Long term conditions Flashcards
What is person centred care?
Only the patient is in a position to make a decision on what patient centered healthcare means to them, as an individual, in the treatments of their condition and the living of their life. (Treatment options, therapies and models of care)
The provision of care that places the patient at the centre ensuring that the healthcare system is designed to meet the needs and preferences of patients as defined by patients themselves.
What brings together the principles and values of patient centred care?
These principles and values are brought together in the International Alliance of Patients’ Organizations (IaPO) Declaration on Patient- Centered Healthcare.
What examples are there that a patient can decide on in patient centred care?
Treatment options, therapies, and models of care
What are the five principles of patient centred healthcare?
1) Respect
2) Choice and empowerment
3) Patient involvement in health policy
4) Access and support
5) Information
What are the complications of long term conditions
Physical, social and psychological well-being.
Constraints on family life,
Capacity to work
Unremitting physical discomfort (often chronic pain)
Who is most commonly affected by long term conditions?
The elderly - 58% of people >60yrs, compared to 14% <40yrs
More deprived
What percentage of GP appointments are due to long term conditions?
50%
What percentage of outpatient appointments are due to long term conditions?
64%
What percentage of inpatient bed days are due to long term conditions?
> 70%
What examples of degenerative chronic disorders?
- Parkinson’s disease
- Multiple sclerosis
- Arthritis
- Many others
What is incidence?
The number of new cases of a disease in a population in a specific time period
Tells us about trends in causation and the aetiology of disease.
What is 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
Tell us about the amount of disease in a population.
What can be the aetiology of a chronic disease?
- Genetic factors
- Environmental factors
- Both or neither
In terms of aetiology what effect is smoking on chronic disease?
An environmental factor - It will lead to a decrease in FEV1
What is vulnerability?
An individuals capacity to resist disease, repair damage and restore physiological homeostasis.
How can natural history describe variance in chronic disease?
- Acute onset = MI or stroke
- Gradual onset = COPD
- Rapid deterioration = Angina
- Relapse and remission = Cancer
What is the target of treatment in chronic disease?
- Directly at the disease
- Effect of the disease
- Coming to terms with the disease
What is the burden of treatment?
Patients and caregivers are often put under enormous demands by the healthcare systems
What components are there in the burden of treatment?
- Changing behaviour or policing the behaviour of others to adhere to lifestyle modifications
- Monitoring and managing symptoms at home
- Adhering to complex and often multiple drug treatment regimes
- Navigating the complexities of administrative systems with NHS
- Accessing, navigating and coping with uncoordinated health and social care systems
What is biographical disruption?
When a long term condition leads to a loss of confidence in the body, and from this follows loss of confidence in social interaction and self identity
What can biographical disruption lead to?
Loss of confidence leading to re-negotiating existing relationships
What needs to occur in terms of biographical disruption before a patient can adjust and cope better with their illness?
They need to come to terms with their condition/disease. This can involve redefining ideas of what good and bad is, such that the positive aspects of their lives are emphasised and the negative impact of the illness lessened
Example of an invisible long term condition?
Diabetes
Example of a visible long term condition?
Paraplegia
Example of a condition that is both visible and invisible?
Multiple sclerosis
How can someone cope with stigma of long term conditions?
A variety of strategies:
- The decision about whether to disclose the condition and suffer further stigma
- Attempt to conceal the condition or aspects of the condition to pass as normal.
What are the impacts of long term conditions on an individual?
- Can be negative or positive
- Can be in denial
- Self pity
- Apathy
What are the impacts of long term conditions on an family?
- Financial
- Emotional
- Physical
- Can become ill themselves
What are the impacts of long term conditions on a community/society?
Isolation of an individual
It is said that the success of a community can be judged on how it looks after its infirm members
What is an expert patient?
A patient who understands a great detail of their disease.
This knowledge should be used as a resource with the patient being listened to and becoming a key decision maker in the treatment process.
How does WHO define disability ?
International Classification of functioning, Disability and health:
Body and Structure Impairment - Abnormalities of structure, organ or system function (organ level)
Activity Limitation - Changed fuctional performance and activity by the individual (personal level)
Participation Restrictions - Disadvantage experienced by the individual as a result of impairments and disabilities (interaction at a social and environmental level)
Who wrote about stigma?
Nurs, 2000
Who wrote about biographical distribution?
Bury, 1988
Bury describes how 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, this process he terms ‘biographical disruption’.
What is the definition of disability in the dictionary?
Lacking in one or more physical powers such as the ability to walk or coordinate ones movements
What is the definition of disability in law?
Disability Discrimination Act - 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.
Medical model 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
Social model of disability?
- Societal cause e.g. low wages
- Conditions relating to housing
- Social/Political action needed e.g. facilities for disabled
- Societal attitude change e.g. use of politically correct language.
What is participation restriction?
Disadvantage experienced by the individual as a result of impairment and disability (Interaction at a social and environmental level)
Rights?
- Disability Discrimination Acts 1995 and 2005
- Equality Act 2010
Your responsibility within long term illness?
- Your attitude will pass on to the patient and people you teach
- Listen to your patient and learn
- Your age and culture can impact you view be mindful of this
- Try to learn how to truly empathise
What can determine a personal reaction to disability?
- 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 e.g. 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 (Parsons 1951)?
Consider possible “benefits” of illness – social, familial, psychological, financial, medications, responsibilities.
What is the epidemiology of disability?
- Congenital
- Injury
- Communicable Disease
- Non-Communicable Disease
- Alcohol
- Drugs-iatrogenic effect and/or illicit use
- Mental Illness
- Malnutrition
- Obesity
What occurs with disability as there is a rise in age?
Prevalence and severity increase
What ratio of those with disability are still in employment?
1/3rd
What are the considerations within Wilson criteria?
Screening for a disease:
- What issues are raised by screening?
- What about conditions we cannot treat, or do not know how to treat?
- Can you think of any ethical issues that might arise in relation to screening?
What are the considerations within Wilson and Jungner criteria for screening?
1) Knowledge of disease
2) Knowledge of test
3) Treatment for disease
4) Cost considerations
Wilson and Jungner criteria for screening - Knowledge of disease?
Knowledge of disease:
- The condition should be important.
- There must be a recognisable latent or early symptomatic stage.
- The natural course of the condition, including development from latent to declared disease, should be adequately understood.
Wilson and Jungner criteria for screening - Knowledge of test?
Knowledge of test:
- Suitable test or examination.
- Test acceptable to population.
- Case finding should be continuous (not just a ‘once and for all’ project).
Wilson and Jungner criteria for screening - Knowledge of treatment?
Treatment for disease:
- Accepted treatment for patients with recognised disease.
- Facilities for diagnosis and treatment available.
- Agreed policy concerning whom to treat as patients.
Wilson and Jungner criteria for screening - Knowledge of cost considerations?
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.
