primary care Flashcards
what does person-centred care mean
places the patient at the centre, they are the only one with the authority to decides what happens to them, thus we must focus on their principles and values. These values are respect, choice and empowerment, patient involvement in health policy, access and support and information.
illness means
ideas concern and experience of the disease/disability. The patients experience.
disease means
symptoms, signs and diagnosis. The biomedical experience
what percentage of GP appointments are long condition
Accounts for 50% of GP appointments
what number of inpatient days in hospital are due to what long term conditions
70%
what is the impact of long term conditions on the individual
some conditions are more prominent than others, it may result in stigma against them. There is the burden of treatment and biographical disruption as well. Further impact may come in the form of being negative, denial, self-pity, apathy, depression, isolation, resulting in unhealthy coping mechanisms like alcohol abuse and painkiller addiction. Other individual responses may be more positive, turning towards friends and family, volunteering, learning about their condition and empowering themselves
what Is the impact of long term conditions on the family of the individual
On the family the impact may be financial, emotional and physical, even resulting in them becoming ill
geographic health differences across Scotland
areas of poor health include the more South Western parts of Scotland in particular Glasgow, whereas more improved health is commonly in the East with Edinburgh and Aberdeen. Long term conditions may also be more commonly found near Glasgow.
burden of treatment means
changing behaviours and lifestyle for both the patient and carer, the monitoring of symptoms, complex treatment regime and polypharmacy as well as coordinating the complex medical system.
biographical disruption means
loss of confidence in the body. Requires patients understanding their condition before they can adjust to it. Involves redefining what is good and bad
what are the multiple factors influencing symtpoms, chronicity and disability
Age, genetic, environmental factors, vulnerability to disease and the natural history of the disease
expert patient refers too
The expert patient – often know more about their condition than the doctors and nurses, they an become key-decision makers in the treatment process.
factors influencing patient’s reaction to a long term condition
Their reaction depends on nature of the disability, information, personality, coping strategies, reaction of those around them, available resources, support and time.
body and structure impairment definition
abnormalities of structure, organ or system function
activity limitation definition
changed functional performance by the individual
participation restriction definition
disadvantage experienced by the individual as a result of impairments and disability
benefits of illness
social, familial, psychological, financial, medication and responsibilities or lack thereof.
medical Causes of activity limitation
individual cause – drunk
underlying pathology – obesity
individual level intervention – health professional advice
individual change – change in behaviour
social causes of activity limitation
societal cause – low wages
conditions relating to housing
political action- facilities, access and policy
societal change – politically correct language
policies in place do prevent activity limitation
disability discrimination acts 1995 and 2005
Equality Act 2010
what are some medical factors for causing a desire to seek medical attention
such as new symptoms, visible symptoms, duration or severity
non-medical factors for causing a desire to seek medical attention
beliefs, expectation, social class, economic, environment, age, gender etc. lay referral and sources for info from peers, family, TV.
general practice role
an interface between the public
incidence means
number of new cases in a population over a specified time
how to convert epidemiology of population into risk
into ratios, the numerator is events and the denominator is the population at risk.
prevalence means
number of people in a population with a specific disease in a single point in time
relative risk refers too
strength of association between a risk factor and the disease under study. ( incidence in exposed group divided by incidence in unexposed group).
public sources of epidemiological data
mortality data, hospital activity statistics, cancer statistics, accident statistics, general practice morbidity, expenditure data, social security statistic, household health survey.
description epidemiology meaning
describe the amount and distribution of disease in human populations.
explanations epidemiology meaning
informing of the natural history, causes of the disease through epidemiology, biochemistry, occupational health and genetics.
disease control epidemiology meaning
what prevention measure could be put in place, lifestyle changes, and therapies available and how they may be monitored for their efficacy.
examples of epidemiology in use
the CHA2DS2-VAsc score for risk of stroke in atrial fibrillation. Others are bleeding risk.
descriptive studies meaning
describe the amount of distribution of a disease in a population, clues about risk factors and aetiologies.
cross sectional studies meaning
draws relationships between disease and other variables of interest in a defined population, prevalence study
cohort study meaning
baseline data on exposure from people who do not have the disease under the study then the group is followed until a sufficient number have the disease.
case control study meaning
two groups of people are compared cases V controls.
standardisation meaning
set of techniques to reduce confounding variables in a comparison.
standardised mortality ratio refers to
standardised death rate converted into ratio for easy comparison
quality of data meaning
whether the data is trustworthy
case definition meaning
decide whether the individual has the condition of interest or not. To prevent differences in definition changing the publication of true incidence.
coding and classification in terms of study design meaning
conversion of disease information to a set of codes for storage and analysis.
ascertainment meaning
subjects missing, depends on intensity of research may reflect incidence.
selection bias meaning
study sample not representative of whole study population
information bias meaning
systemic errors in measuring exposure or disease, researcher more intensively asking case about potential exposures as an example
systematic error meaning
issue in measurement always falling to one side of the true value due to a technique, machine or implementation of that machine
follow up bias meaning
group of subjects more intensively monitored then their comparison group, or the loss of subjects in a cohort study.
what are the criteria for causality
Criteria are strength of association (relative risk), consistency, specificity (single exposure leading to single disease), temporality (exposure comes before disease), biological gradient (dose-response relationship), biological plausibility (association fits In with biochemistry), coherence (association doesn’t conflict with understanding of disease), analogy (another exposure disease relationship exists that can act as a model), experiment (controlled experiment to prove association).
the strongest criterion for causality is
temporality
nice guidelines are developed bases on
systemic review of literature designed to translate knowledge into action. They rate quality of evidence on how comprehensive it was, if the research was clearly defined, likelihood of publication bias, conflict of interests declared etc
what is an audit?
