Pt Evals Of HC Flashcards
LO1: desc policy backg to growth of int in pts views of HC services.
-ev that pt satisfac is imp indiv outcome and is linked to others.
Ethics.
Rejec paternalism, growth of consumerism.
Incr ext regul of health services, emph on accountabil.
Means of securing legitimacy.
-NHS plan 00- organisat of care and accountabil on pt. had to publish pts views (ratings) and how addressed.
-DH 01 inv pts and public in HC.
-NHS act 06- consult pt and public about service planning, changes and op.
-latest white paper- pt voice. Use expers. Ratings and compars. Feedb incl complaints imp in qual ass of services.
-NHS outcomes framework- incls ensuring pt pos exper of care.
LO2: expl options for acc pts views of HC incl qualit and quantit apprs.
-friends and fam recomm test. Rate and comment on services at NHS choices website. Other wbsites and forums.
?robustness. Demog and mode eff. Bad for compar, good for LT monit one organisat.
-healthwatch eng- stat pows to ensure feedb acted on by those who commiss, deliv and regul HC services. Seek pt views and directly pass on.
-PALS pt advice and liason services- health Qs, probs using NHS, inv in HC, NHS info, complaints advice. BUT TRUST BASED so not compl indep.
-complaints proced bit diffic. Need ensure indep.
Pts have to choose CCG or hosp.
-parliament and health service ombudsman if go above norm complaints. NHS eng acted unfair or poor service. Ultim indep view but slow and ? Effec.
-healthwatch 14- peop lack info and ocnfid when complaining. Confusing, some need supp, not clear that services listen.
-INVESTIG PT VIEWs
Indirec- pt compaints and ombudsman reps.
Direc- qualit and quantit.
-QUALIT-
Interv, focus grp, obs. Succ in ID how pts eval care and their priorities.
-QUANTIT-
Used more as cheap and easy. Less training req. anon easy. Stand resps. Facils perf monit.
-loc dev DIY instrums not stand or proven rel and validity. Us highr satisfac than published, lack comparabil. Tend use validated intrums.
-surveys eg GP pt, maternity services, ad inpt, CA pt, comm mental health, childrens, AE.
-dissatisfac eg interpersonal skills- not listened to, not full hx, not reass, not approp advice.
HC content- inconven, contin, acc, hyg, hotel aspects, waiting, cult innapp, compet, outcomes.
LO3: comment on some of the challs of using pts evals to assess qual.
-challs in resp to dissatisfac-
unreasonable or irrational views.
How locate responsib and know what to do.
How much resource to rectify.
How fitness to practice concerns of pt should be viewed.
LO4: outl diff sociologic apprs to underst the pt profess rel.
-FUNCTIONAL- emph consensus and reciprocity.
Illn is soc cult exper. Pts not tech competence to remedy= helpless. Medical tx restores soc eq.
Sick role= right to freed of soc responsib and oblig. New soc status demands medical care- dependance. Should want to get well and not abuse their exemption. Expected to seek help and coop.
Drs role tending to sickness. Use skills to objectively benef pt ints. Intim acc, autonomy, status and rew.
Critic- sick role not apply to LTC. Legit and illegit sick role. Assumes pts passive incompetent. Ass rationality and beneficence of medicine. Not expl why things go wrong.
-CONFLICT apprs- emph conflict.
Friedson- medical domin and suppressed conflict. Dr gatekeeper defining illn, can exploit. Pt has to submit to instit domin.
Medicalisat- lay ideas discounted. Pathologise soc life. Cult iatrogenesis (dep on med, loss self reliance and become sick). Eg childbirth= loss control for wom.
Critic- pt and dr not inevitably in conflict. Pts not passive eg non compliance, complem therap. Pts assertive outside fo consultation. Pts medicalise issues as well.
-INTERPRETIVE/INTERACTIONIST-
Meanings both parties give to interac, and their conduct. Patts. Informal rules imp. What feats of interacs help/hinder care.
-PT CENTRED- emph partnership.
Aspirat less heir, more coop, pts taken seriously. Shift from profess centred. Egalitarian rel. undeprins lot recent policy.
Consultat- explores main concerns, integ underst, agree managem, enhance preven and health prom and contin rel.
shared info and decis making.
Pt contribs- concerns, priors, perceps of cos benef of diff tx, judgem of risk and discomfort, surv vs QoL prior.
Eg BHP- var tx, each riska nd benef, biol markers may not be most val by pt, drs cant predict pt pref.
Challs- people not want to or cant share decis making. Unkn conseq of inv. When should lim pt pow. Who has final responsib. Is there time.
LO5: disting explanatory apprs and aspirational models of the pt profess rel.
- explanatory: functionalism, conflict theory, interpretivism/interactionism.
- aspirational: pt centred/partenership.
LO6: sugg reasons for incr int in complem theraps.
-complem therap= invs any medic sys based on a theory of dis or meth of tx other than orthodox sci of med as taught in med schools.
Osteopathy and chiropractors regulated.
Acupuncture incr ev.
Others eg aromatherap, art, hypno, reflexology, bach flower, indian head massage.
-why people use it- persis symps. AEs of convent tx. Pref holistic appr. More time and atten. Alm a nice break/hobby. Satisfac reported. Incr avail.
LO7: desc what implics pts use of complem theraps may have for medical practise.
-pt concerns- safety and competence, guilt, denial, cost, soc facs.
-dr concerns-
Unqualif and unregul practitioners.
May risk missed or delayed diag.
May refuse convent tx.
May waste money on ineffec tx.
Mech of some complem tx compl imposs.
More fragmented care.
-NICE recomms lim- alexander tech for parkinsons. Ginger and accupress for morn sickn. Acupunc and manual therap for persis low back pain.
-shouldnt divert resource to therap w/o ev base? Poor qual ev- funding, size, method (diffic placebo and double blind).
-drs may be able or asked to prov acc to complem therap. Diff pts diff beliefs. Need be aware of range theraps and why pts use them.
