OTHER GENERAL Flashcards
What is health education?
Giving people the knowledge and skills to change potentially health damaging behaviours
What is health protection?
Protection off individuals, populations through effective collaboration of experts in identifying, preventing and mitigating the impacts of infectious diseases and of environmental, chemical and radiological threats
responsibility of Public Health through legislation to protect public health e.g. not smoking inside, pollution, seat belts
What is beatties typology?
A classification system to categorise health promotion interventions based on their level of control and target population
- health persuasion e.g. mass media campaign
- legislative action e.g. smoking ban in public places
- personal counselling
- community development e.g. local initiatives
What proportion of sympotms are never reported?
70%
What is the symptom iceberg?
A metaphor to describe the concept that the signs and symptoms of a disease that are visible to a person is only thr tip of the iceberg and most symptoms are hidden
It’s used to emphasise the importance of looking beyond the visible symptoms of a disease and considering underlyign factors to identify the root cause
What are illness behaviours?
The ways in which individuals perceive their sympotms and how they respond to and cope e.g. seeking medical attention, engaging in self-care practices, adhering to treatment, engaging in health-promoting behaviours
What are some barriers to health seeking?
Available of services e.g. geographical or not able to get an appointment
Cultural or family attitudes - e.g. not acceptable to be depressed or feeling like they are a different culture to the doctor so they couldn’t understand
Previous bad experience - language barrier, didn’t get what they wanted last time, felt stigma
Logistics e.g. time, child care, loss of earnings from work, no transport
Risk perception
What are some ways we can reduce barriers to healthcare in certain ethnic groups?
Information leaflets in different language
Community outreach and education programmes
Abialbility of interpreters
Increased clinical competency - better understanding of health beliefs of different ethnic groups
Targeted advice for groups based on their risk factors
What is the inverse care law?
The availability and distribution of healthcare services are often inversely related to the need for those services in a population. In other words, the people who need healthcare services the most often have the least access to them. It is based on the premise that healthcare resources are not distributed equally throughout a population. Better off areas have better access to care than poorer ones despite better health
- demonstrated by the Black Report 1980
What are the 5 policies proposed by the Marmot Review 2010 for addressing health inequalities?
- give every child the best start in life - access to high-quality education and care, parenting support and startegies to address child poverty
- enable people to maximise their capabilities and have control over their lives - improve education and employment opportunities, reduce income inequalities, promote healthy lifestyles
- Ensure a health standard of living for all - address income inequalities e.g. affordable housing, healthy food, accessible transportation
- create a fair employment and good work for all - fair wages, job security, opportunities for career advancement
- create and develop healthy and sustainable places and communities - green space, safe accessible transport
What was the marmot review?
The Marmot Review identifies that health inequalities in England are not only unfair, but they are also preventable. The report highlights that social and economic factors, such as poverty, education, housing, employment, and social exclusion, have a significant impact on health outcomes. The review argues that addressing these social determinants of health is crucial to reducing health inequalities.
The Marmot Review proposes a comprehensive and integrated approach to addressing health inequalities in England
Outline SPIKES in breaking bad news
Setting - comfortable, quiet and private room, offer for others to be there
Perception - discuss events leading up to it and establish what the pt knows and is expecting
Invitation - check they want to recieve the news today
Knowledge - drip feed info, pauses, no jargon, regularly check pt understanding
Emotions and empathy - recognise emotions and respond, be honest
Strategy and summary - make a plan, dont rush a decision, check pt understanding, summarise gently, offer to help tell other people, ask for questions
Whats the ABCDE approach for breaking bad news?
Advanced preparation
Build a relationship
Communicate well
Deal with pt reactions
Encourage and validate emotions
What is clinical effectiveness?
The extent to which a healthcare intervention achieves its intended goal of improving health outcomes for patients in clinical practice
How is cost effectiveness identified?
Using the incremental cost-effectiveness ratio (dividing the difference in cost between 2 interactions by the difference in their effectiveness
(Cost A-cost B)/ (QUALYs B-QUALYs A)
What are clinical guidelines?
evidence-based recommendations to assist healthcare professionals and patients in making informed decisions about appropriate healthcare for specific clinical conditions or situations. They provide a structured approach to clinical decision-making and aim to improve the quality and consistency of healthcare practices.
What are the aims of clinical guidelines?
Improving healthcare quality and care is up to date
Provide standards against which HCP can be assessed
Helps make informed decisions based on evidence
Improves communication between pt and HCP and allows pt to make informed decisions
How do we asses efficacy of guidelines?
