Risk Assessment and Prevention of Chronic Disease Flashcards
Secondary Prevention
the patient already has the disease but has not developed symptoms
examples: STD screening, mammogram, colonoscopies, case finding
RISK MANAGEMENT
Tertiary prevention
the disease process has already begin, symptomatic disease is already present, this limits the physical and social consequences of the disease
example: rehabilitation of stroke patient
What is Preventative Medicine?
Health promotion, disease prevention, and application of epidemiological and biostatistical principles to achieve these goals.
Focuss on individuals
(public health focuses on intervention at the population level)
Primary Prevention
keeps the disease from ever occurring through eliminating the cause of the disease or increasing resistance to disease
Examples – Immunization, Fluoride in water, health promotion
1970
How to Practice Prospective Medicine which was generally not accepted by the medical society
1979
the Canadian Task Force on Periodic Physical Examinations recommended that the process be based on gender and age appropriate immunizations, screenings, on a periodic basis
1980
CDC developed its first 31 question risk assessment tool to compute adult risk.
What is the U.S Preventive Services Task Force
USPSTF
Created in 1984
an independent, volunteer panel of national experts in prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations aboutclinical preventive servicessuch as screenings, counseling services, and preventive medications
What occured after 1998?
the Agency for Healthcare Research and Quality (AHRQ) has been authorized by the U.S. Congress to convene the Task Force and to provide ongoing scientific, administrative, and dissemination support to the Task Force
What type of reports does the Task Force Report to congress?
that identifies critical evidence gaps in research related to clinical preventive services and recommends priority areas that deserve further examination.
What change did the Affordable Care Act 2010 make that was implemented in 2011?
a required annual health risk assessment for Medicare Patients designed to improve and prevent onset of chronic illnesses
IMPROVE: 2-3 prevention
PREVENT: 1 (primary)
What are the determinants of population health?
Social/social characteristics
Total Ecology
Genes and biology
health behaviors
medical care
What are the social determinants of health?
Physical Environment
Socio-Economic Factors
Health Care
Health Behaviors
Define Social deteminants of health?
Conditions in which people are born, grow, work, live, age, and the wider set of forces and systems shaping the conditions of daily life.
In 2010, what was the top leading cause of death?
Heart disease
Health Risk Assesment
- Typically a questionnaire or computer program to elicit and evaluate information concerning individuals.
- The assessed person received information about their life expectancy with recommended interventions that may have a positive impact on their health and longevity
- Risk factors are combined from various epidemiologic studies with mortality statistics
- This information is then applied toward the assessment of an individuals risk of mortality
- •The individuals’ information is compared to one with the lowest possible risk factors to encourage positive behavior change.
What is the process of Health Risk Assesment?
- The top leading causes of death for an individuals age-sex-race group of which The 10 year expected risk of mortality for each leading cause of death is calculated.
- This is then summed by computer algorithm to determine an overall 10 year expected risk of mortality, which is then compared to an overall risk for the general population for the individuals age-sex-group – Risk Age
What is the typical data collected for a risk assesment?
- Height
- Weight
- Blood Pressure
- Cholesterol
- Past Medical History
- Family History
What are the Critiques of the HRA?
- Lack of information of the individuals entering the data
- Validating the predictions
- Reference population for baseline risks
Focus on mortality vs. morbidity and quality of life
What are the strengths of the HRA?
- Motivate an individual to make changes in their lifestyle
- Emphasize how nutritional and lifestyle factors affect an assessed person’s risk
Age of the average individual who has the same risk of dying as the one being assessed is known as the?
Risk Age
40 year old man with a risk age of 35 years means?
?
If the risk age is greater than the chronilogical age, what does that mean?
Increase risk of dying
If the risk age is less than the chronilogical age, what does that mean?
