HES Flashcards
What are the conditions required for good health?
Peace, shelter, education, food, income, stable ecosystem, sustainable resources, social justice and equity
What is the WHO definition of a health system?
Organisations, people and actions whose primary intent is to promote, restore and maintain health.
What is the WHO definition of health?
A state of complete physical, mental and social wellbeing not merely the absence of disease or infirmity.
Positive concept emphasising social and personal resources as well as physical capacities.
What are the key concepts of health systems?
- Continual improvement of health status of individuals/ families/ communities
- Defence against health threats
- Protect against the financial consequences of bad health
- Equitable access to people centred care
- Assisting people to participate in decisions affecting their health
What is public health?
The science and art of preventing disease prolonging life and promoting health through the organised efforts of society.
Wheat does public health include?
Health improvements- inequalities and lifestyles
Health service improvements- service planning and equity
Health protection- Infectious diseases and environmental hazards, less concerned with individual patient care.
What is the individual healthcare context?
- Individual health needs identified
- Healthcare delivered and evaluated at individual level
- Focus on individual patient rights
- Dr advocates for individual
What is the population healthcare context?
- Population health needs identified
- Healthcare delivered and evaluated agt a population level
- Focus on equity and social justice
- Drs advocate for communities / patient groups
- Equity
- Social justice
- Advocate for populations
What is the healthcare continuum?
- Promoting and maintaining good health- PRIMARY PREVENTION- address wider health determinants, reduce risk factors for disease
- Early detection and treatment of causes of ill health- SECONDARY PREVENTION- screening, case findings, care pathways for early diagnosis and treatment
- Optimal management of established disease- TERTIARY PREVENTION- limit disease and progression, rehab, improve function and minimise disability
- Support people approaching death- END OF LIFE CARE- planned care, symptom control, dignity, choice control, gd communication
What are the causes of changing healthcare requirements?
Ageing population Migration Chronic diseases TB Travel Ethnic mix Antibiotic resistance Communicable disease issues
What is integrated care?
Organised delivery of health and social care from patient or community perspective.
- Combine care across disciplines
- Integrate services
- Health and social care
- Primary, community, secondary and tertiary care
- Population approaches and patient centred care
- Professional and patient perspectives
What are the 5 themes of the Health and Social care act 2012?
A- Clinically led commissioning B- Increased patient involvement C- Focus on public health D- Focus on quality of healthcare E- Healthcare market competition in best interests of patients
What are the priorities of the 5y forward view?
- Prevention- quality, empower patients and engage in communication
- Healthcare support in homes
- Modern maternity services
- Specialised care centres
- Urgent and emergency care networks
- Primary and acute care systems
- Multispecialty community providers
What are the themes of the local authority health improvement and protection?
Prevent poor housing impacting on health
Lifestyle information and advice
Nutrition, physical activity, workplace and health initiatives
Health improvement research
National child measurement programme
Ensure local health protection arrangements
What are the 3 strands to quality of care in NHS England?
1) Patient safety
2) Clinical effectiveness
3) Patient experience
What is primary prevention?
Preventing disease or injury before it occurs, immunisation, laws enforcing safety of equipment at work
What is secondary prevention?
Reducing the impact of disease or injury
Screening programmes, low dose aspirin/ diet and exercise to reduce risk of health problems
What is tertiary prevention?
Softening the impact of long term health effects, rehab to improve QoL, support groups
What is the difference between health prevention and promotion?
Prevention is the medical model focussing on specific diseases and groups and promotion is a holistic model promoting to give general benefits with a whole pop approach
What are the 3 approaches to health promotion?
Medical, behavioural and socio-environmental
How does medical health promotion work?
Health problem identified eg. CVD Targets at risk individuals Individual approach Surgical/ medical therapy/ medical management of behaviour as intervention Provided by Drs and HCPs
How does behavioural health promotion work?
Health behaviour identified eg. smoking
Targets high risk groups
Individual or population approach
Health education or public health intervention
Provided by public health, pt groups, local govs
How does socio environmental health promotion work?
Identifies env problem eg. isolation/ poverty/ pollution
Targets high risk societal conditions
Community approach
Intervention os community development, political action
Citizens and political movements provide it
What are the 2 target approaches for health promotion?
High risk - few at high risk - large benefit to those few - limited effect at population level - eg. CV screening in primary care Population - target whole population - small changes at individual level - substantial population benefit
What is the health belief model?
