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Public Health 3b > Public Health > Flashcards

Public Health Flashcards

1
Q

Definition of economic evaluation?

A

Comparative study of the costs and benefits of healthcare intervention

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2
Q

What is 1 QALY

A

1 year of perfect health

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3
Q

What 4 things must be considered in health economics?

A

opportunity cost
economic efficiency
equity
economic evaluation

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4
Q

what is opportunity cost

A

the cost of what you cannot do now du to an action you have undertaken (i.e. spending £100,000 on PCI means there is £100,000 less to spend on GP)

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5
Q

What is economic efficiency

A

achieved when resources are allocated between activities in such a way as to maximise benefits

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6
Q

What are the three domains of public health

A

health protection
health improvement
improving services

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7
Q

what are the key concerns of public health

A

inequalities of health
wider determinants of health
prevention

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8
Q

what is the domain of health protection concerned with?

A

measures to control infectious disease risk and environmental hazards i.e. infectious disease, radiation, chemicals etc.

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9
Q

what is the domain of health improvement concerned with?

A

societal interventions such as inequalities, education, housing and empolyment

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10
Q

what is the domain of improving services concerned with?

A

organisation and delivery of safe high quality services for prevention and treatment of care

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11
Q

in which three ways can health interventions be applied?

A

individual level - vaccines
community level - outdoor excersise programme
population level - iodine in salt to prevent iodine deficiency

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12
Q

what is a health needs assessment

A

a systematic method for reviewing the health issues facing a population leading to agreed priorities and resource allocation that will improve health and reduce inequalities

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13
Q

what is the health needs assessment model?

A

needs assessment -> planning -> implementation -> evaluation -> needs assessment

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14
Q

what are the three approaches to health needs assessment?

A
  1. epidemiology
  2. comparative
  3. corporate
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15
Q

define need

A

ability to benefit from an intervention

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16
Q

give some examples of how a health need is measured

A

mortality, morbidity, socio-demographic measure

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17
Q

what are the 4 sociological perspectives of a health need?

A
  1. felt need- individual perceptions of variation from normal health
  2. expressed need- individual seeks to overcome the variation
  3. normative need- the professional defines intervention appropriate for the expressed need
  4. comparative need- comparison between severity, range of intervention and cost
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18
Q

what does an epidemiological approach to the a health needs assessment involve?

A

define the problem,look at the size of the problem (incidence, prevelance), services available, evidence base, models of care and existing serivces to make a recommendation

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19
Q

what are some potential sources of data for an epidemiological health needs assessment?

A

disease registry
hospital admissions
GP database
mortality data

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20
Q

what are the advantages of an epidemiological HNA?

A

uses existing data
provides data based on incidence/mortality
can evaluate service by trends over time

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21
Q

what are the disadvantages?

A

quality of data is variable
data collected may not be required
does not consider the felt needs or opinions of the people affected

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22
Q

what does a comparative health needs assessment involve

A

compares the services recieved by one population with another population e.g. comparing mental health services in two different areas

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23
Q

what factors does a comparative health needs assessment examine?

A

health status
service provision
service utilisation
health outcomes

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24
Q

what are the advantages of a comparative health needs assessment?

A

quick and cheap

indicates whether a health or service provision is better or worse in comparable areas

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25
Q

what are the disadvantages of a comparative health needs assessment?

A

may be difficult to find a comparable population
data may not be high quality
may not yield what the most appropriate level of intervention should be

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26
Q

what does a corporate approach to a health needs assessment involve?

A

ask the local population what their health needs are - uses focus groups, public meetings, interviews and a wide variety of stakehloders i.e. teachers, social workers, charity workers etc.

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27
Q

what are the advantages of a corporate HNA?

A

it is based on the felt and expressed needs of the population in question
recognises the experience of those working in the population
takes into account a wider range of views

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28
Q

disadvantages of a HNA?

A

difficult to distinguish a need from a demand
groups may have invested interested
may be influenced by a political agenda

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29
Q

what is a secondary prevention and give an example?

A

catching a disease in its early or pre-clinical phase

i.e. breast screening

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30
Q

what is a tertiary prevention and give an example?

A

preventing complications of an established disease

e.g. diabetic foot care review

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31
Q

what are 2 approaches to prevention?

A

population approach - preventative measures for everyone

high risk approach - identify individuals above a chosen cut off point and treat

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32
Q

what is the prevention paradox?

A

a preventative measure brings much benefit to the population but little to each participant

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33
Q

what is the wilson criteria for screening programme? (8)

A
  1. important problem
  2. known and detectable latent stage
  3. natural course/progression
  4. test is acceptable to population
  5. treatment available
  6. agreed at risk population to screen
  7. agreed policy on who to treat
  8. must be economically balanced
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34
Q

disadvantages of screening? (3)

A

exposure of well individuals to distressing or harmful diagnostic tests
detection and treatment of subclinical disease that would never cause problems
preventative interventions may cause harm

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35
Q

what is sensitivtiy of screening test and how do you calculate it

A

the proportion of people with the disease who are correctly identified by the screening test

true positive / (true positive + false negative)

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36
Q

what is the specificity of screening and how is it calculated?

A

proportion of people without the disease that are correctly excluded

true negative / true negative + false positive

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37
Q

what is positive predicted value and how is it calculated?

A

proportion of people with a positive test result who actually have the disease

true positive/ true positive + false positive

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38
Q

what is the negative predicted value and how is it calculated?

A

the proportion of people with a negative test result who do not have the disease

true negative/ (true negative + false negative)

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39
Q

incidence?

A

number of new cases of a disease in a population in a given time frame

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40
Q

define prevelance?

A

total number of people with the condition per 100,000 per year

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41
Q

what is lead time bias?

A

when a screening test identifies an outcome earlier than it would otherwise been identified resulting an apparent increase in survival time

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42
Q

what is a length time bias?

A

bias resulting from differences in the length of time taken for a condition to progress to severe effects that may affect the efficacy of the screening method

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43
Q

who does a case report study?

A

individuals

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44
Q

what is an ecological study?

A

study used routinely to show trends in data - used for generating hypothesis but cannot show causation

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45
Q

what are 2 descriptive study types?

A

case report study

ecological study

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46
Q

what are cross sectional studies?

A

divide populations into those without the disease and those with the disease and collects data on these groups t one point in time

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47
Q

advantages and disadvantages of cross sectional study?

A

large cohort
cheap
good for surveillance

prone to bias
cannot infer causation
risk of reverse causality
recall bias and non-response

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48
Q

what is a case control study?

A

restrospective - takes people with a disease and matches them to people without the disease

49
Q

advantages and disadvantages of a case control study?

A

good for rare outcomes
quick
can investigate multiple exposures

difficulty in finding matching controls
prone to selection and information bias

50
Q

what is a cohort study?

A

prospective study that starts with a population without the disease and studies them over time to see if they develop it

51
Q

advantages and disadvantages of a cohort study?

A

low chance of selection bias
prospective
absolute, relative and attributable risks can be determined

requires control group
expensive
time consuming
loss to follow up

52
Q

advantage and disadvantages of RCT?

A

low risk of bias and confounding factors
can infer causality (gold standard)

time consuming
expensive
study population may be different to target population

53
Q

define the “odds” of an event and how is it calculated?

A

ratio of probability of an occurrence compared to the probability of a non-occurence

odds= probability/(1-probability)

54
Q

what is an odds ratio and how is it calculated

A

the oods ratio is the ratio of the odds for an exposed group to the odds for a non-exposed group

(p exposed/(1-P exposed)) / (P unexposed / 1- punexposed))

55
Q

define epidemiology?

A

the study of frequency, distribution and determinants of a disease and health related states in populations in order to prevent and control disease

56
Q

what is person time?

A

measure of time at risk from entry into a study to disease onset, loss to follow up or end of study

57
Q

define incidence rate

A

number of persons who have become cases in a given time period / total person-time at risk during that period

58
Q

how to calculate attributable risk

A

incidence in exposed - incidence in unexposed

59
Q

how to calculate relative risk

A

incidence in exposed / incidence in unexposed

60
Q

how to calculate relative risk reduction?

A

(incidence in non-exposed - incidence in exposed)/ incidence in non-exposed

61
Q

how to calculate absolute risk reduction?

A

incidence in non-exposed - incidence in exposed

62
Q

what is the number needed to treat and how is it calculated?

