HaDSoc Flashcards
What is clinical governance?
A system through which the NHS organisations are accountable for continuously improving the quality of their services and high standards
- accepts clinical excellence to flourish
- obligation for accountability
What is the swiss cheese model of accident causation?
There are holes in the layers and if they line up it allows accidents to slip through
The more layers the less chance of hazards lining up, need to put safety measures in place to plug the holes
- The layers are barriers, defences and safeguards
- some holes are due to active failures, others due to latent conditions eg organisation and management
State maxwells dimensions of quality
- Acceptability - does the care promote satisfaction
- Effective - curing pts
- Access
- Relevance - does the population need the service
- Efficiency - cost effective, no waste
- Equitable - everyone with the same needs gets the same care
What is an adverse event? Give examples of preventable and unpreventable adverse events
Adverse events are injury caused by management (not underlying disease) that prolongs hospitalisation, produces disability or both
Non preventable: side effects of chemotherapy
Preventable: wrong dose or medication given, some types of infections
What are some NHS quality improvement mechanisms?
- Standard setting - NICE set quality standards based on best available evidence
- Commissioning - CGCs responsible for budget for their area
- Financial incentives - used to both reward and penalise
- Disclosure - all trusts have to publish quality accounts which are available to the public
- Regulation, registration and inspection - CGC can inspect at any time without warning
- Clinical audit and quality improvement - identifying quality of care then trying to improve it
What are some of the critiques of evidence based practice?
- it is impossible to collate and maintain so much data
- RCTs can be limited on ethical grounds
- what works for a population may not work for an individual
Why are some possible explanations as to why lower class is strongly associated with ill health? (as outlined in the black report)
- may be artefact due to measurement problems
- may actually be that ill health causes lower class
- cultural explanation, low classes engage more in damaging behaviour such as smoking
- materialist explanation, low income means less money to spend on health
What us the symptom iceberg?
Only a small proportion of illness actually gets presented to GPs
- 1/3 seek advice
- 1/3 self medicate
- 1/3 do nothing
What are lay beliefs?
What is lay referral?
How people understand and make sense of health and illness
Lay referral is the chain of advice the sick person gets from other lay people prior to/ instead of seeking help from professionals
What are the principles of health promotion?
- Empowering: allows individual power to change
- Participatory: involves everyone
- Holistic: physical, mental, social
- Intersectoral: collabs relevant sectors
- Equitable: guided by justice
- Sustainable: about continuing change
- Multistrategy
What are primary, secondary and tertiary health promotions?
Primary - aims to prevent onset of disease such as smoking cessation
Secondary - aims to detect and treat disease early such as screening
Tertiary - aims to minimise the effects of established disease such as renal transplantation
What is the sociological theory on chronic illness?
The work of chronic illness is
- everyday life work eg coping and normalisation
- emotional work eg protecting emotional wellbeing of others and self
- biographical work eg maintaining of sense of self and value
Why is it important to measure health?
- indicates the need of health care
- allows targeting of resources
- assesses effectiveness of interventions
What are the criteria screening?
Disease: must be an important problem, needs to be fully understood, detectable. detection must lead to benefit.
The Test: simple, safe, precise, valid
Treatment: effective treatment must be available, treatment must be advantageous
What are the critiques of screening?
- programmes are complex
- evaluation can be difficult
- idea of victim blaming
- false positives, false negatives
What is sensitivity and specificity?
How are they calculated?
Sensitivity is the proportion of people with the disease who test positive - calculated by number of people with the disease who test positive / total people with the disease
Specificity is the proportion of people without the disease who test negative - calculated by number of people without the disease who tested negative / total people with no disease
What is positive predicted value?
How is it calculated?
The proportion of people who test positive who actually have the disease
Calculated by number of people who tested positive and have the disease / total number who tested positive
- PPV is strongly influenced by prevalence, a low prevalence condition will have a low PPV
What is prevalence?
The total number who have the disease irrespective of how they test.
Total number of people with disease / total number of people
What is negative predicted value?
How is it calculated?
The proportion of people who test negative who actually dont have the disease
Calculated by the number of people who test negative and dont have the disease / total number who test negative
What are the issues with a false positive and false negative result?
False positive: go through the anxieties of testing when they dont actually have the disease, lower uptake in the future
False negative: the disease goes un-diagnosed, they are falsely reassured and may present late
What is lead time bias?
Screening programmes detect slow progressing disease best - early diagnosis falsely appears to prolong survival
Patients live the same amount of time but just know they have the disease for longer
What are the 3 core principles of the NHS?
Universal, comprehensive, free at point of entry
What are the 5 Ds of rationing in the NHS?
Deterrent - reduce demands via prescription charges
Delay - waiting lists modulate excess demands
Deflection - GPs deflect demand from secondary care
Dilution - fewer tests, cheaper drugs
Denial - reduce services eg IVF and sterilisation reversal
What are the principles for resource allocation?
Scarcity - some sacrifice is inevitable
Efficiency - need to get the most out of a resource
Equity - allocating on basis of need
Effectiveness - the extend to which a desired outcome is achieved
Utility - the value an individual item places of health state
Opportunity cost - once you have used a resource in one way you can no longer have it in another way
