Long-term conditions Flashcards
75 year old lady, retired.
No recent appointments at the surgery since her usual GP retired.
Why might she not have attended recently?
- Long-standing relationship with usual GP (trust, person-centered relationship)
- Worried about new relationship with new GP
- Has symptoms concerning her and is avoiding presenting due to worry about concerning problem being found
- Might have been well
What is person-centered care?
Provision of care that places the patient at the center, ensuring that the health care system is designed to meet the needs and preferences of patients as defined by patients themselves.
What are the five principles of patient-centered health care?
- Respect
- Choice and empowerment
- Patient involvement in health policy
- Access and support
- Information
Which groups of people have higher prevalences of developing long-term conditions?
- Older people
2. More deprived people
Long-term conditions account for what percentage of all GP appointments?
50%
Long-term conditions account for what percentage of all inpatient bed days?
64%
Long-term conditions account for what percentage of all outpatient appointments?
70%
Define incidence
The number of new cases in a disease in a population in a specified period of time.
Define prevalence
The number of people in a population with a specific disease at a single point in time or in a defined period of time.
Define vulnerability
An individuals capacity to resist disease, repair damage and restore physiological homeostasis
(Different organs have different levels of vulnerability)
What are demands placed by healthcare systems on patients and caregivers (burden of treatment)?
- Changing behavior or policing the behavior of others to adhere to lifestyle modifications
- Monitoring of managing symptoms at home
- Complex treatment regimes and multiple drugs (polypharmacy)
- Complex administrative systems, and accessing, navigating, and coping with uncoordinated health and social care systems
Define biographical disruption
When the experience of a long term condition (chronic illness) leads to a loss of confidence in the body, and from this follows a loss of confidence in social interaction or self-identity
What does biographical disruption involve?
- `re-negotiating’ existing relationships at work and at home
- make some sense of their condition before they can begin the process of `adjusting’ to it
- redefining ideas of what is
good' andbad’, such that the positive aspects of their lives are emphasized, and the negative impact of the illness lessened.
How do people with long-term conditions cope with stigma?
- disclose the condition and suffer further stigma
Or - attempt to conceal the condition or aspects of the condition and pass for normal
Example of visible long-term condition
Paraplegia
Example of invisible long-term condition
Diabetes
Example of both visible and invisible long-term condition
Multiple sclerosis
Impact of long-term conditions
On the individual – can be negative or positive. Can include denial, self pity and apathy.
On Family – can be financial, emotional and physical (may become ill as a result)
Community/society - isolation of an individual
What is the dictionary definition of disability?
Lacking in one or more physical powers such as the ability to walk or coordinate ones movements
What is the legal definition of disability?
Difficulty can be physical, sensory or mental. A disability that makes it difficult for them to carry out normal day to day activities, ongoing for more than 12 months.
What is the WHO’s first definition of disability?
- Body and Structure Impairment: Abnormalities of structure, organ or system function (organ level)
What is the WHO’s second definition of disability?
- Activity Limitation: Changed fuctional performance and activity by the individual (personal level)
What is the WHO’s third definition of disability?
- Participation Restrictions: Disadvantage experienced by the individual as a result of impairments and disabilities (interaction at a social and environmental level)
List 4 medical models of disability
- Individual/personal cause e.g. accident whilst drunk
- Underlying pathology e.g. morbid obesity
- Individual level intervention e.g. health professionals advise individually
- Individual change/adjustment e.g. change in behaviour
Last 4 social models of disability
- Societal cause e.g. low wages
- Housing conditions
- Social/Political action needed e.g. facilities for disabled
- Societal attitude change e.g. use of politically correct language.
What does personal reaction to disability depend on?
- The nature of the disability
- The information base of the individual (ie education, intelligence and access to information)
- The personality of the individual
- The coping strategies of the individual
- The role of the individual (loss of role, change of role)
- The mood and emotional reaction of the individual
- The reaction of others around them
- The support network of the individual
- Additional resources available to the individual (i.e. good local self-help group, socio-economic resources)
- Time to adapt (i.e. how long they have had the disability)
What is ‘The Sick Role’?
A concert that concerns the social aspects of becoming ill and the privileges and obligations that come with it.
What are worldwide causes of disability?
- Congenital
- Injury
- Communicable Disease
- Non-Communicable Disease
- Alcohol
- Drugs-iatrogenic effect and/or illicit use
- Mental Illness
- Malnutrition
- Obesity
What types of disruption can disability cause?
Personal - impaired quality of life
Economic - On health care system (cost burden)
Social
In the UK, what percentage of the disabled population is employed?
33%
What is the Wilson and Jungner criteria for screening?
Wilson and Jungner criteria for screening
- Knowledge of disease:
- Knowledge of test:
- Treatment for disease:
- Cost considerations:
Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole.
According to the Wilson and Jungner criteria for screening, what is meant knowledge of the disease?
- The condition should be important.
- There must be a recognizable latent or early symptomatic stage.
- The natural course of the condition, including development from latent to declared disease, should be adequately understood.
According to the Wilson and Jungner criteria for screening, what is meant knowledge of the test?
- Suitable test/examination
- Test acceptable to population
- Case finding should be continuous (not just a ‘once and for all’ project)
According to the Wilson and Jungner criteria for screening, what is meant by treatment for disease?
- Accepted treatment for patients with recognised disease.
- Facilities for diagnosis and treatment available.
- Agreed policy concerning whom to treat as patients.
According to the Wilson and Jungner criteria for screening, what is meant by cost considerations?
Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole.