A

number of patients needed to treat to prevent a bad outcome

1/(risk in non-exposed - risk in exposed)

63
Q

what are the five factors that could be responsible if a study finds an association between an exposure and an outcome?

A 
bias 
chance 
confounding factors 
reverse causality 
a true causal association
64
Q

define bias

A

a systematic deviation from the true estimation of the association between exposure and outcome

65
Q

what are the 3 main types of bias?

A

selection bias - systematic error in the selection of participants

information bias - systematic error in the measurement i.e. observer or recall bias

publication bias

66
Q

what is the definition of a confounding factor?

A

a situation in which the association between an exposure and an outcome is distorted because of the association of the exposure with another factor

67
Q

what are the 3 types of health behaviours?

A

health behaviour - aimed to prevent disease (eating healthy)

illness behaviour - aimed to seek remedy (going to the doctor)

sick role behaviour - any activity aimed at getting well (taking medicine)

68
Q

what is the theory of planned behaviour?

A

proposes that the best predictor of behaviour is the intention

69
Q

what are the 3 factors of the theory of planned behaviour?

A
  1. attitude - i do not think smoking is a good thing
  2. subjective norms- perceived social pressure to undertake the behaviour - people who are important to me want me to stop smoking
  3. perceived behavioural control -a persons appraisal of their ability to perform the behaviour i.e. give up
70
Q

criticisms of theory of planned behaviour?

A

does not take into account emotions
no timescale
elements cannot be measured
relies on self reported behaviour - people may lie

71
Q

6 stages of change model/transtheoretcial model?

A 
pre contemplation 
contemplation 
preparation 
action 
maintenance
relapse
72
Q

advantages and disadvantages of stages of change model?

A

accounts for relapse
acknowledges individual stage
time frame considered

not all people move through every stage
continuum
does not take into account social norms

73
Q

what is nudge theory?

A

changing the environment to make the best option the easiest i.e. fruit net to check out

74
Q

what are the 4 factors of the health beliefs model?

A

individuals will change their behaviour based on percieved:

  1. susceptibility
  2. severity
  3. benefits
  4. barriers - most important
75
Q

criticisms of health beliefs model?

A

does notconsider emotions
does not differentiate between first time and repetitive behaviour
cues to action are missing (i.e pain, reminders in post)

76
Q

what 4 approaches can help people act on their intentions?

A
  1. percieved control - ask them how it felt when something went well
  2. anticipated regret - ask them to reflect on how it felt when they did not do something well
  3. preparatory actions - remind people to prepare for change i.e. throw away cigs
  4. implementation intentions - help them help themselves through routines
77
Q

what are the factors of unrealisitc optimism that influence peoples perception of risk?

A
  1. lack of personal experience
  2. its preventable by personal action
  3. if its has not happened by now, it is unlikely to happen
  4. belief that the problem is infrequent
78
Q

who needs to be notified of notifiable disease?

A

the proper officer of the local authority

79
Q

what are the levels of maslows hierarchy of needs?

A 
physiological 
safety
love and belonging
esteem 
self actualisation
80
Q

what 4 ways can errors be classified?

A
  1. intention
  2. action
  3. outcome
  4. context
81
Q

what 3 ways can intention errors be classified?

A

skills based errors - action made was not what was intended
rule based errors - incorrect application of a rule
knowledge based errors - lack of knowledge

82
Q

what 2 ways can an error be classified based on action?

A

generic factors

task specific

83
Q

what 4 ways can an error be classified based on outcome?

A

near miss
succesful detection and recovery
death
cost of litigation etc

84
Q

what 4 ways can an error be classified based on context?

A

interruptions and distractions
nature of procedure
team factors
organisation factors

85
Q

2 perspectives of error?

A

person approach

system approach

86
Q

strategies to reduce errors? (6)

A
  1. simplification of clinical process
  2. checklists and memory aides
  3. information technology
  4. team training
  5. risk management
  6. mechanisms to improve uptake of evidence based treatment patterns
87
Q

tools for risk identification? (3)

A

audit
incident reporting
complaints and claims

88
Q

definition of never event?

A

serious, largley preventable patient safety incident that should not occur if the available preventative measures have been implemented

89
Q

define negligence?

A

a breach of duty of care which results in damage

90
Q

6 factors that contribute to negligence?

