Healthcare Flashcards
Define health
WHO
A state of complete physical, mental and social wellbeing. Not merely the absence of disease and infirmity
Health is a positive concept emphasising social and personal resources, as well as physical capacities
Where was the health promotion charter formed and when
And what does it state
Ottawa - Ottawa charter for health promotion in 1986
States
Health is a resource for everyday life, not an objective for living
Conditions required: peace, shelter, education, food, income, a stable ecosystem, social justice and equality
What determines health?
What is this model called who determined this model?
Determinents of health rainbow model Dahlgren and whitehead 1) sex, age, constitutional factors 2) lifestyle factors 3) social and community networks 4) living and working conditions - education, water and sanitation, housing, un/employment, work environment, healthcare services, agriculture and food production
Define health systems
WHO: all organisations, people, and actions whose primary intent is to promote, restore and maintain health
Good health system delivers quality services to all people, where and when they need them
Not just treating disease but addressing the conditions for health
Key components of a health system
1) improve health status of individuals, families and communities
2) defend population against health threats
3) protect against the financial consequences of ill health
4) provide equitable access to people centred care
5) assist people to participate in decisions affecting their health
Define public health
The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society
Individual vs population care
Continuum of care - what is primary prevention
Promoting and maintaining good health
- addressing wider health determinants - poverty, housing, education, employment and environment
- reducing the risk factors for disease and ill health
Continuum of care - secondary prevention
Early detection and treatment of causes of ill health
- screening programmes
- case finding
- care pathways for early diagnosis and treatment
Continuum of care - tertiary prevention
Optimal management of established conditions
- preventing/ limiting disease progression
- rehabilitation/improvement of functioning
- minimising disability
Continuum of care - end of life care
Supper for people approaching death
- planned care
- symptom control
- dignity and choice and control for patient
- Good communication between the patient, family and professionals
What are the changing needs for the Uk population
Increasing in number Increasing in age Increasing life expectancy Increasing prevalence of chronic illness - alcohol consumption - overweight and obesity Increased patient expectation - can treat everything Technological advances
Traditional methods of care
Disease based approach to to healthcare
Separate health and social care
Separate physical and mental health
Gaps in healthcare for the most vulnerable: older adults, long term physical and mental conditions - different places operate for the vulnerable persons different needs so have to be involved with multiple healthcare departments and agency to receive care - confusing and hard work for an elderly person
New integrated care
Patient and community perspective Combine processes across disciplines Integrate: - health and social care - primary, community, secondary and tertiary care - prevention and treatment services - population approach, patient centred care - professional and patient perspectives
New NHS structure
Plurality of healthcare providers: NHS, voluntary and private organisations
Local government and GPs decide
NHS England responsible for performance indicators and improvement:
1) prevent premature death
2) QOL for chronic patients
3) help recovery for ill health or injury
4) ensure positive experiences
5) treat in a safe environment, protect from avoidable harm
Key outcomes:
Increase healthy life expectancy taking account health quality and length of life
Reduce differences in life expectancy and healthy life expectancy between communities through greater improvements in more disadvantaged communities
What is health promotion?