Asks the question “are we doing what we believe is the right thing and in the right way?”
evaluates structure of care, process of care and outcome of care. It should be transparent and non-judgemental. It compares present provisions with the desired outcome.
developed regions 2050 demographic pyramid
in developed regions as reach the year 2050 the number of 60+ patients will make up a significant part of our population, much larger than that of 0-20 year olds.
in less developed regions 2050 demographic pyramid
by 2050 the populations will be decreased, and from 0-50 begin to average out in comparison to 2000 with it being quite a youth dominated society. In particular there 60+ population will also increase.
in the least developed regions 2050 demographic pyramid
in the least developed regions, the population will still be quite youth dominated, but this will be decreasing in comparison to 2000’s and there will be a small increase in the number of 60+.
life expectancy in the U.K is sitting at what for males?
79.5yrs for male
life expectancy in the u.k. is sitting at what for females?
83.1 years for females
what has happened to life expectancy and healthy life expectancy in the u.k?
both have increased but life more
austerity has had what impact on life expectancy?
decreased it
what region of Scotland will be impacted more by the changing demographic and when?
highlands by 2031
leading cause of death for women in England
Dementia and Alzheimer’s
leading cause of death in England for men
For men it is Heart disease currently for the leading cause of death.
what is being done to combat the changing demographic in Scotland
To combat this, it requires national level reform to bring together social and health care, and to work alongside third sector organisations. There is significantly increased spending on social care.
by 2037 how many carers will be in the u.k?
There is also a significant need for carers, there will be 9 million carers in the U.K. by 2037.
the effect of polypharmacy and multi-morbidity
older patients often have more than one chronic health condition complicating their management as one treatment may worsen another condition. Results in balancing out conditions, symptoms, EGFR and treatment
what services are available for elderly people
living in own home with support from family
living in own home with support from social services
sheltered housing
residential home
nursing home care
half of working carers live in a household…
where no-one is paid to work
a third of carers have lost out on what?
A third of carers have lost out on financial income as a result of caring, resulting in cutting back in essentials like food or heating.
anticipatory care plan refers too
“advance and anticipatory care planning as a philosophy, promotes discussion in which individuals, their care providers and often those close to them, make decision with respect to their future health or personal and practical aspects of care.”
impacts of being a carer
financial, health, social and lack of representation and recognition
what is involved in anticipatory care plans
Involves legal attorney, medical problems of emergency and assessments and personal statement of wishes and beliefs
most carers are caring for
parents or in laws
over a quarter of carers are caring for
spouse or partner
ten percent of carers are looking after children
under the age of 18
health and social care team legislation
Public bodies (Joint Working) Act 2014 created new public organisations known as integration authorities to break down barriers between the NHS boards and local authorities.
GP partners role
GPS are independent contractors to the NHS, therefore they are responsible in providing adequate premises for their practice and employing staff. The bulk of the work is carried out in consultations, serving as a point of first contact.
practice nurse role
have their own responsibilities and may work in a team or supervising other healthcare assistants, they can obtain blood samples, immunisations, minor and complex wound management, men’s health and women’s health screening, sexual health services and smoking cessation and travel health advice.
district nurse role
visit patients in care homes or at home providing direct care, teaching patients and families, in charge of their own caseloads. Their role is to reduce admission and readmissions trying to ensure patients can be returned home. They also monitor the health of patients.
midwife role
provide caring during all stages of pregnancy, labour and post-natal.
health visitor role
lead and deliver child and family health services (pregnancy to 5 years) and ongoing services for vulnerable children and safeguarding.
macmillan nurse role
– palliative care and support for those with cancer from point of diagnosis
care manager role
working with individuals to identify goals and locate specific support services to enhance their well-being, highly trained social workers.
physiotherapist role
help treat people with physical problems caused by illness, accident or ageing
dietician role
interpretation and communication of nutrition to ensure people are informed and make practical decisions regarding food and lifestyle.
occupation therapy role
assessment and treatment of physical and psychiatric conditions using specific activity to prevent disability and promote independent function. Help in overcoming disability.
how should a team function?
agreed common purpose, set objectives and ways to monitor progress, agreed teamworking conditions and process for resolving conflict and ensure each team member understands and acknowledges the skills of colleagues, ensure communication between members and the patient. Furthermore, the team should work on the basis of evidence, evaluate how efficient and effective it I, and take active steps to facilitate inter professional collaboration
