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Primary care > mid life practice > Flashcards

mid life practice Flashcards

1
Q

b) Quantifying the health of patients is a very difficult task, with various complexities which impact both the doctor and patient perspectives especially when tackling complex diseases such as CVD.

Name the algorithm used to calculate a persons risk of developing stroke or heart attack (1 mark)

A

q risk

/ qrisk3

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2
Q

c) As time has gone on, there has been a growing demand to assess the quality of primary care health outcomes. One such measure was introduced in April of 2004, known as QOFs.

What does QOF stand for? (1 mark)

A

Quality Outcomes Framework

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3
Q

d) Name three potential advantages to measuring primary care quality via QOFs (3 marks)

A
  • Reduce variability within practice (aka quality control)
  • Drive up standards
  • Provide data
  • Reward ‘good’ practice (incentivization)
  • Embed health promotion into primary care practice
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4
Q

e) Name three unintended consequences to using QOFs in primary care (3 marks)

A
  • Prioritising certain aspects of health promotion (emphasises profit motive)
  • Demotes Patient’s Agenda (no longer patient centric)
  • Undermines GPs autonomy
  • Encourages overtreatment
  • Policy before Evidence (increased bureaucracy etc)
  • Under-resourced
  • Underlined variability within practices
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5
Q

ADULT HEALTH PROMOTION

WHOSE RESPONSIBILITY?

A 
Government
Local Authorities
Public Health
Hospital Specialists
GPs
Nurses
Dietitians
Patients
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6
Q

ADULT HEALTH PROMOTION

IN PRIMARY CARE

A
  • ACCESS TO PATIENTS
  • HOLISTIC
  • LONG TERM CARE
  • CHEAP
  • EFFECTIVE
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7
Q 
EXPECTATIO
NS & 
TENSIONS IN 
THE GP 
CONSULTATI
ON
A
  • EXPECTATIONS
  • PREVIOUS EXPERIENCES
  • OTHER PEOPLE’S EXPERIENCES
• TENSIONS
• CHANGING ROLE OF GP AND ALLIED 
HEALTH CARE PROFESSIONALS
• CHANGING ROLE OF PATIENT
• CHANGE IN PUBLIC PERCEPTIONS AND 
TRUST OF THE MEDICAL PROFESSION
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8
Q 
CHANGING ROLES 
OF 
DOCTORS 
AND 
PATIENTS
A

Doctors – apothecaries to
professionals
Patients to agents– passive to
partners

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9
Q

what is it necessary for doctors to do (authority)

A
  • Ask personal questions
  • Conduct intimate examinations
  • Perform intrusive investigations
  • Persuade people to comply
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10
Q

difference between doctors an patients? (old view)

A 
Doctors-Authoritative
- Knowledge
• Ethical Principles
• Autonomy 
• Self-governance, 
• Self-regulation
• ?Self-interest
• Defensive

Patients - passive
• Little Knowledge
• Trust in clinical and ethical judgement
• See doctors as accountable to themselves
• Passive resistance

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11
Q

key changes in nhs?

A 
FEES FOR PATIENTS
• IMPROVEMENTS IN PRIMARY CARE 
DELIVERY
• SHIFT TOWARDS TREATMENT IN 
PRIMARY CARE 
• INCREASED SPECIALISATION
• CHANGES IN GENERAL MANAGEMENT
• INTRODUCTION OF AN INTERNAL 
MARKET
• QUALITY CONTROL
• INTRODUCTION OF PATIENT CHARTERS 
LISTING PATIENTS RIGHTS AND 
STANDARDS
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12
Q

difference between doctors and patients following changes?

A

Doctors - educators
• Knowledge (increasingly specialist, competence, EBM)
• Ethical Principles including public health
• Autonomy
• Self-regulation
• Self-interest
• Accountabilty

Patients- informed Consumers
• Knowledge more 
widely available
• Ethical Principles 
(Rationing)
• Anti – authoritarian 
(transparency, 
doctors as public 
servants)
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13
Q

NHS
REFORMs 1997-
2001

A 
INDEPENDENT STANDARD 
SETTING
• NICE
• CENTRE FOR HEALTH IMPROVEMENT
• NATIONAL SERVICE FRAMEWORKS
• HEALTH CARE COMMISSION

PATIENT SAFETY
• NATIONAL PATIENT SAFETY AGENCY
• NATIONAL CLINICAL ASSESSMENT
AUTHORITY

IMPROVED PERFORMANCE
• NHS MODERNISATION AGENCY

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14
Q

what is the CURRENT difference between doctors and patients?

A 
Doctor - partners
• Knowledge (increasingly specialist, competence, EBM)
• Ethical Principles - Reaffirmed
• Autonomy 
• Transparent
• Regulated
Patients - experts
- Knowledge more 
widely available
• Ethical Principles 
(Shared)
• Accountable
(doctors as public 
servants)
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15
Q

brief summary of change in doctor patient relationship from 60s to 80s to 2000s

A

doctor:
authoritative, advocate/advisor, educator, facilitator, partner

Patient:
Passive citizens, consumer, informed, particpant, expert

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16
Q

ONGOING
CHANGES TO THE
ROLE OF
GP

A 
GPS AS BUDGET HOLDERS 
• GPS AS PATIENTS’ MANAGERS, ADVOCATES, 
GATEKEEPERS
• CHARGE OF LONG TERM CARE
• HEALTH PROMOTION  
• PRIMARY & SECONDARY
• SCREEN FOR & MANAGE RISK FACTORS 
• VOLUNTARY
• PROVIDERS OF HEALTH INFORMATION IN THE 
CONTEXT OF THE PANDEMIC
• TEAM LEADERS/ COORDINATORS OF THE 
PRIMARY HEALTH CARE TEAM
17
Q