Targets individual
Perceptions of threat, benefits of avoiding threat, perceived susceptibility, severity, benefits, barriers, self efficacy
What is the stages of change model?
Readiness to change behaviour, attitudes and norms, intention, attitude, subjective norm, behavioural control
What is the precaution adoption process model social?
Journey from lack of awareness to action and maintenance. Unaware, unengaged, decide about acting, acting, maintenance
What is the social cognitive theory?
Targets interpersonal level
- Personal, environmental factors, behaviour
- Capability, self efficacy, expectations, reinforcements
What are the steps on the intervention ladder?
Do nothing and monitor
Provide info- inform and educate the public
Enable choice- participation in schemes and enable to change behaviour
Guide choice through disincentives- influence not to pursue activities
Guide choice through incentives- e.g. tax breaks to purchase bikes
Restrict choice
Eliminate choice
What is health communication?
Health promotion strategy
TV, billboards, leaflets, food labels
What is health education?
Health promotion strategy
Opportunity for learning, manage disease or condition in a 1:1 group session or school based education
What is self help/ mutual aid?
Health promotion strategy
Alcoholics ananymous, weight management
What is organisational change?
Health promotion strategy
Supportive environment to enable healthy choices
What is community development/ mobilisation?
Health promotion strategy
Local concern, petition and action
What is policy / legislation?
Health promotion strategy
Legislation is enforced by law
Policy is POA to guide adherence to legislation
What is the role of a Dr in health promotion?
Should be in all consultations Advocacy and lobbying Ask about lifestyle Offer advice and referral Empower pt to manage disease Public health research Role model Info/ education Aim at primary prevention Self help leaflets Tailor to pt Raise awareness Education/ surveillance
What is screening?
Process of identifying apparently healthy people who may be at an increased risk of a disease or condition. Offer testing and info to reduce risk.
Can lead to the early detection of disease, precursors and susceptibility.
How can screening be done?
Questionnaire, examination, lab test, imaging
What is sensitivity?
How good is a test at picking up those with disease?
a/a+c
What is specificity?
How good is a test at picking up those without the disease?
b/b+d
What is the positive predictive value?
If test is + how likely is it you do have the disease?
a/a+b
What is the negative predictive value?
If the test is - how likely is it you don’t have the disease?
d/c+d
How do screening and testing programmes work?
Systematic invitation of an agreed population of healthy individuals then further investigation and assessment of those screening positive.
What is the criteria used by the NSC?
The condition / knowledge of the disease is important, has a latent phase, natural history is understood, primary prevention is implemented.
The test is suitable and valid, agreed suitable cut offs, agreed policy for +s
The programme has RCT evidence of effectiveness, info is understandable by those screened, clinically, sociably and ethically acceptable, benefits>harm, value for money
What is lead time bias?
Time by which diagnosis is advanced because of screening leading to apparent increased survival
What is length time bias?
Long pre clinical phase more likely to be detected by screening and usually have better prognosis
Give a detailed definition of tertiary prevention
Using measures to reduce or limit impairments and disabilities and to promote the patients’ adjustment to irremediable conditions. Improve function and minimise impact of established disease; prevent and delay complications and subsequent events through management and rehab.
What are the 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 the medical profession
What are the key characteristics of tertiary prevention?
The patient has established disease
Focus of prevention is to improve functioning and prevent gradual decline
Intervention begins after the acute disease process has run its course
Timescale for receipt of benefits
What are the types of tertiary prevention?
Clinical interventions - surgical, pharmacological
Allied/ collaborative interventions - physio, psychological, occupational therapy
Societal interventions- minimising disability
What is the tertiary prevention ‘shopping list’?
Rehabilitation Post critical illness Cognitive behavioural therapy Medication adherence strategies Mental health relapse prevention Dietary advice Routine reviews Self management plans Community support groups
What is palliative care?
Looking after people with incurable diseases, relieving their suffering and supporting them through difficult times.
What are the principles of palliative care?
Improve the QoL of pts and families with terminal illness by preventing and relieving suffering by identifying and relieving pain and other physical, psychosocial spiritual etc problems. Helps regard dying as a normal process, neither hastens nor postpones death, integrates psychosocial and spiritual care, is a support system to allow patients to live as actively as possible up to death and helps the family cope with bereavement.
Define end of life care
Enables the supportive and palliative care needs of the pt and family to be identified and met throughout the last phase and into bereavement including management of pain, symptoms and psychosocial and spiritual aspects.
