Public Health Flashcards
Three domains of public health
Health protection
Health Improvement
Improving services
Determinants of health
Genetic
Lifestyle
Environmental
Health care
Inverse care law
the availability of medical or social care tends to vary inversely with the need of the population served
Health needs assessment definition
A systematic approach for reviewing the health issues affecting a population which leads to agreed priorities and resource allocation that will improve health and decrease inequalities
Health needs assessment cycle
Needs assessment
Planning
Implementation
Evaluation
Health needs assessment types
Epidemiological
Comparative
Corporate
Types of need
FENC Felt Expressed Normative Comparative
Maslow’s hierarchy of need
Physiological -> Safety -> Love/belonging -> Esteem -> Self-actualization
Resource allocation types
Egalitarian
Maximising
Libertarian
Wright’s matrix for assessing the quality of a service
Maxwell’s Dimensions and Donabedian’s approach
Maxwell dimensions
3As and 3Es
Access, appropriateness, Acceptability
Equity, Efficient, Effective
Donabedian’s approach
Structure, Process, Outcome
Health Psychology
Health behaviour, Illness behaviour, Sick role behaviours
Transtheoretical model
PC PAM
precontemplation Contemplation Preparation Action Maintenance
Transtheoretical advantages
Acknowledges individual stages of readiness
Accounts for relapse
Temporal element
Transtheoretical disadvantages
Some individuals skip stages
Change may be continuous, not discrete
Doesn’t consider values e.g cultural and social factors
Theory of planned behaviour
ASP
Attitudes, Subjective Norms, Perceived behaviour control
Lead to intention
P PAIR takes to Behaviour -
Preparatory actions Perceived control Anticipated regret Implementation intentions Relevance to self
Theory of planned behaviour advantages
Can be applied to wide variety of health behaviours
Useful for predicting intention
Takes into account importance of social pressures
Theory of planned behaviour Disadvantages
No temporal element, direction or causality
Doesn’t consider emotions
Assumes attitudes can be measured
Health belief model
Perceived susceptibility Perceived severity Health motivation Perceived benefits Perceived barriers
Variables contributing to the HBM
Demographic variables
Psychological characteristics
HBM advantages
Can be applied to wide variety of health behaviours
Cues to action are unique component
Longest standing model (who cares?!)
HBM Disadvantages
Other factors may influence the outcome
Doesn’t consider emotions
Doesn’t differentiate between first time and repeated behaviours
Medical negligence process
Was there a duty of care?
Was there a breach in that duty?
Was the patient harmed?
Was the harm due to the breach in care?
Medical negligence rules
Bolam Rule: Would a reasonable doctor do the same?
Bolitho rule: Would that be reasonable?
Types of error
Sloth Fixation/loss of perspective Lack of skill System error Mistriage Ignorance Bravado/timidity Playing the odds Communication breakdown Poor team working
Swiss cheese model of human error causation steps
Latents failures: Organizational influences
Unsafe supervision
Preconditions for unsafe acts
Active failures: Unsafe acts
Never event definition
a serious, largely preventable patient safety incident that should not occur if available, preventative measures have been implemented
Three bucket model of error
Self, Context, Task
Self bucket
Level of:
Knowledge, Skill, Expertise, Current capacity to do task
Context bucket
Equipment Physical environment Workspace Team/support Organisation and management
Task bucket
Errors
Complexity
Novel task
Process
Screening
identifying apparently well individuals who have (or are at risk of having a particular disease)
Screening criteria
Wilson and Jungner
Disease
test
outcome
Screening disease criteria
Important, Natural history known, Early treatment better than late
Screening test criteria
Acceptable to the population
Facilities available
Simple, safe, precise and validated
Screening outcomes criteria
Ongoing feasibility
Treatment available
Cost-benefit analysis
Cross-sectional study design
Snapshot data of those with and without disease to find associations at a single point in time
Cross-sectional study +ves
Quick and cheap
Few ethical issues
Cross-sectional study -ves
Prone to bias
No time reference
Case-control study design
Retrospective observational study which looks at a certain exposure and compares similar participants with and without the disease
Case-control study positives
Good for rare diseases
Inexpensive
Case-control study negatives
Can only show association (not causation)
Unreliable due to recall bias
Cohort study design
Longitudinal prospective study which takes a population of people recording their exposures and conditions they develop
Cohort study positives
Can show causation
Less chance of bias
Cohort study negatives
Large amount lost to follow up
Expensive
RCT Design
Similar participants randomly controlled to intervention or control groups to study the effect of the intervention
Gold standard
RCT positives
Can infer causality
Less risk of bias/ confounders
RCT negatives
Time consuming and expensive
Ethical issues can interfere
Factors to assess causality
Bradford-Hill
Biological plausibility Temporal relationship Dose-response relationship Strength association Specificity Consistency Altered by experimentation Coherence with existing themes Consider reverse causality
Confounders definition
risk factors, other than those being studied, that influence the outcome
Bias types
Selection bias: discrepancy of who is involved
Information bias:
Measurement bias: different equipment
Observer bias
Recall bias: past events incorrectly remembered
Reporting bias: responder doesn’t tell the truth
Publication bias: some trials are more likely to be published than others
Bias definition
a systematic error that results in a deviation from the true effect of an exposure on an outcome
Epidemiological Health needs assessment description
Defines problem and size of problem
Looks at current services
Recommends improvements
Epidemiological Health needs assessment limitations
Data available may be poor
May be inadequate evidence base
Doesn’t consider felt need
Comparative Health needs assessment description
Compares services received by one population to another
Comparative Health needs assessment limitations
Data available may vary in quality
May be hard to find comparable population
Comparison may not be perfect
Corporate Health needs assessment description
Takes into account views of any groups that may have an interest eg patients, health professionals, media, politicians
Corporate Health needs assessment limitations
May be hard to distinguish need from demand
Groups have vested interest – leads to bias
Dominant individuals may have undue influence
Felt need description
Individual perceptions of deviations from normal health
Expressed need description
Seeking help to overcome variation in normal health
Normative need description
Professional defines intervention for expressed need
Comparative need description
Comparison between severity, range of interventions and cost
types of economic evaluation
BUME - Cost/Benefit analysis (Monetary units), Cost utility analysis (QALY)s, cost minimisation analysis (minimise cost for the same outcome), cost effectiveness analysis (natural units)
Units economic evaluation
QALYs, Natural units, Monetary
equity
fair and just distribution of costs and benefits
Opportunity cost
The benefits lost from not allocating resources to the next best option
Define efficiency
When resources are distributed in such way as to maximise benefit.
