Improving Health Services Flashcards
What is qualitative research?
Collection and analysis of non-numerical information via formal research methods - allows the researcher to gain an understanding of the target population’s behaviors/attitudes/experiences - why and how
give examples of Qualitative data types
- Interviews
- Focus groups
- Letters/diaries
- Case notes
- Speeches
- Video diaries
- Internet conversations
- Observation notes
give examples of Qualitative research methods
- Content Analysis
- Grounded Theory
- Framework Analysis
- Protocol Analysis
- Ethnography
- Phenomenology
- Discourse Analysis
- Conversation Analysis
- Thematic analysis
- Interpretative Phenomenological Analysis (IPA)
What is a theme?
“Themes are recurrent and distinctive features of participants’ accounts, characterising particular perceptions and/or experiences, which the researcher sees as relevant to the research question”
• A theme can reflect a pattern of responses or meaning within the data
• The researcher’s judgement determines what a theme is
how are themes identified?
- Immersing in the data: read & re-read transcripts to familiarise with the depth and breadth of their content
- Coding transcripts: identifying ‘interesting’ data until data saturation (no new ideas emerge)
- Organising codes into meaningful groups (categories)
- Generating themes* – interpret relationships between categories, explain patterns within and between categories… to tell a story!
when are qualitative methods most useful?
When the research topic is:
- Concerned with interaction or process
- Complex
- Not quantifiable
- Sensitive
When the research objective is to:
- interpret, illuminate, illustrate
- understand how or why
- explore understudied research areas
- learn about few/hard to reach people
what are the Psychosocial aspects of prenatal testing
Ethical Social Cultural Policy and Practice Methodology expertise
what in particular influences attitude towards religion?
religion, community and family all influence attitudes (there are other factors)
Despite this, studies have shown people will bend the guidelines of religion if decisions are perceived personal; for example regarding reproduction, or have severe outcomes; for example the child would suffer greatly if not aborted.
give an example of qualitative research being used to make change
Down syndrome leaflets
Figured out using images of down’s children caused potential parents NOT to abort as it equated the termination with killing the person in front of them. Asking questions about this allowed change which has facilitated parents to make their own choice without bias.
what are the limitations of Qualitative research methods?
•Generalisability
– Sample selection based on certain experiences (not random)
– Sample size – often small
Reliability – findings are based on interpretations by the researcher, and therefore their Knowledge (depth & breadth) of the research topic, along with their Imagination and ability to identify ‘important’ findings
what are the Strengths of qualitative findings
- Unpredictable and insightful
* Usually unobtainable using a quantitative approaches based on preconceived ideas
what is commissioning?
‘the set of linked activities required to assess the … needs of a population, specify the services required to meet those needs within a strategic framework, secure those services, monitor and evaluate the outcomes’.
what is purchasing?
‘the process of buying or funding services in response to demand or usage’.
what is contracting
‘the technical process of selecting a provider, negotiating and agreeing the terms of a contract for services,
AND ongoing management of the contract including payment, monitoring, variations’.
what is Procurement
‘the process of identifying a supplier, and may involve for example competitive tendering, competitive quotation, single sourcing. It may also involve stimulating the market through awareness raising and education’.
what are the stages in the commissioning cycle?
Planning stage
Procurement Stage
Monitoring stage
what are important parts of the planning stage of the commissioning cycle?
- Health Needs Assessment
- Reviewing Current provision
- Identifying Gaps and Priorities
- Capacity Planning
what are important parts of the procurement stage of the commissioning cycle?
- Service Design/Redesign
- Defining Contracts
- Procuring Appropriate Services
- Managing Demand
what are important parts of the monitoring stage of the commissioning cycle?
- Monitoring Activity and Quality
- Invoicing and payment
- User and Local Authority Views
- Feedback
what skills does a commissioner need?
Personal Skills – Excellent listener – Outcomes focussed – Realistic – Resilient – Enabler – Honest broker
what are the proposed priorities set by the kings fund for Health and Social Care Commissioners?
- Support for self-management of disease
- Primary prevention
- Secondary prevention
- Reduce ambulatory care sensitive conditions (people who go to hospital who don’t need to)
- Improve management of patients with mental and physical health needs
- Better coordinated and integrated care
- Support for end of care life
- Effective medicines management
- Systemic approach to urgent care
what are the key themes of proposed priorities set by the kings fund for Health and Social Care Commissioners?
a more systemic approach to chronic disease management
the empowerment of patients
a population based approach to commissioning
more integrated models of care
what is NICE?
The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance for health and social care
why does NICE provide guidance?
Addressing inappropriate variations in clinical practice and “post-code” prescribing
It is impossible for clinicians to read and appraise all relevant evidence themselves
To help patients access care based on the best available research evidence
The need to apply established treatments of proven clinical and cost effectiveness
what guidance does nice aim towards the NHS?
