Long-term conditions

Question 1

75 year old lady, retired.
No recent appointments at the surgery since her usual GP retired.
Why might she not have attended recently?

Answer 1

1. Long-standing relationship with usual GP (trust, person-centered relationship)
2. Worried about new relationship with new GP
3. Has symptoms concerning her and is avoiding presenting due to worry about concerning problem being found
4. Might have been well

Question 2

What is person-centered care?

Answer 2

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.

Question 3

What are the five principles of patient-centered health care?

Answer 3

1. Respect
2. Choice and empowerment
3. Patient involvement in health policy
4. Access and support
5. Information

Question 4

Which groups of people have higher prevalences of developing long-term conditions?

Answer 4

1. Older people

2. More deprived people

Question 5

Long-term conditions account for what percentage of all GP appointments?

Answer 5

50%

Question 6

Long-term conditions account for what percentage of all inpatient bed days?

Answer 6

64%

Question 7

Long-term conditions account for what percentage of all outpatient appointments?

Answer 7

70%

Question 8

Define incidence

Answer 8

The number of new cases in a disease in a population in a specified period of time.

Question 9

Define prevalence

Answer 9

The number of people in a population with a specific disease at a single point in time or in a defined period of time.

Question 10

Define vulnerability

Answer 10

An individuals capacity to resist disease, repair damage and restore physiological homeostasis
(Different organs have different levels of vulnerability)

Question 11

What are demands placed by healthcare systems on patients and caregivers (burden of treatment)?

Answer 11

1. Changing behavior or policing the behavior of others to adhere to lifestyle modifications
2. Monitoring of managing symptoms at home
3. Complex treatment regimes and multiple drugs (polypharmacy)
4. Complex administrative systems, and accessing, navigating, and coping with uncoordinated health and social care systems

Question 12

Define biographical disruption

Answer 12

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

Question 13

What does biographical disruption involve?

Answer 13

1. `re-negotiating’ existing relationships at work and at home
2. make some sense of their condition before they can begin the process of `adjusting’ to it
3. redefining ideas of what is good' and bad’, such that the positive aspects of their lives are emphasized, and the negative impact of the illness lessened.

Question 14

How do people with long-term conditions cope with stigma?

Answer 14

1. disclose the condition and suffer further stigma
   Or
2. attempt to conceal the condition or aspects of the condition and pass for normal

Question 15

Example of visible long-term condition

Answer 15

Paraplegia

Question 16

Example of invisible long-term condition

Answer 16

Diabetes

Question 17

Example of both visible and invisible long-term condition

Answer 17

Multiple sclerosis

Question 18

Impact of long-term conditions

Answer 18

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

Question 19

What is the dictionary definition of disability?

Answer 19

Lacking in one or more physical powers such as the ability to walk or coordinate ones movements

Question 20

What is the legal definition of disability?

Answer 20

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.

Question 21

What is the WHO’s first definition of disability?

Answer 21

1. Body and Structure Impairment: Abnormalities of structure, organ or system function (organ level)

Question 22

What is the WHO’s second definition of disability?

Answer 22

2. Activity Limitation: Changed fuctional performance and activity by the individual (personal level)

Question 23

What is the WHO’s third definition of disability?

Answer 23

3. Participation Restrictions: Disadvantage experienced by the individual as a result of impairments and disabilities (interaction at a social and environmental level)

Question 24

List 4 medical models of disability

Answer 24

1. Individual/personal cause e.g. accident whilst drunk
2. Underlying pathology e.g. morbid obesity
3. Individual level intervention e.g. health professionals advise individually
4. Individual change/adjustment e.g. change in behaviour

Question 25

Last 4 social models of disability

Answer 25

1. Societal cause e.g. low wages
2. Housing conditions
3. Social/Political action needed e.g. facilities for disabled
4. Societal attitude change e.g. use of politically correct language.

Question 26

What does personal reaction to disability depend on?

Answer 26

1. The nature of the disability
2. The information base of the individual (ie education, intelligence and access to information)
3. The personality of the individual
4. The coping strategies of the individual
5. The role of the individual (loss of role, change of role)
6. The mood and emotional reaction of the individual
7. The reaction of others around them
8. The support network of the individual
9. Additional resources available to the individual (i.e. good local self-help group, socio-economic resources)
10. Time to adapt (i.e. how long they have had the disability)

Question 27

What is ‘The Sick Role’?

Answer 27

A concert that concerns the social aspects of becoming ill and the privileges and obligations that come with it.

Question 28

What are worldwide causes of disability?

Answer 28

1. Congenital
2. Injury
3. Communicable Disease
4. Non-Communicable Disease
5. Alcohol
6. Drugs-iatrogenic effect and/or illicit use
7. Mental Illness
8. Malnutrition
9. Obesity

Question 29

What types of disruption can disability cause?

Answer 29

Personal - impaired quality of life
Economic - On health care system (cost burden)
Social

Question 30

In the UK, what percentage of the disabled population is employed?

Answer 30

33%

Question 31

What is the Wilson and Jungner criteria for screening?

Answer 31

Wilson and Jungner criteria for screening

1. Knowledge of disease:
2. Knowledge of test:
3. Treatment for disease:
4. 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.

Question 32

According to the Wilson and Jungner criteria for screening, what is meant knowledge of the disease?

Answer 32

1. The condition should be important.
2. There must be a recognizable latent or early symptomatic stage.
3. The natural course of the condition, including development from latent to declared disease, should be adequately understood.

Question 33

According to the Wilson and Jungner criteria for screening, what is meant knowledge of the test?

Answer 33

1. Suitable test/examination
2. Test acceptable to population
3. Case finding should be continuous (not just a ‘once and for all’ project)

Question 34

According to the Wilson and Jungner criteria for screening, what is meant by treatment for disease?

Answer 34

1. Accepted treatment for patients with recognised disease.
2. Facilities for diagnosis and treatment available.
3. Agreed policy concerning whom to treat as patients.

Question 35

According to the Wilson and Jungner criteria for screening, what is meant by cost considerations?

Answer 35

Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole.