Readings Flashcards
APTA applauds the recently released? Why?
National Prevention and
Health Promotion Strategy and its call for public and private partners to take action and “move the nation away
from a health care system focused on sickness and disease to one focused on wellness and prevention.”
The National Prevention Strategy’s strategic directions to?
create healthy and safe
communities, reduce or preferably eliminate health disparities, integrate clinical and community prevention, and assist individuals in making healthful lifestyle choices will improve the health of our nation and provide increasing
opportunities for individuals across the lifespan and of all abilities.
The National Prevention Strategy: America’s Plan for Better Health and Wellness is a call to?
action for health care
providers and physical therapists to assist our nation in reducing disability, improving function, and advancing health status.
Vision 2020 states?
PTs will be the health care professionals as the practitioners of choice to whom consumers have direct
access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.
Vision elements? (6)
- -Autonomous Physical Therapist Practice
- -Direct Access
- -Doctor of Physical Therapy and Lifelong Education
- -Evidence-based Practice
- -Practitioner of Choice
- -Professionalism
Vision goals? (4)
1) EFFECTIVENESS OF CARE
2) PATIENT- AND CLIENT-CENTERED CARE ACROSS THE LIFESPAN
3) PROFESSIONAL GROWTH AND DEVELOPMENT
4) VALUE AND ACCOUNTABILITY
A core aspect of teaching patients involves?
Helping them assume responsibility for their health
Alternative terms now being used for compliance? (2) Why?
- adherence
- cooperation
- To promote responsibility for one’s health. Compliance connotes patients as passive recipients of professionals’ advice
Essential aspects of therapists’ intervention to assist pts. in returning to function?
Enhancing cooperation or motivating pts
Some factors related to HEP nonadherence? (3
- perceived barriers and encounters
- lack of positive feedback
- degree of pt.’s perceived helplessness
How to foster motivation? (3)
By influencing the pt.’s beliefs, attitudes, and therefore behavior
Main factor categories related to non-adherence? (4)
- personal variables
- disease variables
- treatment variables
- patient-practitioner relationship
Why will the ability to effectively understand the pt.’s perspective be increasingly important? (4)
Because of shrinking health care resources, PTs will have to set priorities and maximize resources; teach pts in a smaller number of visits, and adherence will becoming essential in assessing pt outcomes
An explanatory model is developed how? (3)
- By thinking about the patient’s wants and needs,
- how to understand more about a pt.’s receptivity to change,
- and how to help a pt do more exercises at home
Explanatory model is used to?
Guide pt. eval and tx decision making
Explanatory model defined as? It represents? (4)
- The notions patients, families, and practitioners have about a specific illness episode
- The pt.s’ attempt to self-disprove and ascribe the course of the condition
- the likely consequences of the condition
- the time before it resolves
- txs
The patient-practitioner collaborative model integrates?(6)
- the patient in context to their life
- pt. beliefs, attitudes, skills, feeling, shaped by a lifetime of disease
What are the two conceptualizations of ill health? Define each.
- Disease: represents what went wrong with the body as a machine
- Illness: represents the person’s experience of the disease on their life
Four proposed phases for promoting health?
1) establishing the therapeutic relationship
2) diagnosing through mutual inquiry
3) Finding common ground through negotiation (creating a tx pt is most likely to following)
4) intervening and following up (usually involves renegotiation and problem solving)
To discover barriers, the PT should acknowledge the difficulty of an exercise program and ask what questions? (4)
- what problems do you anticipate?
- what are your beliefs about exercise?
- what are the worst things about exercise, and what are the best things?
- What’s the most important thing I can do to help you succeed?
Strategies to enhance pt self-efficacy? (4)
- skills mastery
- modeling
- reinterpretation of physiologic signs and symptoms (how pt. interprets their s&s)
- persuasion
What is a stimulus for promoting more prevention activity?
HEDIS - requires managed care organizations to report on more than 50 prevention-oriented indicators
What’s the most significant structural change affecting how PTs work with pts?
Structural changes due to the growth of managed care organizations such as low reimbursement
What are the most common contributors to musculoskeletal problems? (4) Why are PTs likely to discuss them?
- chronic inactivity
- obesity
- tobacco
- alcohol
- exercise can be a part of the solution for these risk behaviors and musc. problems
Initiating and maintaining a behavior change usually involves addressing..? (3)
- knowledge
- motivation
- resources
Example of how to use the TTM?
People go through different stages during the process of change. It is helpful if the PT views intervention, adherence, and prevention as an ongoing conversation that occurs at each visit. Have the pt. also keep a tx log to keep the conversation going and promote that patient’s belief that you won’t forget.
What can you say to elicit adherence motivation?
Mr. Smith, if your problem doesn’t improve, what important activities would this cause you to quit or do less of? What is the worst thing about that? With all that at stake, what do you think would happen if you didn’t do your home program?
What to say to address adherence?
Completing an HEP regularly and correctly is important to your getting well and getting you back to your meaningful activities. We need to agree on the most effective tx that you’re willing to do regularly and correctly.
Line up the TTM stages with the TBM (5)
1) Precontemplation stage = belief in susceptibility to the disease
2) Contemplation stage = belief in consequences of the disease & belief in susceptibility to the disease
3) Preparation stage = belief that changing will decrease threat & belief in consequences of the disease
4) Active stage = belief costs/barriers less than benefits & belief in ability to make change
5) Maintenance stage
General strategy for initiating and maintaining a behavior change? (3)
1) provision of info
2) motivation
3) resources
What is reciprocal determinism?
dynamic interaction between person, behavior, and environment in
which the behavior is performed
Differences between disease and illness?
- Disease represents what went wrong with the body as a machine
- Illness represents the person’s experience of a disease on his or her life
Two key concepts of the ecological perspective help to identify intervention points for
promoting health?
- first, behavior both affects, and is affected by, multiple levels of influence;
- second, individual behavior both shapes, and is shaped by, the social environment (reciprocal causation).
3 key concepts for Intra/Interpersonal Levels?
- behavior is controlled by what people know and think,
- knowledge is needed for behavior to change, perceptions/motivations/skills &
- the social environment are key influences on behavior
Explanatory theory describes?
describes the reasons why a problem exists. It guides the search for factors that contribute to a problem
Change Theory guides?
the development of health interventions. Spells out concepts that can be translated into program messages and strategies
Individual ecological level examples of strategies? (4)
- educational sessions
- interactive kiosks
- print brochures
- social marketing campaigns
Interpersonal ecological level examples of strategies? (2)
- mentoring programs
- lay health advising
Community ecological level examples of strategies? (2)
- media advocacy campaigns
- advocating changes to company policy
Following a treatment plan requires that the patient? (4)
(1) chooses to do so
(2) know when to enact
the plan
(3) has the psychomotor skills to perform the plan and
(4) remain motivated to follow
through until the problem resolves.
How should you choose interventions - discover? (2) Discuss?
- *Discover patient’s beliefs and tailor treatment to them.
- Discover patient’s motivations, which
important activities or symptoms that will serve as treatment goals to motivate treatment
behavior. - Discussing positive and negative aspects to exercise
Most common mistake is making the treatment regimen?
Too complex
Patient-Practitioner Collaborative model - establish therapeutic relationship how? (4)
- Communicate respect and care via:
- positive verbal and nonverbal interactions
- active listening
- responsive touch
Patient-Practitioner Collaborative model - How do you come to a diagnosis via mutual inquiry? (4)
identify:
- disease beliefs
- tx beliefs
- valued activities
- potential barriers to tx
Patient-Practitioner Collaborative model - how do you negotiate common ground - identify? Link to? Identify? Assess? Make a?