The process of enabling people to increase control over and to improve their health
The combination of educational and environmental support for actions and conditions of living conductive to health
Example of health promotion:
Drink driving campaigns, tobacco controls, immunisation programmes, screening programmes water fluoridation
Health promotion can impact on primary, secondary and tertiary prevention
There are 3 approaches to health promotion
1) medical
2) behavioural
3) social-environmental
Medical approach includes
Health problem: disease categories E.g CVD, mental and physiological risk factors
Strategies: surgical and medical therapies
Target: high risk individuals
General approach: individuals
Actors: HCPs
Behavioural
Health problem: behavioural risk factors
Strategies: health education, social marketing, advocacy for public policies
Target: high risk group
General approach: individualised with elements of public policy
Actors: public health, patient groups, government. HCPs
Socio-environmental
Health problem: psychosocial/soci-env risk (poverty)
Strategies: commuiy development and political action
Target: high risk societal conditions
General approach: focused of political/economic policy
Actors: citizens, social organisations, political movements
Target groups in health promotion:
High risk approach: Identify high risk and target intervention here Large benefit to those at risk Little benefit to wider population E.g. CVD screening
Population approach: Target whole population Small changed at individual level Substantial population benefit E.g, north Karelia project on Finland reduce CVD and it worked
To actions of health promotion:
1) Prevent unhealthy behaviours - sun cream, helmet, seat belt
2) promote healthy behaviours - exercise, healthy eating campaigns, smoking campaigns
Theories of health promotion- individual
Theory based on individual approach
- health belief model
Focus: individual perceptions of threat from the health problem and the benefit of avoiding the threat
Key concepts: precontemplation, contemplation, decision, action and maintenance
Theory of health promotion - interpersonal level
Social cognitive theory:
Focus : personal factors, environmental factors, human behaviour, exert influence on each other
Key concepts: reciprocal determinism, behavioural capability, expectations, self efficacy, observational learning and reinforcements
Theory of health promotion - community level
Communication theory :
Focus: how different types of communication affect behavioural
Key concepts: agenda setting (media, public, policy) problem identification
Health promotions strategies:
Health communication: TV adverts, Bill boards, leaflets, food labelling, front of cigarettes packets
Health education: healthcare workers and community support - DESMOND. Education is important - not always enough to promote behaviour change
Self help - AA
Organisational change- school healthy eating drives only healthy food. Smoking ban
Policy - legislations seat belt law
2 branches : interventionists and libertarians
Role of the doctor in health promotion
Consider health promotion in a consultations
Ask about lifestyle
Offer advice and appropriate referral if necessary
Empower patients to mange chronic illness and offer support
Undertake public health research
Contribute to national reports
Advocacy and lobbying
Secondary prevention - screening
Identifying apparently healthy people who may be at risk of a disease or condition.
They can be offered information, further tests and treatment to reduce further risk or complications
How is screening carried out
Questionnaire depression scale Examination BP measurement Lab tests PAP smear Imaging - mammography Always some over lap between normal and abnormal groups, leading to negatives and false positives
Define sensitivity
True positive/ (true pos/false neg)
How good he test is at picking up the disease
Proportion of true positives compared to all positives
Problem is can pick up lots of people without the disease
Define specificity
How good is the test at correctly excluding those without the condition
Proportion of true negatives given out of those without the disease
True negatives/ true neg + false pos
How likely the result given is correct
Positive predictive value - how likely the positive result given is correct
True positive / true positive + false neg
Negative predictive value - how likely the negative result is correct
True negative / true neg + false pos
Prevalence of a disease
Positives over all the rest
Difference between screening test and screening programme
Test is the sorting of the week people who probably have the disease from those who probably do not
And the programme is the systematic invitation of an agreed population of apparently healthy individuals to undertake a screening test
Associated risks of the result of screening tests
So all screening tests have some negatives which lead to a decreased attendance such as inconvenience of time, place, around work and children. There can be fear associated with it some tests can hurt slightly or be uncomfortable. Fear associated with results.
Associated risks of a true negative, true positive, false negative and false positive.
True negative - just the associated risks of the test itself such as the radiation and possible discomfort of the mammogram
True positive - fear of the future, actually have the cancer so need further tests and treatments
False positive- further tests that are invasive and not necessary
False negative - think you are fine and then go on to have the disease possibly discovered at a ,after stage which may lead to a porter prognosis
Criteria for screening
Disease/ conditions can be treated there is a treatment plan in place for those identified
Disease has a latent period where it can be picked up in an apparently healthy individual
Cost and benefits of the screening programme need to be weighed up cost more to screen than treat those who present at a later stage
Natural history of the disease - how it develops
Suitable test - not to invasive can be applied to all population being tested relatively easily
What is the national screening committee ?
