Public Health Flashcards
Definition: Patient compliance
The extent to which the patients behaviour (in terms of taking meds, following diets, or other lifestyle changes) coincides with medical or health advice
Discuss the different models regarding patient-doctor communication
Patient compliance: a paternalistic relationship, the patient must follow the doctors orders. Professionally focused, assumes that the ‘doctor knows best’ and does not look at the problems that patients have in managing their illness. NO LONGER THE CASE
Patient adherence: Acknowledges the patients beliefs, more of a patient centred model. The doctor is still considered the expert but there is more communication to enhance patient knowledge, satisfaction, and adherence.
- Focuses on the consultation of the patient as a whole person with individual preferences
- Shared control of the consultation, patient has decisions
Give 6 examples of non-adherence
- Not taking prescribed medication
- Taking bigger/smaller doses than prescribed
- Taking it more/less often than prescribed
- Stopping the medicine without finishing the course
- Modifying treatment to accommodate other activities (work, social)
- Continuing behaviours against medical advice (smoking, alcohol, diet)
What are the reasons for non-adherence?
Unintentional- difficulty understanding instructions, inability to pay, problems using treatment, forgetting –> CAPACITY AND RESOURCE
Intentional- patients’ beliefs about their health/condition, belief about treatments, personal preferences –> PERCEPTUAL BARRIERS
What are the two key beliefs influencing patient evaluations of prescribed medicines?
Necessity of the drug (personal need for treatment)
Concerns about a range of potential adverse consequences
What are the impacts of goof patient-doctor communication?
- Better health outcomes
- Higher compliance to therapeutic regimens
- Higher patient and clinical satisfaction
- Decrease in malpractice risk
What are the duties of a doctor regarding communication, partnership, and teamwork?
Work in partnership with the patients
Work with colleagues in a way that best serves patient interests
What are some ethical considerations to consider regarding patient adherence and communication?
- Mental capacity (mental capacity act 2005)
- Decision may be detrimental to patients wellbeing
- Potential threats to the health of others e.g. infectious diseases (public health act 2010)
- When the patient is a child e.g. when does the child have consent? (childrens act 1989)
What is Substance abuse?
- Recurrent substance use resulting in a failure to fulfil major role obligations such as work, school, or home life.
- Recurrent substance misuse in situations in which it is physically hazardous, e.g. Driving or operating machinery
- Continued substance misuse despite persistent or recurrent social or interpersonal problems caused by its effects, e.g. friction with family members.
What are some tests to measure if a person has alcohol misuse?
AUDIT
SADQ (alcohol withdrawal symptoms)
MMSE (assess cognitive impairment
What is dependency?
A state in which a person only functions normally in the presence of a drug. Manifests as a physical disturbance when the drug is withdrawn
What is the best drug to treat withdrawals?
Chlordiazepoxide (class: benzodiazepines)
How does Chlordiazepoxide work? what are its contraindications and side effects
- Enhances actions of GABA (inhibitory transmitter in CNS)
- Never use as standalone treatment for depressions (causes suicidal tendencies), don’t use while pregnant, severe pulmonary insufficiency etc)
- Causes headache, muscular pain, anxiety, seizures
- If impaired liver function, use lorazepam instead (contraindicated)
What drug is used to treat Wernicke’s encephalopathy?
Pabrinex
What drugs can be used to prevent alcohol relapse?
- Acamprosate (Campral) tablets–> acts on GABA/NMDA
- Disulfiram (Antabuse) tablets –> disrupts oxidation of alcohol. Results in acetaldehyde build up (SE’s–> flushing of skin, tachycardia, SOB)
- Nalmefine (selnicro)–> opioid receptor antagonist (alcohol effects still present but no reward)