Lower risk of dying than someone else the same chronological age
TRANSTHEORTICAL MODEL –STAGES OF CHANGE
- Pre-contemplation: no intention on changing behavior
- Consciousness raising
- dramatic relief
- environmental re-evaluation
- Contemplation: Aware problem exist but with no commitment to action
- self-reevaluation
- Preperation: intent on taking action to address the problem
- Self and social liberation
- Action: Active modification of behavior
- Using and fosterinf social support and caring relationships
- Contigency management
- Counter conditioning
- Maintenance: Sustained change; new behavior replaces old
- Continue positive reinforcement and social support
- Stimulus control
- Maintain self efficacy
- Relapse: fall back into old patterns of behavior
5 A’s Behavior Change Model
- Assess: Belief, behavior, and knowledge
- Advice: Provide specific information about health risk and benefits of change
- Agree: Collaborately set goals based on patient’s interest and confidence in their ability to change behavior
- Assist: Identify personal barriers, stratagies, problem-solving techniques and social/environmental support
- Arrange: Specify plan for follow-up
What should be part of the personal action plan?
- List Specific goals in behavioral terms
- List barriers and strategies to address barriers
- Specify follow-up plan
- Share plan with practice team and patients social support
What are the 3 factors part of the social cognitive theory?
- Personal Factors
- Environmental factors
- Behavioral factors
Wha does the interaction between the person and the environments involve?
Involves beliefs and cognitive competence developed and modified by social influences
What does the interaction between the environment and their behavior involve?
Involves the person’s behavior determining their environement, which in turn, affects their behavior
What is the interaction between person and their behavior inflenced by?
Influence by their thoughts and actions
Health Belief Model
- THE DESIRE TO AVOID ILLNESS, OR CONVERSELY GET WELL IF ALREADY ILL; AND,
- THE BELIEF THAT A SPECIFIC HEALTH ACTION WILL PREVENT, OR CURE, ILLNESS. ULTIMATELY, AN INDIVIDUAL’S COURSE OF ACTION OFTEN DEPENDS ON THE PERSON’S PERCEPTIONS OF THE BENEFITS AND BARRIERS RELATED TO HEALTH BEHAVIOR.
The HBM is more descriptive than explanatory, and does not suggest a strategy for changing health-related actions.
For the most effective use of the model it should be integrated with other models that account for the environmental context and suggest strategies for change.
What should be included in a successful Health Risk assessment counseling session?
provider introduction and orientation to the session
- identify risk (HRA and patient comments)
- identify patient’s readiness to change
- identify patient’s goal(s)
- identify patient’s incentives and barriers to changing now
- design a detailed plan ahead
- state any needed follow up or referrals
- briefly summarize and close the session with patient agreement
Patient Centered Interview
Core Skills
OARS
Opens Questions
Affirmations
Reflections
Summaries
LOOK AT IMAGE
What is Motivational interviewing?
uses empathy rather than confrontation. It acknowledges that the patient, not the physician, is responsible for changing behavior.
What are the components of Motivational Interviewing?
F = Feedback—Compare the patient’s risk behavior with nonrisk behavior patterns. She may not be aware that what she considers normal is risky.
R = Responsibility—Stress that it is her responsibility to make the change.
A = Advice—Give direct advice (not insistence) to change the behavior.
M = Menu—Identify “risk situations” and offer options for coping.
E = Empathy—Use a style of interaction that is understanding and involved.
S = Self-efficacy—Elicit and reinforce self-motivating statements such as “I am confident that I can stop drinking.” Help the patient to develop strategies, implement them, and commit to change.
What is NURS?
EMPATHY -
NAME
UNDERSTAND
RESPECT
SUPPORT
- Establish an emotional focus by using emotion-seeking skills, the patient’s emotional story
- address the emotion
example
Dr: . . . So you get mad when he gets on you? [N]
Pt: Yeah, he really gets me mad. I just get so furious I could scream sometimes (clenches fist and strikes table firmly).
Dr: . . . It sure makes sense. [U] It seems like you’ve done so much there to help and all you get is grief from him. [R] I appreciate the way you’re able to talk about it. [R] He sure gets you mad . . . [N]
Pt: He sure does. Just talking about it gets me upset and gives me a headache right now.
Dr: I can imagine. [U] You’ve put up with a lot. [R] Let’s work on this together. [S]
