PDS Flashcards
Audit cycle
Topic identification – importance Standard setting – using guidelines Data collection – what date is to be collected and whether it will be retrospective or prospective Data analysis Change implementation
Affordability
Some households may have less access to funds through the previous allocation of funds to some unnecessary expenditures such as smoking and alcohol
This may lead to a reduced capacity to be have disposable income to pay for some aspects that could lead to a healthy lifestyle:
Some forms of exercise
Healthy diet
Optimal allocation
Involves deciding what to fund and what not to fund
Equity
Fairness of how resources are allocated
Efficency
Maximising benefits in the face of budgets
Effectiveness
Measured by clinical improvements such as increasing survival or improving QoL
Cost effectiveness analysis
Most common approach used in clinical practise. Increments per surviver compared against previous treatment
Negatives with cost effectiveness analysis
Public health programmes are likely to have multiple components and therefore multiple potentially beneficial (or harmful) outcomes
CEA only focuses on a single outcome dimension
It ignores all other effects and if some of these are important then it is possible that the conclusions drawn will be wrong
Can not compare interventions if the single simple outcome is not common across interventions
Cost utility analysis
Measures, then values the impact of an intervention in terms of improvements in BOTH quantity AND quality of life
Often reported as quality adjusted life years (QALYs)
Allows comparisons to be made across all areas of a health intervention. Reported as cost per QALY gained
QALY
QALYs take into account not only length of life, but also the quality of the life years. Calculated by the increased life span and the QoL improvement a treatment offers
Cost benefit analysis
Values all costs and benefits in monetary units. If benefits exceed costs, the evaluation would recommend investing in the programme and vice versa
Favoured approach by economists working in other areas such as environment, development, and transport for economic evaluation
Negatives of cost benefit analysis
Often just report costs so may ignore benefits or problems with treatment. Difficult to implement into the NHS due to not valuing health via monetary perspective
Incidence
Number of new cases in a given population in a given time period, usually per year or per quarter
Prevelance
Number of people in the population in a given time period who are living with the condition
Susceptible population
Those with no immunity (either through vaccination or acquired). Some populations may be more susceptible than others:
Pregnant women
The very young or very old
Immunocompromised
IVDU
Transmission of infectious diseases
Person to person by inhalation of infected airborne droplets or particles (eg influenza, TB)
Contact with bodily fluids (eg ebola)
Directly from person to person by sexual contact (eg syphilis, HIV)
By ingestion of contaminated food or water (eg salmonella, hepatitis A)
Indirectly through surface or other contamination (eg hepatitis C from contaminated needles, HIV from blood products)
Through an intermediate animal host or vector (eg malaria)
Risk of communicable disease linked to
Severity of the disease, susceptibility of the population and transmission of the disease
Primary prevention of a disease
Stopping cases occurring i.e. vaccination, food hygiene, sanitation and education
Secondary prevention
Controlling the infectious outbreak once it has begun. Ie contact tracing, closing of restaurant, needle exchanges, treatment of case in isolation esp if infectious
Notifable disease
Encephalitis, meningitis (meningococcal) and hepatitis Brucellosis Cholera Diphtheria Enteric fever (typhoid or paratyphoid fever) Food poisoning - Haemolytic uraemic syndrome (HUS) Infectious bloody diarrhoea Invasive group A streptococcal disease Legionnaires’ disease Leprosy Malaria Mumps, measles, rubella Rabies Severe Acute Respiratory Syndrome (SARS) Scarlet fever Tetanus, TB, smallpox Viral haemorrhagic fever (VHF) Whooping cough Yellow fever
Surveillance in public health
Microbiology laboratory reports
Infectious disease notifications from doctors
Immunisation information
Ad hoc reports from schools, hospital, EHOs
Control of spread:
Reporting of cases or outbreaks - initiates action
Treatment of cases
Isolation / exclusion from work
Contact tracing – advice, prophylaxis, vaccination
Infection control during healthcare
High risk GI infections
Group 1 – Foodhandlers
Group 2 - Healthcare, nursery or other care staff with vulnerable clients
Group 3 - Children < 5 years of age
Group 4 - Others unable to perform good standards of hygiene because of ability or available facilities, e.g. those with learning difficulties, people camping
Group 5 - People living in institutionalised care i.e. care homes etc
E Coli O157
1000 cases per year.
50% are in <16yr olds, highest rates in <5yr olds
Faecal-oral transmission (can be via a contaminated surface).Highly transmissible, low infective dose
15% of cases develop HUS
HUS can be fatal due to the shiga toxin produced by e.coli. Leads to thrombocytopenia, haemolytic anaemia and renal failure
E.coli 0157 control
Identify the possible source of infection – and so prevent other primary cases
Prevent onward transmission from the case to others – secondary cases
Early identification and notification by clinicians is essential
Public health action requires a multi-agency team (health protection, clinicians and labs, environmental health
Violations
A violation is defined as a deviation from safe operating procedures, standards or rules.
Routine violation - cutting corners, a common occurrence and often tolerated
Optimising violation is where actions are taken for personal reasons rather than patient benefit eg motivated by greed/risk taking personality
Necessary violation is where someone knowingly misses out steps in a task in the need to get the job done - eg rushed medicine dispensing
Meningitis prophylaxis
Rifampicin BD for 2 days, stat dose of ciprofloxacin
If pregnant IM ceftrixone
Hard to reach groups examples
minority ethnic groups and refugees, MH, travellers, homeless people
people with learning disabilities
LGBT, sex workers, HIV patients
the elderly, teenagers
people with physical disabilities (including hearing and visual loss)
victims of domestic abuse
Hard to reach groups definitions
Those who are underserved, ‘service-resistant’, or ‘slipping through the net’. Or those who traditionally wouldn’t seek help.
PETeR
Policy, education, technology and resources
Voluntary vs involuntary prevention measures
Voluntary work best for high socioeconomic class
Compulsory work better for lower socioeconomic class
Health protection
Surveillance, control, communication and prevention
Contextual
Contextual factors are those that are based on the place itself, and the fact that this will change the health of the population.
Economic environment - house prices, house quality, job access
Social environment - services available (GP, pharmacy, childcare), place stigma
Physical environment - pollution, contaminated land
Compositional
Compositional factors are those that are based on the population that live there - their behaviour, attitudes, and how they live.
Risk taking behaviours including smoking, drinking, misuse of drugs
Incomes and wages due to educational attainment
Demographics of a population
Diagnostic momentum
This is when a diagnostic label sticks, despite accumulating contrary evidence
Anchoring
Too heavy reliance on the first piece of information - incorrect as the first piece of information was the history, and there is no evidence that this alone is what the GP based his diagnosis on
Search satisficing
Stopping the search when we find something convenient - there’s no clear evidence that the search was actually stopped, as more information came in following the hypothesis of lung cancer
Premature closure of hypothesis - jumping to a conclusion before all the info has been gathered
Jumping to a conclusion before all the info has been gathered
Availability bias
Only seeing something because it comes easily to mind - this wasn’t really described in this scenario
Run charts
Analyse 16 - 25 data points in time sequence and compare the results to the median line in order to identify special cause variation. Key features include Number of runs, shifts (run length) and trends (run direction).
Medical error
The failure to complete a planned action as intended or the use of a wrong plan to achieve an aim
Adverse effect
An injury caused by medical management rather than by the underlying disease or condition of the patient
