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Health Care Management > PCCD Poging 2 > Flashcards

PCCD Poging 2 Flashcards

1
Q

Shared Decision Making

A
  • The decision-making model is situated on a continuum between paternalism and consumerism.
  • Physician is an expert in the medical field an the patient is an expertise on their life.
  • Define problem, presemt options, discuss pros/cons, patient values/preferences, doctor recommendations, check understanding, make decision and arrange follow-up.
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2
Q

Shared decision making vs informed consent

A

Informed consent is an legal concept and shared decision making is an moral concept. Informed consent is therefore a must and shared decision making is desirable.

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3
Q

Three different talks SDM

A

Choice talk
There is exchange of information between a patient and his doctor, medical and personal information included.

Option talk
Possible options and outcomes are discussed and considered by patient and doctor.

Decision talk
Doctor and patient reach consensus about what needs to be done.

There is not one route.

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4
Q

Why SDM? Ethicists

A

The right of patients to determine what happens to their bodies is self-evident. SDM increases autonomy of the patient.

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5
Q

Why SDM? Economists

A

Increase in consumer power is a means to subject health care providers to market discipline. SDM will increase cost effectiveness.

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6
Q

Why SDM? Epidemiologists

A

Patients have an almost universal desire to be informed and to be involved in the treatment in one way or another.

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7
Q

Why SDM? Clinicians

A

More active involvement of patients in the decision making process improves treatment relationship with better outcomes as a result. Enhanced patient adherence, more satisfsaction and better clinical outcomes.

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8
Q

Possible objections on SDM

A
  • Options may harm those patients who are having difficulties in decision making. Options may result in a growing awareness of missed opportunities.
  • Patients may find it difficult to appreciate outcomes because of their inability to foresee how they themselves will adapt to outcomes.
  • Choice and having a say raise expectations. Disapointment and dissatisfaction lie ahead when clinical realities fail to meet expectations.
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9
Q

Patients where SDM is more appropriate

A

For relatively healthy patients (prevention consults)
For patients with active coping abilities
For patients with chronic conditions

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10
Q

Patients where SDM is less appropriate

A

For elderly patients
For less educated patients
For patients with acute or very severe somatic problems
For patients who have to take minor decisions
For patients with mental health problems

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11
Q

Situations where SDM is especially appropriate

A
  • There is uncertainty regarding effectiveness or outcome
  • Risks and benefits are considerable or equal
  • The patient is willing and able to participate actively
  • The patient is able to comprehend and appreciate trade-offs
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12
Q

What are the obstacles on SDM?

A

Lack of resources (Time, money)
- Seeing more patients in less time is profitable
- Implementation of SDM is costly

Fear of loss of professional autonomy

Poor communication
- Giving information about risks and possible outcomes can be extremely difficult

Patient needs and expectations
- Belief among doctors that do not wish to be fully informed and have little desire for continuous active participation
- Preferences among patients for active participation do in fact vary
- SDM has to be a choice as well

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13
Q

What are the requirements for SDM?

A
  • Reformed health care system and underlying legislation seem to favor consumerism. Legislation will need to change.
  • Willingness to invest in the development of decision aids, self-help, patient support groups, case management
  • Attention for SDM in doctors training programs, investment in development of SDM skills, also on the part of patients.
  • The will on the part of clinicains to practice SDM whenever possible
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14
Q

What is SDM? (Legáre)

A

Defines shared decision-making (SDM) as an interpersonal, interdependent process in which the healthcare provider and the patient collaborate to make decisions about the patient’s health. It involves both parties recognizing the need for a decision, understanding the best available evidence, and incorporating the patient’s values and preferences into the decision-making process.

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15
Q

What is SDM? (Gillick)

A

The patient receives information about available treatment options, including their associated benefits and risks.

The clinicians and the patient then consider these options in light of the patient’s circumstances, goals, and preferences.

Together, they select the best course of action

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16
Q

Interpretative patient choice (Gullick)

A

This model shifts the focus from choosing specific treatments to articulating broader goals, with physicians helping patients to translate those goals into appropriate medical care.

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17
Q

Who is responsible for the consequences of a medical decision?

A

If the doctor gave permission to a treatment below the professional standard, the doctor is responsible.

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18
Q

The eight dimensions of PCC

A

Patient preferences
Information and education
Access to care
Physical comfort
Emotional support
Family and friends
Coordination of care
Continuity and transition

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19
Q

Different levels of barriers in PCC (Kuipers, 2021)

A

Patient
- Differences in patient needs and health literacy

Organization
- Differences in education, motivation and skills of healthcare professionals/organizations

National
- Restrictive information sharing and a lack of supportive financial structures

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20
Q

Weight stigma

A

Discrimination or bias towards individuals because of their weight or size

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21
Q

Jayadevappa vs Rathert

A

The Jayadevappa is more about the global and bigger process of applying an evaluating PCCD. It is more on an organizational level, how to facilitate PCCD and evaluate PCCD.

Rathert model is more on an individual and micro level. It is more about the mechanism of PCCD, how PCCD relate to outcomes.