- identify best tx pt. is likely to follow
- link to valued activity
- identify specific barriers to tx
- assess self-efficacy
- make a mutual agreement for long and short term goals
Patient-Practitioner Collaborative model - intervention and follow up: teach? Evaluate? (2) Problem solve to? Modify?
- teach performance skills, provide knowledge of how to implement and monitor self-tx, design reminder strategies
- evaluate for tx effect
- evaluate for adherence
- problem solve to eliminate barriers to adherence
- modify success indicators as pt progresses
Treatment Adherence Guidelines (patient-practitioner collaboration model)? (10)
- Anticipate non-adherence
- Consider the prescribed self-care regimen from the patient’s perspective
- Foster a collaborative relationship based on negotiation
- Be patient-oriented
- Customize treatment
- Enlist family support
- Provide a system of continuity and accessibility
- Make use of other health care providers as well as community resources
- Repeat everything
- Do not give up
What are The Five A’s Behavioral Intervention Protocol?
- address the issue
- assess the pt
- advice the pt
- assist the pt
- arrange follow-up (accountability)
Address the issues by addressing? (2)
a. Address adherence to home program
b. Address a prevention issue
Assess the pt. through going over? (3)
a. Recent attempts (What worked vs what didn’t)
b. Patients readiness to change
c. Motivation (help patient to understand positive and negative consequences. What
would you have to give up if this condition got worse? etc.)
Assist the patient by negotiating? Educating? Problem solving?
a. Negotiate a plan (treatment program, health risk modification program)
b. Educate the patient about the home program and about any other mistaken beliefs
or areas of ignorance (what, when, how, why)
c. Problem solve any barriers to following the home program of behavior change
plan
Comparison of Five A’s Protocol with Social Learning, Health Belief, TTM Model - Step one: address the issue?
No match
Comparison of Five A’s Protocol with Social Learning, Health Belief, TTM Model - Step two: assess - task 1 (prior attempts) - social learning theory? HBM? TTM?
- SLT: reveals pt self-efficacy about prior programs
- HBM: None
- TTM: Reveals if pt. is in action stage
Comparison of Five A’s Protocol with Social Learning, Health Belief, TTM Model - Step two: assess - task 2 (readiness to change) - social learning theory? HBM? TTM?
- SLT: None
- HBM: None
- TTM: Reveals if pt. is in precontemplative or contemplative stage
Comparison of Five A’s Protocol with Social Learning, Health Belief, TTM Model - Step two: assess - task 3 (motivational reflection) - social learning theory? HBM? TTM?
- SLT: personal positive and negative consequences
- HBM: None
- TTM: Facilitates movement to next stage
Comparison of Five A’s Protocol with Social Learning, Health Belief, TTM Model - Step three: advise - social learning theory? HBM? TTM?
- SLT: establish social performance expectation
- HBM: provide cue to action
- TTM: None
Comparison of Five A’s Protocol with Social Learning, Health Belief, TTM Model - Step four: task 1 (negotiate) - social learning theory? HBM? TTM?
- SLT: identify goal, steps, and rewards
- HBM: None
- TTM: establish stage-appropriate plan
Comparison of Five A’s Protocol with Social Learning, Health Belief, TTM Model - Step four: task 2 (educate) - social learning theory? HBM? TTM?
- SLT: develop program and self-efficacy
- HBM: address patient’s problem susceptibility, severity, program effectiveness
- TTM: facilitates movement to next stage
Comparison of Five A’s Protocol with Social Learning, Health Belief, TTM Model - Step four: task 3 (address barriers) - social learning theory? HBM? TTM?
- SLT: none
- HBM: problem solve program costs and positive consequences of not changing
- TTM: facilitates movement to next stage
Comparison of Five A’s Protocol with Social Learning, Health Belief, TTM Model - Step five: arrange follow-up - social learning theory? HBM? TTM?
SLT: establishes monitoring expectation