SSRI -AC
Scope + purpose - what intends to do
Stakeholder involvement - has it considered target position
Rigor of development - has it been formed using systematic approach
Independence - recommendations are not due to external influence
Applicability - advice on how to implement and identify barriers to implementation
Clarity - does it make clear recommendations
What are the qualities of good guidelines?
Valid (lead to expected results)
Reproducible
Cost-effective
Representative
Clinically applicable
Flexible with pt preference
Clear and readily understood
Reviewable
Amendable to audit
What are the barriers to using guidelines?
Lack of awareness of how current practice is inappropriate
Attitudes on doubts over credibility of sources
Confidence in skills set
Time and resource limitations
Organisational culture
Social influence e.g, team norms
How can you encourage people to use guidelines?
Educational sessions on teaching new guidelines and explaining its purpose
Audio/visual aids
Computer reminders
Audit and feedback for proof it works
What are performance league tables
a method of ranking and comparing the performance - rank hospitals based on various performances indicators e.g. waiting times
Aim is to provide information to public about quality of care so pt can make informed decisions about where to seek care, and encourages HCP to improve their performance
What are benefits of publicly available performance indicators?
Allows quantification of quality in an easily categorised and measureable way
Drives improvements in quality
Identifies areas for improvement
Gives pt trust in doctors amd allows pt more choice - transparancy, open and honest
What are the limitations of using publicly available performance indicators?
Can be misleading e.g. a doctor with a high death rate may be because they do more complex surgeries - this could result in performance becoming priority over care: doctors attempting less complex cases in the future
Most hospital deaths are not preventable so may be a poor marker of quality
Could result in bad hospitals getting worse and good hospitals getting better as pt with good prognosis go to good hospitals
Pt losin faith in doctors
Creates an individualistic culture of blame
May not be interpreted accurately e.g. not accounting for confounders when considering surgery survival rates
How do cost-effective interventions differ from clinically effective interventions, and why is it possible for a clinically effective intervention to not be cost-effective, while cost-effective interventions are always clinically effective?
Cost-effective interventions are those that provide good value for money, meaning that the benefits of the intervention outweigh the costs associated with it. Clinical effectiveness, on the other hand, refers to the extent to which an intervention produces a beneficial health outcome in a particular patient population.
it is possible for a clinically effective intervention to not be cost-effective. This may occur when the costs of the intervention are high relative to the health benefits that it provides. For example, a new cancer drug that provides a modest increase in survival may be clinically effective, but if it is very expensive, it may not be considered cost-effective.
Conversely, it is generally true that cost-effective interventions are also clinically effective, as interventions that are not effective in improving health outcomes are unlikely to provide good value for money.
What are examples of data measures of quality?
Population based e.g. mortality data, length of hospital stage, re admission rates
Primary care data e.g. QoF, data in GP computer systems
Adverse event rates
National clinical audit data
Patient experience data
Patient Reported Outcome measure data
What are Patient Reported outcome Measures currently available for?
Hip and knee replacements
Hernias
Cataracts
What are some examples of patient-reported outcome measures?
Short Form Health Survery (SF-36)
Hopsital Anxiety and Depression Scale (HADS)
Patient Health Questionnaire (PHQ9)
What is root cause analysis?
Structured investigation that aims to dentist the true cause of a problem and the actions necessary to eliminate it rather than simply addressing the symptoms/immediate cause
What is SHOT?
Serious Hazard of Transfuson
A UK haemovigilance scheme that collects anonymised info on advers events and reactions to blood transfusions
Which medical speciality get dude the most?
Obs and gynae - most malpractice claims due to complexity of childbirth and the potential for adverse outcomes
What are active failures?
unsafe acts committed by people who are in direct contact with the patient or system
Unintentional - their actions inadvertently result in a mistake or accident
Intentional - a violation
What are latent errors?
Ones inherent to the system e.g. working environment, stag training
What are knowledge-based errors?
Errors in planning due to inadequate knowledge or experience
E.g. misdiagnosis by junior doctor
What are rule-based errors?
Misapplication of a good rule/guidelines
E.g. applying a guidelines for a 10 year old to a neonate
What are skill-based errors?
An unintended deviation from a. Good plan e.g. attention/memory lapse
Whats a routine unintentional error?
Normalisation of bad practice
What are the types of unintentional errors?
Routine
Situational
Reasoned
Malicious