Advises ministers on all aspects of screening policy - including latest research evidence, multidisciplinary expert groups, patient and service users
Assess proposed new screening programmes against criteria to ensure they do more harm than good at a reasonable cost
Criteria used:
- there is knowledge of the disease natural history it has a latent period and first prevention is implemented
- effective treatment is available, there is policy on who to treat and adequate facilities are available
- the programme has RCT evidence info is understandable to those screened, the test is clinically, socially and ethically acceptable, benefits> harms, value for money
- the test is suitable, simple, safe, valid, precise, valid acceptable, agree suitable cut offs and an agreed policy for a positive result
Influencing screening policy
Media in the US changed age for screening programme
Celebrities used unwittingly in screening programme adverts
Biases for screening
Volunteer/ detection bias those that show up are a certain category of people they are educated to show up - may have a family history or friends with the disease so more likely to attend usually lower risk than those who do not show up - usually more health aware so don’t have poor lifestyle choices that may lead to cancer for example
Lead time bias those who have the test may be detected early so live ‘longer with the disease’ but die at the same time as those not screened but presented it may seem that those screened lived longer but they don’t they live the same time as those not screened just that they presented at a later stage if they were screened they would live the same time.
Length time bias: those who are screened and detected usually have a less aggressive disease than those who present to the GP so seems like the live longer but they have a less aggressive disease with a longer latent phase than those who present to the GP
What is tertiary prevention
Using measures available to reduce or limit impairments and disabilities and promote the patients adjustment to irremediable conditions
Imported function and minimise impact of established disease: prevent and delay complications and subsequent events through management and rehab
Disease is not acute and treatment is not curative just reversing the impact
Boundaries of tertiary prevention
Lack of clear margins: chronic disease and chronic symptoms
Ongoing process: no end points
Multimodal, long term interventions, poor evidence
Poor consensus in medical profession e.eg using glycaemic index as an indicator of diabetic control
Concept of wellness
Types of tertiary interventions
Clinical - medication and surgery
Allied/collaborative : physio, psychological, occupational therapy
Societal interventions- minimising disability
Examples of tertiary intervention
Stroke rehabilitation
Cardiac rehabilitation
Renal disease
Types of tertiary prevention
Rehabilitation, post critical illness, CBT, medication adherence strategies, mental health relapse prevention, dietary advice, routine reviews, self management plans, community support groups
Chronic disease pyramid
Level 1 self care and management
Level 2 disease/ care management
Level 3: case management
What is palliative care
Active holistic care of patients with advanced progressive illness. Management of pain and other symptoms of incurable illnesses. Supporting patients and their families through difficult times.
Provision of psychological, spiritual and social needs addressed. - QOL for patients and their families
Supportive care vs palliative care
Palliative care is the active treatment process for an incurable disease
Supportive care is the support the patient and the family received throughout the treatment process to the end of life stage
What do the holistic aspects concern
Physical pain can impact psychological wellbeing and vice versa. Social impact such as lack of money can impact psychological problems and also spiritual needs not being met can impact other aspects.
Gold standards framework 7cs
Communication Coordination Control of symptoms Continuity of care Continued learning Carer support Care in the dying phase
Advanced care planning
Advanced statement - guide clinicians formalise patients wishes but is not legally binding
Advanced decisions to refuse treatment same and the other guide clinicians but is legally binding
Barriers to end of life care
Lack of communication and referral of palliative care centres
Lack of availability of services
Lack of advance care plans
Lack of recognition of the expert family who have looked after the patient for much longer and have insight into the condition when this is overlooked the patients do not receive the full care they need and deserve
Liverpool care pathway
Controversy around it some patients treatment was poor
So in July 2013 it was changed phased out an individual care pathways were introduced
Unless there is a very good reason a decision to withdraw treatment should not be taken away during any out of hours period
Understanding the epidemiology of dying?
Would you be surprised if the patient were to die in the next few months weeks days?
General indicators of decline - deterioration, increasing need or choice for no further active care
Specific clinical indicators related to certain conditions
