Long-Term Conditions and Problem Solving Flashcards
Differences between acute and chronic illnesses
Acute illnesses more short-lived and amenable to cure with the demise of acute illness
Chronic illnesses have become increasingly prevalent due to ageing population causing a burden of disease on healthcare system
Examples of common chronic illnesses
Osteoarthritis
Ischaemic heart disease
Respiratory disease
Persistent diseases that don’t lead to early death constitute an important group of health problems as patients may endure multiple handicaps affecting physical, social and psychological wellbeing, leading to
Constraints on family life
Failure to re-establich functional capacity to work
Unremitting physical discomfort e.g. chronic pain
What is the incidence?
Number of new cases
What is the prevalence?
Number of existing cases
What is pathophysiology?
Pathological basis of underlying disease
What is clinical disease?
The specific clinical consequence which results from the pathophysiological process
What is the illness episode?
Time between illness onset and offset
What is the response?
Pattern of decrease in symptoms and/or signs indicating decrease in severity of underlying pathological process
What is recovery?
Sustained period of health following illness episode when clinical features are no longer present or insufficient to warrant further investigation or change in treatment
What is remission?
Period following episode of illness to warrant the use of “recovery” - signs and symptoms have lessened in insufficiency and remain insufficient to warrant further investigation or treatment
What is relapse?
Reinstatement in clinical features following an episode of illness
What is recurrence?
Reinstatement of new episode of illness following abatement of clinical features of sufficient duration to warrant the term “recovery”
What is body and structure impairment?
Disturbance to body structures, organ or system function which presents at birth or arises from disease or injury and equates to the presence of clinical disease
What is activity limitation?
Restriction or lack of ability to perform activity in a manner or within a range considered normal
What is participation restriction?
Social construct depending on the meanings and values - social disadvantage for the individual resulting from activity limitation or impairment that limits or prevents role normal for that individual
WHO definition of health
Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity
Factors affecting aetiology of chronic disease
Long-term complex interaction of factors
Genetic factors
Environmental factors
What is vulnerability?
Individual’s capacity to resist disease, repair damage and restore physiological homeostasis
Important in extremes of life
Who might chronic illness impact?
Individual affected
Family
Community/society
How is an individual affected by chronic illness?
Positive or negative
Can include denial, self-pity or apathy
How is a family affected by chronic illness?
Financial
Social
Other family members may become ill as a result
Natural history of disease
Acute onset
Gradual with slow or rapid deterioration
Relapse and remission
Treatment is aimed at
disease or effect of disease
Factors affecting chronic illness
Stress and coping
Personality
Resilience
Illness behaviour
Coping strategies
Problem-solving Support-seeking Escape avoidance Distraction Cognitive restructuring
Coping strategy classification
Emotion focused - modifying response to problem
Problem focused - action to change or address stressor
What is resilience?
Positive capacity to cope with change, stress and adversity
Adapt successfully to challenges
Behaviour is influenced by
Attitude - positive or negative
Subjective norm
Perceptions of control over behaviour
Person is more likely to make a behavioural change if
They have a positive attitude towards it
It brings about consequences important to them
They believe others think it is important that they do it
They feel they have the necessary resources, skills or opportunities to overcome barriers
Stages of change
Pre-contemplation Contemplation Preparation Action Maintenance Relapse
How does stress affect health?
Prevents people from making rational health decisions
Stress hormones can exacerbate physical symptoms
Factors affecting symptom perception
Existing conditions
Psychological factors
Pain
Emotions
Psychological impact of chronic disease
Anxiety and depression
What is illness?
What the patient experiences when unwell
What is disease?
What the doctor sees and interprets and what action they suggest
Patient sick role
Exempt from daily responsibilities
Not responsible for being ill and unable to get better without help of health care professional
Must seek help from HCP
Under social obligation to get better as soon as possible to be able to take up social responsibilities again
Health care professional sick role
Must be objective and not judge patient morally
Must not act out of self-interest or greed but put patients interests first
Must obey to professional role of practice
Have and maintain necessary knowledge and skills to treat patients
Right to examine patient intimately, prescribe treatment and has wide autonomy in practice
Secondary gains from being classed as sick
Care and sympathy
Concern from family and friends
Financial allowances associated w/ disability
Using apparently disabling illness as explanation for failures
Avoiding work
Restoring status or domination in family
Achieving revenge for bad treatment or pay from employer or insurance company
Medical features of disability
Individual/personal cause
Underlying pathology
Individual level intervention
Individual change/adjustment
Social features of disability
Societal causes
Conditions relating to environment
Social/political action needed
Social attitude change
GMC good medical practice on disability
Doctors must not unfairly discriminate against patients by allowing their personal views to adversely affect their professional relationship with patients or the treatment they provide or arrange. This includes disability as well as many other factors. You should challenge colleagues who do not comply with this guidance and be aware of own attitudes and prejudices of disability and address this by finding out about common disabilities.
Equality act 2010 definition of disability
Disability is one of the characteristics protected under this legislation as well as age, race and sexual orientation. A person has a disability if they have a mental or physical impairment that has a continuing effect on their ability to perform day to day activities.
Disability discrimination act 1995 definition of disability
Person with disabilities is one with physical, sensory or mental impairment which has a substantial, adverse and long term (>12 months) effect on ‘normal’ day to day activities.
Causes of cognitive and physical under-development or physical limitation or absence
Genetic or chromosomal disorders
Accidents
Chronic disease
Medical models of disability
Disability intrinsic to individual and direct consequence of underlying disease
Reduction can only be achieved via amelioration of underlying pathology
Medical intervention means to restore “normality”
Social models of disability
Socio-cultural focus, disability placed outside individual
People not per se limited by medical condition but by behavior of others towards them and environmental conditions
Underpins legislation to remove barriers
Reduces limitations e.g. wheelchair access, hearing aid loop systems etc
Psychological models of disability
Describes how activities performed by someone with a health condition underpinned by same psychological processes of nondisabled person.
Includes motivation, mood disorders and self-efficacy. Also upbringing, resilience, coping and self-motivation
Also lived experience of disability including self image, social and economic marginalization, uncertainty about wellbeing and feelings of powerlessness.
Types of problem solving
Pattern recognition
Hypothetico-deductive reasoning
Inductive reasoning
When is hypothetico-deductive reasoning used?
To rapidly narrow down list of differential diagnoses
When is inductive reasoning used?
If nothing is known about the presentation, systematically consider what could be wrong
