HBS 21-26 Flashcards
CAM
Complimentary and alternative medicine
Complementary medicine vs Alternative
Complimentary: Used with conventional
Alternative: Used instead of conventional
4 most popular CAMS
chiropractic manipulation, herbal medicine, massage, homeopathy.
Perceptions of CAM
Traditional, Holistic, Natural, Life as energy, Patient led
Placebo
Any biologically inert therapy that derives benefit.
Placebo effect
Tendency to mimic a drug in effect and adherence with changes to physiological and behavioral state, as well as habituation, dependency and withdrawal.
Non-interactive placebo theory
Placebo effects stem from characteristics of the medication (color, size, brand price, strength), health professional (higher the professionalism, higher the placebo), or patient.
Interactive placebo theory
Placebo effects stem from experimenter bias (if a doctor does not know the placebo is given, the effect is greater), reporting errors (do they actually think they are better or do they just report it?), learning theory (does a white coat elicit a response), or anxiety reduction theory (does feeling less anxiety because of care given make them feel better?).
Physiological placebo theory
Placebo can create withdrawal and dependency. So maybe placebos activate the body’s release of opiates.
Patient expectation placebo theory
Patient expects to improve. This impacts their behavior, reporting bias, symptom representation and increase susceptibility to learning theory.
Nocebo
Negative expectations can result in negative outcomes and this effect. Patient is more likely to report negative side effects if told about them.
Adherence
The extent to which a persons behavior (taking medication and lifestyle) is in accordance to the recommendations of a health care professional.
Subjective measurements of adherence
Patient’s self-report, patient’s diary, clinician’s estimate.
Objective measurements of adherence
Direct monitoring, tablet counting, physiological markers, prescription redemption records, fluid level tests.
Condition related factors to non-adherence
Chronic vs acute, severity of symptoms, rate of progression, availability of treatments.
Therapy related factors to non-adherence
Price, efficacy, complexity, duration, difficulty, side-effects of treatment.
Health system factors to non-adherence
Extent of education, poor medication access, patient-provider relationship.
Social/economic factors to non-adherence
Price, illiteracy, stigma, accessibility
Patient related factors to non-adherence
Unintentional and deliberate:
Illness perception: is it curable, are the symptoms manageable, is it hereditary?
Conformity
Yielding to real or imaginary social pressure.
Conformity experiments:
Asch experiments
Asch experiments
Confederates given the wrong verbal answer to basic questions had a tendency to compel the participant to also give the wrong answer.
Conformity in healthcare:
Not speaking up when there is an error. Fear of whistleblowing. Mistakes and bad practice go unchanged.
Obedience
Form of compliance that occurs when people follow direct commands. Obedience increases with transfer of liability, when command comes from authority figure with high prestige.
Obedience experiment:
Milgram experiment using shock voltage.
Bystander effect
People are less likely to provide help when within a group because responsibility is diffused.
Obedience in healthcare:
Orders may be followed that are inappropriate, incomplete, or inappropriate. Rules, which exist to ensure safety, may be broken.
Dimensions of quality healthcare:
SET PEE:
Safety Efficacy Timelines Patient-centeredness Efficiency Equity
Patient Safety
The freedom from accidental injury or harm due to medical care or accidental error.
Common medical errors
Adverse drug events Surgical injuries Wrong-site surgery Restraint-related injury Falls Burns Pressure ulcers Mistaken patient identities
Adverse healthcare event
An event or omission that arises during healthcare, leading to physical or psychological harm of the patient.
This can include medical errors, misdiagnosis, poor monitoring.
Rasmussen’s 3 levels of performance
- Knowledge based: Novel situations requiring stored knowledge.
- Rule based: Familiar problems solved by stored rules.
- Skill based: Stored patterns.