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22
Q

Four views on evidence-based patient-centered care according to Lacy and Backer, 2008

A

Either/or
Integrated
Continuum
Cyclical

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23
Q

Either/or

A

In the either/or model of evidence-based and patient-centered care, each approach was distinct from the other.

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24
Q

Integrated

A

Group members conceptualized overlapping spheres, creating a band of practice in which the practitioner applies concepts from both spheres.

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25
Q

Continuum

A

When viewed as a continuum, EBPCC ranged from purely evidence based to purely patient centered. When viewed as a balance, this model suggests a point at which a clinician incorporates both patient centeredness and evidence-based medicine and that the best practice involved balancing the two.

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26
Q

Cyclical

A

In this model, EBPCC is a process that moves from patient-centered care through evidence-based care and then back to patient-centered care. While the original presentation was as a single cycle, the comments of the larger groups were more consistent with an iterative model.

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27
Q

Aspects of patients wilt multimorbidity

A

Two or more co-exisiting chronic conditions
Complex care needs
Uncertainty
Fragmented care
Multiple healthcare providers involved

28
Q

What do patients with chronic conditions need?

A

A continuous relationship with a care team and practice system organized to meet their needs for:
Effective treatment
Information and support for their self-management
More intensive self-management
Coordination of care across settings
Systematic follow-up and assessment tailored to clinical severity

29
Q

Chronic care model

A

The chronic care model provides an overview of the system changes we need to reach productive interactions in order to improve outcomes and chronic care delivery.
Focuses on the health care system only.

30
Q

The components of the CCM

A

Community resources and policies
Health system
Self-management support
Delivery system design
Decision support
Clinical information systems
Informed activated patient
Prepared, proactive, practice team
Productive interactions
Improved outcomes

31
Q

CCM Community; resources and policies

A

To help patients access effective and useful services and resources in their surrounding community
* Encourage patients to participate in effective community programs
* Form partnerships with community organizations to support and develop interventions that fill gaps in needed services
* Advocate for policies to improve patient care

32
Q

CCM Health system

A

To assure that practices within the organization have the motivation, support and resources needed to redesign their care systems
* Visibly support improvement at all levels of the organization
* Promote effective improvement strategies aimed at comprehensive system change
* Provide incentives based on quality of care
* Encourage open and systematic handling of problems
* Develop agreements that facilitate care coordination within and across organizations

33
Q

CCM Self-management support

A

To empower and prepare patients to manage their health and healthcare.
* Emphasize the patient’s central role in managing health
* Use effective self-management support strategies
* Organize internal and community resources

34
Q

CCM Delivery system design

A

To assure the delivery of planned, effective and efficient care and self-management support.
* Define roles and distribute tasks among team members
* Use planned interactions to support evidence-based care
* Provide case management services for complex patients
* Ensure regular follow-up by care team
* Give care that patients understand and fits cultural background

35
Q

CCM Decision support

A

To promote clinical care that is consistent with scientific evidence and patient preferences.
* Embed evidence-based guidelines into daily clinical practice
* Integrate specialist expertise and primary care
* Use proven provider education methods
* Share guidelines and information with patients

36
Q

CCM Clinical information systems

A

To organize patient and population data to facilitate efficient and effective care.
* Provide timely reminders for providers and patients
* Identify relevant subpopulations for proactive care
* Facilitate individual patient care planning
* Share information to coordinate care
* Monitor performance of practice team and care system

37
Q

What is an informed activated patient?

A

Patients have the motivation, information, skills, and confidence necessary to effectively make decisions about their health and manage it.

38
Q

What is a prepared proactive practice team?

A

Teams of professionals have the patient information, decision support, time, and resources necessary to deliver high-quality care

39
Q

How can you recognize productive interactions?

A

Assessment of self-management skills and confidence as well as clinical status
Tailoring of clinical management
Collaborative goal-setting and problem-solving resulting in a shared care plan
Active, sustained follow-up

40
Q

Theory of Relational Coordination

A

Relational coordination theory proposes that relationships of shared goals, shared knowledge, and mutual respect influences, timely, accurate, problem-solving communication, and the other way around. This enables stakeholders to effectively coordinate their work across boundaries.

41
Q

Relation between CCM and the relational coordination

A

The relational coordination theory has a relation with the CCM, because they are both about interactions between different stakeholders in the healthcare system to take an active role and thereby improving the outcomes.

42
Q

Solution for socioeconomic inequalities in health

A

Observed problem of health inequality -> Perceived causes of problem -> Policy goals to address causes -> Theories about how and why interventions might work to bring about change in causes ->Design of intervention programme -> Putcome of programme

43
Q

Categories to reduce health inequalities

A

Strengthening individuals
Strengthening communities
Improving living and working conditions
Promoting healthy macro-policies

44
Q

Strengthening individuals

A
  • Strengthening individuals in disadvantaged circumstances;
  • Using person-based strategies;
  • The problem is mainly in terms of an individual’s personal characteristics, solution in terms of personal education and development to make up for these deficiencies
    E.g. information campaigns, lifestyle support groups or one on one counseling
45
Q

Strengthening communities

A

Interventions aimed at strengthening communities through building social cohesion and mutual support;

Horizontal social interactions between members of the same community or group to allow community dynamics to work. Building better infrastructure or places to relax, make it easier for people to meet.

