Long Term Conditions

Question 1

What is the patient being at the centre of care known as?

Answer 1

Patient centred care

Question 2

Who is the only person in the position to make decisions on what patient centred care means to them?

Answer 2

The patient

Question 3

What are the principles and values that define patient-centreness brought together by?

Answer 3

International Alliance of Patients’ Organisation (IaPO) declaration

Question 4

What are the 5 principles of the International Alliance of Patients’ Organisation (IaOP) declaration?

Answer 4

Respect

Choice and empowerment

Patient involvement in health policy

Access and support

Information

Question 5

Is the prevalence of long term conditions increasing or decreasing?

Answer 5

Increasing

Question 6

What can the handicaps of long term conditions impact in terms of well-being?

Answer 6

Physical, social and psychological well-being

Question 7

Who are chronic conditions most prevalent in?

Answer 7

Older people and deprived groups

Question 8

In terms of GP appointments, outpatient appointments and inpatient bed days, what percentage do chronic conditions account for?

Answer 8

50% of all GP appointments

64% of all outpatient appointments

Over 70% of all inpatient bed days

Question 9

What is incidence?

Answer 9

Number of new cases of a disease in a population in a specified period of time

Question 10

What is prevalence?

Answer 10

Number of people in a population with a specific disease at a signle point in time or in a defined period of time (existing cases)

Question 11

What does incidence tell us about?

Answer 11

Trends in aetiology of diseases and can plan for the future (such as increasing staffing for more clinics)

Question 12

What does prevalence tell us about?

Answer 12

Amount of disease in a population and is useful in assessing the current workload

Question 13

What is chronic disease usually the end result of?

Answer 13

Long term complex interactions between genetic and environmental factors (could be both or neither)

Question 14

In terms of chronic disease, what is meant by vulnerability?

Answer 14

Someone’s capacity to resist disease, repair damage and restore physiological homeostasis can be deemed vulnerable

Question 15

What is an example of an organ that repairs well, and one that does not?

Answer 15

The liver repairs well, the brain does not

Question 16

How can the natural history of diseases vary?

Answer 16

May have acute onset

May be gradual with a slow or more rapid deterioration

May be relapse and remission

Question 17

What are examples of diseases with an acute onset?

Answer 17

Stroke or MI

Question 18

What is an example of a disease with a slow or more rapid deterioration?

Answer 18

Angina

Question 19

What is an example of a disease with relapse and remission?

Answer 19

Cancer

Question 20

What can treatment be aimed at?

Answer 20

The disease, or the effect of the disease

Question 21

What is meant by the “burden of treatment”?

Answer 21

Patients and caregivers are often put under enormous demands by healthcare systems

Question 22

What kind of things cause “the burden of treatment”?

Answer 22

Changing behaviour or policing the behaviour of others to adhere to lifestyle modifications

Monitoring and managing their symptoms at home

Complex treatment regiments and multiple drugs (polypharmacy) contribute to the burden of disease

Complex administrative systems, and accessing, navigating and coping with uncoordinated health and social care systems

Question 23

What is biographical disruption?

Answer 23

Long term conditions lead to loss of confidence in the body

There is then loss of confidence in social interactions, or self-identity

Question 24

What is a consequence of biographical disruption?

Answer 24

People need to adapt to their condition, which involves redifining the ideas of what is good and bad such as positive aspects of their lives being emphasized

Question 25

What must be remembered about the visibility of long term conditions?

Answer 25

Some are visible and some are invisible, and some are both

Question 26

What can be said about the stigma of long term conditions?

Answer 26

Having a chronic condition subjects a person to possible stigmatisation by those who do not have the illness

Question 27

What does coping with stigma involve?

Answer 27

A variety of strategies including decision about whether to disclose the condition or attempt to conceal the condition or aspects of the condition and pass for normal

Question 28

Who can the impact of chronic conditions be on?

Answer 28

The individual Family Community/society

Question 29

What are examples of the impact of chronic conditions on the individual?

Answer 29

Can be negative or positive, could include denial, self-pity and apathy

Question 30

What are examples of the impact of chronic conditions on the family?

Answer 30

Can be financial, emotional and physical Other members could become ill as a result

Question 31

What is the patient becoming very knowledgable about their chronic condition, perhaps even moreso than some doctors, called?

Answer 31

The expert patient

Question 32

What are the different definitions of disability?

Answer 32

Lacking on one or more physical powers such as the ability to walk or coordinate ones movements (dictionary) 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 (legal, Disability Discrimination Act) International Classification of Impairments, Disability and Handicap (ICIDH), updated with ICF which removes the terms disability and handicap

Question 33

What does ICF stand for?

Answer 33

International Classification of Functioning, Disability and Health

Question 34

What does ICF consider disability to be?

Answer 34

Body and structural impairment Activity limitation Participation restriction

Question 35

What does ICF mean by body and structure impairment?

Answer 35

Abnormalities of structure, organ or system function (organ level)

Question 36

What does ICF mean by activity limitation?

Answer 36

Changed functional performance and activity by the individual (personal level)

Question 37

What does ICF mean by participation restriction?

Answer 37

Disadvantage experiences by the individual as a result of impairments and disabilities (interactions at a social and environmental level)

Question 38

What are the 2 different models of disability?

Answer 38

Medical and social

Question 39

What is in the medical model of disability?

Answer 39

Individual/personal cause (such as accident whilst drunk) Underlying pathology (such as morbid obesity) Individual level intervention (such as health professionals advice individually) Individual change/adjustment (such as change in behaviour)

Question 40

What is the social model of disability?

Answer 40

Societal cause (low wages) Conditions relating to housing Social/political action needed (such as facilities for the disabled) Societal attitude change (such as use of politically correct language)

Question 41

What legislation protects people with disabilities?

Answer 41

Disability Discrimination Acts (1995 and 2005), only applies in N. Ireland now as has been replaced by the Equality Act 2010 in the rest of the UK

Question 42

What are your responsibilities as a doctor towards disability?

Answer 42

Recognise your attitudes will pass onto your patients and those who you treat Listen to your patients and learn Recognise your own age and culture may affect your views Co-ordinate the MDT Intervene in the form of rehabilitation