ALLIED HEALTH CARE
PROFESSIONALS IN HEALTH
PROMOTION

A
  • HEALTH VISITORS –FOCUS ON CHILDREN
  • DISTRICT NURSES – FOCUS ON ELDERLY/HOUSEBOUND
  • PRACTICE NURSES
  • HEALTH CARE ASSISTANTS
  • PHYSICIANS ASSISTANTS
  • PARAMEDICS
  • PHARMACISTS
  • MEDICAL ASSISTANTS
  • PRACTICE SPECIFIC
18
Q

what is q risk

A

• THE QRISK3 ALGORITHM CALCULATES A PERSON’S RISK
OF DEVELOPING A HEART ATTACK OR STROKE OVER THE
NEXT 10 YEARS. IT PRESENTS THE AVERAGE RISK OF
PEOPLE WITH THE SAME RISK FACTORS AS THOSE
ENTERED FOR THAT PERSON.
• AIM:
• CONSIDER THE PATIENT AND DOCTOR PERSPECTIVES
AROUND THE TENSIONS AROUND HEALTH PROMOTION IN
PRIMARY CARE CONTEXT
• APPRECIATE THE COMPLEXITY AROUND SEEMINGLY
STRAIGHT FORWARD INTERVENTIONS

19
Q

WHY MEASURE QUALITY OF

PRIMARY CARE?

A

• QUALITY IMPROVEMENT OR BENCHMARKING: TO DETERMINE
EXISTING QUALITY AND IMPROVEMENT.
• COMPARISONS TO STIMULATE AND MOTIVATE CHANGE
• PAY-FOR-PERFORMANCE SCHEMES
• QUALITY CONTROL: MINIMUM OR INTENDED STANDARDS
• REGULATION: COMPLIANCE WITH LEGAL OR SAFETY
STANDARDS
• TO INFORM SERVICE USERS: TO COMPARE PROVIDERS
• FOR MARKETING : TO HIGHLIGHT AND ADVERTISE A STANDARD
OF QUALITY (E.G. ACCREDITATION)

20
Q 
HOW TO 
MEASURE 
QUALITY 
OF 
PRIMARY 
CARE?
A 
• WHAT IS GOING TO BE MEASURED 
(FOR EXAMPLE, STRUCTURES, PROCESSES OR 
OUTCOMES)?
• HOW IS IT GOING TO BE MEASURED (USING 
CLINICAL AUDIT, INDICATORS OR PATIENT SURVEYS, 
TRIALS OR COMPLEX INTERVENTIONS ETC.)?
• WHOSE VIEWS ARE BEING REPRESENTED 
(PATIENTS, HEALTH PROFESSIONALS OR 
GOVERNMENTS/PAYERS, ETC.)
• WHO WILL GET TO SEE THE DATA ONCE 
THEY HAVE BEEN COLLECTED?
21
Q

QOF

INTENTIONS

A 
REDUCE VARIABILITY WITHIN 
PRACTICE
• DRIVE UP STANDARDS
• PROVIDE DATA
• REWARD ‘GOOD’ PRACTICE
• EMBED HEALTH PROMOTION INTO 
PRIMARY CARE PRACTICE
22
Q

QOF COMPONENTS

A

Clinical standards - chronic disease areas
including public health

Organisation standards

Patients’ experience

Additional services.

23
Q

IMPACT OF QOF

A

• INCENTIVISED CODING & PRACTICE SPECIFIC DATA
• REDUCED VARIABILITY & PERFORMANCE/ ACHIEVEMENT EXCEEDED
EXPECTATIONS (DORAN, T. ET AL., 2006).
• FINANCIAL INCENTIVES GENERATED AN ACCELERATED, BUT NOT LASTING,
IMPROVEMENT OVER-AND-ABOVE EXISTING TRENDS IN QUALITY IMPROVEMENT
IN UK PRIMARY CARE (CAMPBELL, S.M. ET AL., 2009).
• HOWEVER, PATIENT EVALUATIONS OF QUALITY OF CARE ACROSS THE SAME
TIME PERIOD DID NOT CHANGE EXCEPT FOR ASSESSMENTS OF CONTINUITY OF
CARE, WHICH DECLINED.
• INTERVIEWS WITH PATIENTS WITH MANY QOF CONDITIONS SHOWED THAT NO
PATIENT HAD HEARD OF QOF AND MANY FELT UNEASY WITH THEIR DOCTOR BEING PAID INCENTIVES TO DO ROUTINE TASKS (HANNON, K., LESTER, H., AND CAMPBELL, SM., 2012).
• PROVIDED MODEL FOR OTHER LOCAL & NATIONAL INCENTIVES E.G. NHS HEALTH CHECKS, DOAC MONITORING IN PRIMARY CARE

24
Q

UNINTENDED
CONSEQUENC
ES OF QOFS

A 
• PRIORITISING CERTAIN ASPECTS OF 
HEALTH PROMOTION 
• DEMOTES PATIENT’S AGENDA
• UNDERMINES GPS AUTONOMY 
• ENCOURAGES OVERTREATMENT
• POLICY BEFORE EVIDENCE
• UNDER-RESOURCED 
• UNDERLINED VARIABILITY WITHIN 
PRACTICES
25
Q

QOF AMENDMENTS

A 
Use of guidelines, external choice
Reduced amount based on performance
Adding areas  
Guidance on exception reporting
Removing organisational indicators
26
Q

Health promotion in primary care

Finding the story

A 
Population level 
Research and evidence base
Policy changes / Public Health interventions
Pharmaceutical industry influence
Moral and ethical questions for society: ageing, health economics, 
Primary Care level
Research and evidence base 
Systems and incentives
Consultation level
Clinician and patient factors 
Tensions and conflicts

Primary care (10 decks)

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