Vertical social interactions on a societal-wide basis;

46
Q

Improving living and working conditions

A

Initiatives at this level identify the critical cause of observed health inequalities to be greater exposure to health-damaging environments, both at home and at work, with declining social position

47
Q

Promoting healthy macro-policies

A

o These locate the causes of health inequalities in the overarching macroeconomic, cultural and environmental conditions prevailing in a country, which influence the standard of living achieved by different sections of the population, the prevailing level of income inequality, unemployment, job security and so on;

o Resulting interventions are aimed at altering the macroeconomic or cultural environment to reduce poverty and the wider adverse effects of inequality on society.

48
Q

Social Production Function theory

A

The SPF theory claims that people produce their own total well-being by trying to optimize achievement of universal goals within the constraints they are facing. Total well-being consists of physical well-being and social well-being.

The universal goals are: comfort, stimulation, affection, behaviour confirmation and status.

Lower level goals are needed to reach higher level goals.

49
Q

Pcc interventions known to be effective for health literacy patients

A

Information and education
- Assess what patients already know
- Communicate as clear as possible
- Confirmation of understanding
- Special health education materials

Family and friends
- Use patients support network/family preferrable a high health literacy person

Access to care
- Make the signs clear
- Make the telephone triage system easy to navigate

Patient preferences
- Fit dosing schedule around patients daily routine
- Simplify regimens as much as possible

Coordination of care
- Use of lay health educators/navigators
- Multidisciplinary disease management education followed by telephone call

50
Q

Buffering SPF

A

Adding more to an already saturated goal, so that in case of loss of another goal, you have a buffer.

51
Q

Opportunities for substitution effect SPF

A

When producing one goal becomes unavailable, you shift to another goal.

52
Q

Multifunctionality

A

Resources that combine the production of different universal instrumental goals.

53
Q

Expanded Chronic Care Model

A

The expanded chronic care model includes elements of population health promotion.
In this model broad prevention efforts, social determinants of health and community participation are sufficiently integrated in chronic care delivery.
The main aim of this adapted version is to integrate population health promotion into the prevention and management of chronic diseases.
This model does not only focus on the people that are already sick, but on the whole community.
The health system is part of the community.

54
Q

ECCM Build healthy public policy

A
  • Policy and legislation aimed at improving population health;
  • Safe and healthier goods, services and environments;
  • ‘Make the healthier choice, the easier choice’;
55
Q

ECCM Create supportive environments

A

Realizing living and employment conditions that are safe, stimulating, satisfying and enjoyable;

56
Q

ECCM Strengthen community action

A
  • Empowerment of communities;
  • Partnering with communities to promote community health and healthy environments.
57
Q

ECCM Outcomes

A

Productive interactions and relationships among community members/groups, healthcare professionals, and organizations;

Functional and clinical outcomes as well as population health outcomes.

58
Q

The ICCC

A

This framework tries to fill gaps in the CCM in order to make it applicable to a wider national context.

The Innovative Care for Chronic Conditions framework (ICCC) is an adaptation of the CCM from a global perspective

The ICCC framework adapts better to the context of health policy development in low- and middle-income countries. In this framework there is a role for positive policy environment and the role of the community is strengthened. Both the community and the health care organization have an even share of responsibility for chronic care.

59
Q

ICCC Positive Policy Environment

A

Strengthen partnerships
Integrate policies
Promote consistent financing
Support legislative frameworks
Provide leadership and advocacy
Develop and allocate human resources

60
Q

ICCC Community

A

Raise awareness and reduce stigma
Encourage better outcomes through leadership and support
Mobilize and coordinate resources
Provide complementary services

61
Q

ICCC Health care organization

A

Promote continuity and coordination
Encourage quality through leadership and incentives
Organize and equip health care teams
Use information systems
Support self-management and prevention

62
Q

ICCC Micro level

A

The micro level is the triangle in the middle. Every member in this partnership should be informed, motivated and prepared. The partnership is between community partners, patients and families and the health care team.

63
Q

ICCC Meso level

A

Healthcare organization elements reframed, the community is strongly emphasized. The community services should complement organized healthcare.

64
Q

ICCC Macro level

A

Positive policy environment to support care for chronic conditions. It contains leadership, policy integration, financing, allocation of human resources, legislation, and partnerships between different sectors.

65
Q

Age friendly city

A

“In an age-friendly community, policies, services and structures related to the physical and social environment are designed to support and enable older people to “age actively”— that is, to live in security, enjoy good health and continue to participate fully in society” (WHO, 2007).

66
Q

Active aging

A

is the process of optimizing opportunities for health, participation and security

67
Q

8 domains of active aging

A
  • Outdoor space and buildings;
  • Transportation;
  • Communication and information;
  • Housing;
  • Respect and social inclusion;
  • Social participation;
  • Civic participation and employment
  • Community support and health services.

Health Care Management (4 decks)

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