidance within 3 months of issue
