Impact of long-term condition Flashcards
Person-centred care
- 5 principles
Patient at centre of decision making
International Alliance of Patients’ Organisation Declaration
- Respect
- Choice and empowerment
- Patient involvement in health policy
- Access and support
- Information
Increasing problem/prevalence
Epidemiology
- Incidence: number of new cases of a disease in a period of time (causation/aetiology)
- Prevalence: number of people in a population with a specific disease at a defined period of time (current healthcare workload)
More common in older and deprived groups
Older age - 58% of people over 60 - 14% of people under 40 Deprived - 60% higher prevalence and 30% more severe disease in poor social class
Long-term condition statistics
- 50% of GP appointments
- 64% of outpatient appointments
- > 70% of inpatient beds
Long-term conditions can lead to
Multiple handicaps
- Physical
- Social
- Psychological
Chronic pain can lead to
- Reduction in work capacity (1/3 with disability are employed)
- Other disabilities
- Constraints on family life
Broad impact
Individual
- Negative: denial, self-pity and apathy
- Positive: motivation
Family
- Financial
- Emotional
- Physical
- Contagious
Community/society
- Isolation of individual
- Community success judged on how it looks after ill members
Natural history
- Acute onset
- Gradual onset: rapid/slow
- Relapse and remission
Aetiology of long-term conditions
- Genetic factors
- Enviromental factors
- Both
- Neither
Variety of individuals’ responses to long-term conditions
Vulnerability
- Individuals capacity to resist disease, repair damage and restore physiological homeostasis
Stigmatisation
- Invisible/visible/both
- By those who are unaffected
- Coping: disclose or conceal condition
Treatment
- Resolve disease or treat symptoms
- Come to terms with chronic disease
- Admit failure in diagnosis or cure is necessary
Burden of Treatment
Demands/workload of healthcare and its effects on those with long-term conditions
- Lifestyle modifications
- Monitoring and managing symptoms at home
- Polypharmacy
- Complex admin system working with uncoordinated health and social care system
Biographical disruption
Long term condition leads to loss of body confidence
- in social interaction
- renegotiation
- need to make sense (good/bad) of condition before adjusting
Expert patient
Patient understands disease better than healthcare professional
- Key decision makers
Disease
Symptoms, signs, diagnosis (biomedical perspective)
Illness
ICE, patient perspective
Disability (WHO)
- Body and structure impairment
- Activity level/limitation
- Participation restriction
Epidemiology of disability (6)
- Congenital
- Injury
- Disease (non-/communicable)
- Alcohol/drugs (iatrogenic/illicit)
- Mental illness
- Malnutrition/obesity
WHO medical model of disability
- Individual cause (accident whilst drunk)
- Pathology (obesity)
- Individual intervention (health professional advice)
- Individual change (in behaviour)
WHO social model of disability
- Societal cause (low wage)
- Housing conditions
- Social/political action (facilities for disabled)
- Social changes (language)
Disability Legal rights
- Disability Discrimination Acts 1995 and 2005
Attitude towards disability
- Listen to patients and learn
- Take into account age and culture
- Ensure empathy
- Don’t spectate: assess, coordinate MDT, intervene with rehab
Factors affecting an individuals reaction to disability
- Nature of disability
- Information (education, intelligence, access to info)
- Personality
- Coping strategy
- Individual role
- Mood and emotional reaction
- Reaction of those around
- Support network
- Time to adapt
- Additional resources e.g. benefits
Sick role: patients
- Exemption from societal norms
- Not responsible for condition
- Should try to get better
- Seek professional help and cooperate
Sick role: healthcare professional
- Objective (not judge morally)
- Act for patient interest (not greed)
- Obey professionalism code
- Maintain necessary knowledge and skill
- Right to examine intimately and prescribe medication
Wilson and Jungner Criteria for screening
- Disease knowledge (recognisable latent/early stage, known natural course)
- Test knowledge (suitable, acceptable to population)
- Disease treatment (accepted, facilities available, agreed policy for whom to treat)
- Cost considerations (economically balanced)