Define supportive care
Care helping the pt and family to cope with their condition and its treatment from pre diagnosis through to death and bereavement.
Define palliative care
Active total care of patients whose disease is unresponsive to treatment. Control of symptoms pain and mental health. Achieve the best QoL
What are the 4 areas of a holistic approach to palliative care?
Physical, psychological, social and spiritual
When can palliative care be provided?
At the same time as other treatments to complement what is already going on and make the care more holistic.
What is the difference between spectacular and subtacular admission?
Spectacular- acute crisis, care prioritised, more ED staff.
Subtacular- lower priority, worsening of an established chronic condition
What is the end of life care strategy DOH 2008?
Covers all conditions, settings and is in a legal framework.
What are the aims of the EOL care strategy?
To bring about a step change in quality of care for people approaching the end of life.
To enhance the choice at the end of life
Deliver gov manifesto commitment to double investment in palliative care.
3 triggers that suggest a pt is nearing the end of their life
1) ‘Would you be surprised if…’
2) General indicators of decline, deterioration, increasing need or choice for no further active care
3) Specific clinical indicators related to certain conditions
What is scarcity?
Central problem addressed by the discipline of economics- resource scarcity.
The purpose behind economic analyses- to help decision makers faced with choices concerning resource scarcity.
What is a normative economic stance?
Economic analyses indicate the nature of the resource allocation decision that ought to be followed if certain objectives are to be achieved.
What is a positive economic stance?
Economic analyses seek to predict observable factors and so provide information on the likely costs and benefits associated with alternative courses of action.
What is opportunity cost?
The value of resources forgone by choosing to deploy resources in one way rather than in their best alternative use.
What is technical efficiency?
Producing output in the best way possible without wasting resources, meeting a given objective at the least cost
What is allocative efficiency?
Producing the pattern of output that best satisfies the pattern of the consumers’ wants or needs
What are the key objectives for economic analysis?
To promote the efficient use of health care resources
To ensure the maximum total benefit is derived from the finite resources available
Define economic evaluation
A comparative analysis of alternative courses of action in terms of both costs and consequences
What are the outcomes of cost effectiveness analysis?
Must choose one outcome- lives saved or increased survival
What are the outcomes of cost utility analysis?
Must consider QoL and QALYs
What are the main types of economic evaluation?
Cost consequence analysis Cost effectiveness analysis Cost minimisation analysis Cost utility analysis Cost benefit analysis
What is the incremental approach to economics?
Would answer- what is the difference in costs and the difference inconsequences of option A compared to option B
What is marginal benefit?
Increasing in benefit as a result of increasing production by one additional unit.
What is marginal cost?
Increasing in cost as a result of increasing production by one additional unit.
What is the incremental cost effectiveness ratio?
ICER= (difference in cost)/(difference in consequence)
What is cost effectiveness analysis?
Results in terms of cost per unit effect, can address technical efficiency questions. Decision rule is dominance or CE ratio
What is cost utility analysis?
Outcomes in QALYs gained
Combine life years and QoL
Results in cost per additional QALY gained
Can be used to compare across treatment areas
Decision rule- dominance or CU ratio
What needs to be identified in an economic health perspective?
Relevant costs and outcomes these depend on perspective of analysis-
Health service
Public sector
Patient
Society
Depends on type of economic evaluation- cost effectiveness analysis, cost utility analysis
What outcomes are looked at?
Clinical outcomes, measured in natural units, proxy outcomes, condition specific measures, and generic measures- life years gained
What are the advantages and disadvantages of clinical outcomes?
Advantages- part of a clinical study, easily understood/ transparent to clinicians/ decision makers
Limitations- lack of comparability across different disease areas, what does the unit actually mean?
What happens if there’s more than one outcome?
If there are multiple outcomes with high or low cost and large or moderate impacts in QoL, what happens?
Valuing health- QALYs combine length and quality of life into one unit, weight life years and look at cost per QALY
What is a QALY?
Combines length and quality of life, max value = 1, used to weight life years. QALY = sum(length of life) x QoL
How are QALYs calculated?
Prognosis with treatment - Prognosis without treatment= total gain in QALYs.
Where does the information (for QALYs) come from?
Life years- life tables and literature
QoL- value judgement
- questionnaires with predetermined weights
- direct measurement from health state description
- published values in literature