A 
system failure
human factors 
judgement failure 
neglect
poor performance 
misconduct
91
Q

what 4 questions should be asked when negligence is suspected?

A

is there a duty of care?
was there a breach in that duty?
did the patient come to harm?
did the breach cause the harm?

92
Q

what 2 tests can be used to decide if there was a breach in the duty of care?

A

bolam - would a group of reasonable doctors do the same?

bolitho - would it be reasonable for them to do so?

93
Q

4 types of learner?

A
  1. theorist- complex situation
  2. activist - new experiences
  3. pragmatist - wants feedback
  4. reflector - watches others
94
Q

3 reasons why rationing needs have increased in terms of resource allocation?

A

shift from acute to chronic illness
normal physiological events have become medicalised
increase in choice and increase in expensive drugs

95
Q

define ratiioning?

A

resource is refused because of lack of affordability rather than clinical ineffectiveness

96
Q

what are 3 allocation theories?

A

egalitarian principles: provide all care that is needed for everyone

maximising (utilitarian): maximise public utility

libertarian: each is responsible for their own health, well-being and fulfilment of life plan

97
Q

what is the definition of an evaluation of health services?

A

evaluation of whether a service is achieving its objectives

98
Q

3 elements of the framework for a health service evaluation?

A
  1. structure - buildings, staff, equipment
  2. process - no. of patients seen
  3. outcome - mortality, morbidity, QOL
99
Q

what are some issues with health outcomes in an evaluation?

A

the link between health service and health outcome may be difficult to establish
time lag
large sample size needed
data may not be available

100
Q

what are maxwells 6 dimensions when assessing the quality of health services?

A 
Acceptability 
Accessibility 
Appropriateness
Effectiveness
Efficiency
Equity
101
Q

what is equity?

A

what is fair and just

102
Q

what is equality?

A

concerned with equal shares

103
Q

what are the 2 types of equity?

A

horizontal - equal treatment for equal need

vertical - unequal treatment for unequal need i.e. areas with poor health may need high expenditure on health service

104
Q

what is opportunity cost? HE

A

to spend resources on one activity means sacrifice in terms of a lost opportunity cost elsewhere

105
Q

what is economic efficiency? HE

A

allocating resources between activities in a way to best maximise benefit

106
Q

what is economic equity? HE

A

fair and just distribution of costs and benefits

107
Q

what is meant by an equity-efficiency trade off? HE

A

improving equity often leads to a loss in efficiency

108
Q

define economic evaluation? HE

A

the assessment of efficiency - a comparative study of the costs and benefits of health care interventions

109
Q

how can health benefits be measured? HE

A

natural units- BP
QUALY
monetary value

110
Q

what is a QUALY? HE

A

combines length of life with QOL

length (years)x quality (utility - on a scale of 0 to 1)

111
Q

what are the types of economic evaluation? HE

A

cost effectiveness analysis
cost utility analysis
cost benefit analysis
cost minimisation analysis

112
Q

what is cost effectiveness analysis? HE

A

outcomes measured in natural units i.e. the cost of life per year gained

for example - ICER is measured as £10,000 per life year gained for a heart transplant

113
Q

what is cost utility analysis? HE

A

outcomes measured in QALYS i.e. cost per QALY gained

for example - £18,000 per QALY for a heart transplant

114
Q

what is cost benefit analysis?HE

A

outcomes measured in monetary units

115
Q

what is cost minimisation analysis? HE

A

outcomes are the same in both treatments therefore minimising the cost

116
Q

what is the incremental cost effectiveness ratio?HE

A

comparing for example: a new drug vs old drug, new treatment vs watch wait

e.g. existing screening - £100,000 per year detects 80 cases, new screening £200,00 a year detects 90 case
ICER= (200,000-100,000)/(90-80)= £10,000 per extra case

117
Q

what is a funding threshold? HE

A

when a new more expensive treatment is funded by the NHS, another treatment must have its funding reduced

118
Q

what is the NHS current funding threshold? HE

A

the NHS will fund a treatment if the cost is less than £20,000 per QALY

119
Q

what are the three main models of financing healthcare?HE

A
  1. public funding
  2. social insurance
  3. private

Public Health 3b (2 decks)

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