- Technology appraisals – largely new pharmaceuticals
- Guidance on devices and diagnostics
- Medical technology guidance – cost saving
- Interventional procedures – safety and efficacy
- Clinical guidelines
What are clinical guidelines?
- Guidance on the appropriate treatment and care of people with specific diseases and conditions in the NHS.
- Based on evidence of clinical and cost-effectiveness
NICE also define standards
what are the Core principles of NICE guidance
- Comprehensive evidence base – not just RCTS
- Expert input - from clinicians, economists etc
- Patient and public involvement (Citizen’s Council)
- Independent advisory committees
- Genuine consultation with all stakeholders
- Regular review and updating
- Open and transparent process – meetings held in public.
what is Colloquial evidence
It includes evidence about values (including political judgement), practical considerations (resources, professional experience or expertise and habits or traditions) and the interests of specific groups (lobbyists and pressure groups).
where does NICE collect a lot of Colloquial evidence
Citizen’s Council
What are the Stages of guideline development?
topic referral scoping development consultation validation publication
what does NICE base their decisions on?
cost per QALY.
Nice also negotiates with producers of expensive medications to come to ‘deals’ that bring them within acceptable cost for their QALYs gained
what percentage of the population has three or more risk factors?
by 2008, about 25 per cent of the population reported having three or more risk factors, compared with more than 33 per cent in 2003.
what four behaviours are particularly linked to disease?
– tobacco use,
– physical inactivity,
– unhealthy diet
– harmful use of alcohol.
what is comorbidity?
Comorbidity is the presence of one or more additional disorders (or diseases) co-occurring with a primary disease or disorder; or the effect of such additional disorders or diseases. The additional disorder may also be a behavioural or mental disorder.
do comorbidities need to have the same cause, or be otherwise related?
yes.
medical conditions existing in the same patient with no link at all are known as MULTIMORBIDITIES.
how many people suffer from multiple conditions?
up to 80% in the oldest patients. note that
Estimates of prevalence of people suffering from multiple conditions vary widely
what is one of the most important comorbidities to consider and treat?
Physical and mental health comorbidity. Disabled people get depressed.
what social factor dramatically increases chance of suffering multiple health conditions?
socio-economic condition.
what aspect of care is more important in patient suffering many conditions?
social care
what are the 4 overarching themes of commissioning for patients who suffer multiple conditions?
- Systematic and proactive management of chronic diseases
- Empowerment of patients
- Population based approach to commissioning
- Integrated models of care
describe the trends in alcohol consumption
- For mild drinking being male and 45+ increases risk.
- For heavy drinking, being male and 16-24. Living in the north, being employed increase risk.
- You are more likely to smoke if you drink.
how much does the harmful use of alcohol costs the NHS in England
£3.5 billion a year and 8% of all hospital admissions
describe the trends in smoking
Generally going down
Unemployed, more deprived people smoke more, as do people in the north, centre of London and Yorkshire.
what measures are in place to decrease smoking prevalence?
- Smokefree campaigns
- Sale of tobacco
- Taxes and smoking laws
- Smoking restrictions
- Packaging?
what measures are in place to decrease alcohol consumption?
- Change4Life
- NHS Health Check
- Improving treatment (payment by results)
- Public Health Responsibility Deal
- Minimum pricing?
describe the trends in obesity
Generally rates going up
what conditions are men who are obese at highly greater risk of?
- Five times more likely to develop type 2 diabetes
- Three times more likely to develop cancer of the colon
- more than two and a half times more likely to develop high blood pressure – a major risk factor for stroke and heart disease.
what conditions are women who are obese at highly greater risk of?
- Almost thirteen times more likely to develop type 2 diabetes
- More than four times more likely to develop high blood pressure
- More than three times more likely to have a heart attack.
what measures are in place to try to reduce the public obesity problem?
- Food & Drink Federation: help people understand what they buy & eat
- New Policy Institute: poverty and income inequality
- BMA: ban advertising junk food
- PHE: “simple-swaps”
- Association for the study of Obesity: greater availability of interventions (including physical activity) to reduce weight
what can be said about risk factor clustering?
Smoking, heavy drinking, and a lack of fruit/ vegetable consumption are clustered. A lack of physical activity clustered additionally with a lack of fruit/vegetable consumption. In contrast, people who are physically active are more likely to smoke and to drink heavily.
are men and woman differently clustered in terms of risk factors?
The overall pattern of clustering was similar for men and women. However, the clustering was more pronounced for women than for men, especially between smoking and heavy drinking.
what social difference is likely to lead to a person having many risk factors for disease?
People in low Socioeconomic status are likely to have many risk factors
