Public health

Question 1

Goals of medicine optimisation

Answer 1

• Improve their outcomes
• Take their medicines correctly
• Avoid taking unnecessary medicines
• Improve medicines safety
• Reduce wastage of medicine

Question 2

What is adherence/concordance?

Answer 2

• Making a shared decision with patients
  The extent to which a patient’s behaviour, taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provide

Question 3

State some non-intentional and intentional reasons for non-adherence.

Answer 3

Non intentional (practical barriers - capacity and resource) - Difficulty understanding instructions, inability to pay, forgetting

Intentional (motivational barriers + perceptual barriers) - Patients beliefs about their health/condition, personal preference

Question 4

What is the necessity-concerns framework?

Answer 4

These are key beliefs influencing patient evaluations of prescribed medicines. – 2 categories
Necessity beliefs - Perceptions of personal need for treatment

Concerns - About a range of potential adverse consequences.

The higher the necessity belief and the lower the concerns, the higher the adherence of the patient.

Question 5

What does patient-centred care encourage?

Answer 5

• Focus in the consultation on the patient as a whole person who has individual preferences in a social context.
• Shared control of the consultation, decisions about interventions or management of health problems with the patient.

Question 6

What are the impacts of good doctor to patient communication

Answer 6

• Better health outcomes
• Higher adherence to therapeutic regimens in patients
• Higher patient and clinician satisfaction
• Decrease in malpractice risk

Question 7

What are some ethical considerations you should have when dealing with patients?

Answer 7

• Mental capacity - mental capacity act (2005) - e.g. dementia, severe learning disability
• Decisions that may be detrimental to a patient’s wellbeing
• Potential threat to the health of others (e.g. infectious diseases)
• When the patient is a child (a 3rd party will be required, should more weight be given to the child or parent’s wishes?)

Question 8

Describe the public health act (health protection regulations 2010)

Answer 8

It provides a legal basis to detain and isolate an infectious individual. it allows for a person who has category 4 or 5 infections diseases to be brought to a specific place for isolation if they pose a serious public health risk to others and if all other reasonable efforts to support treatment have failued.

Question 9

How are infections prevented and controlled?

Answer 9

Identify risks
- Identify routes and modes of transmission
- Identify virulence of organisms (+consequence of infection)
- Screening and clinical/lab diagnosis

Question 10

Benefits of knowing HIV status and list some scenarios of testing for HIV status

Answer 10

Benefits of knowing HIV status
- Reduction in morbity and mortality
- Reduction in vertical transmission
- Reduction in sexual transmission
- Partner notification
- Access to appropriate treatment and care
Early diagnosis: reduces mortality, morbidity, transmission and is cost effective

e.g. Clinician initiated testing triggered by clinical indicators of immuno-suppression, routine screening in high prevalance locations, screenings in high risk groups, patient initiated request for testing.

Question 11

What is the COBAS HIV test? what is the typical screening algorithm (mindmap)

Answer 11

It is a diagnostic test used for screening and detecting HIV.
Although it is highly sensitive (false negative unlikely), there is the occasional false positive.

If the first COBAS screening test is negative –> the lab reports it as negative.

If the final lab report is negative –> repeat a blood test from patient after 6 weeks (as the presence of antibodies or antigens may take 1-6 weeks to appear depending on patient)

If first COBAS test is positive –> confirm in lab with a different assay (geenius line assay)

If final report is positive, confirm with the patient that it is positive but a second confirmatory blood sample is required.

Question 12

How is a HIV point of care test (POCT) compared to a COBAS screening test?

Answer 12

POCT test
- Finger prick blood - so more convenient and less invasive than venous blood draws

• Immediate result
• but lower sensitivity and specificity compared to COBAS so higher chance of false positives and negatives