Session 2 Flashcards
Why measure health?
To have an indication of the need for health care
To target resources where they are most needed
To assess the effectiveness of health interventions
To evaluate the quality of health services
To use evaluation and effectiveness to get better value for ,ones
Monitor patients progress
What are commonly used measures of health?
Mortality
Morbidity
Patient based outcomes
What is a patient based outcome?
Attempt to asses wellbeing from patients point of view
Why use patient based outcomes?
Increase in conditions where the aim is to manage rather than cure
Biomedical tests are just one part of the picture
Need patient centred care
Need to pay attention to iatrogenic effects of care
How can patient based outcomes be used?
Clinically To asses benefits in relation to cost in clinical audit Measure health status of populations Compare interventions in clinical trials Measure of service quality
What is PROMs?
Patient reported outcome measure- measures of health directly from patient
Why was PROMs introduced?
Improve the clinical management of patients
Comparison of hospitals
Enhance quality of life for people with long term conditions
Help people to recover from episode of ill health or following injury
What procedures does PROMs follow in the NHS?
Hip replacement
Knee replacements
Grown hernia
Varicose veins
Challenges of PROMs?
Minimise the time and cost of collection, analysis and presentation of data
Achieving high rates of patient participation
Provides appropriate output of different audiences
Avoiding misuse of PROMs
What illnesses are more common in people with chronic illness?
Depression and anxiety
What triggers anxiety?
A response to a threat e.g. threats to identity or well being and big life events e.g. surgery
Likely to occur at different stages in healthcare
What is anxiety?
A feeling of intense dread or uneasiness
May be panic attack, OCD or general anxiety
What triggers depression?
response to loss, failure or helplessness e.g. reactions to symptoms or medication side effects, loss of health and identity, physiological changes
usually long term
What are the symptoms of depression?
depressed, irritable, less enjoyment in activities, change in weight, change in sleep, change in activities , fatigue, feelings of guilt and worthlessness, can not concentrate or think, have suicidal thoughts suicidality
Why is it hard to see depression or anxiety in patients?
Symptoms may attributed to illness or treatment, the patients may not disclose symptoms as may feel judges
Health care professionals may avoid asking due to time constraints and belief its not there job
What is the importance of recognising and addressing psychological problems?
listen, ask and provide the opportunity to raise problems so the patient will come forward and you can help them with the NICE- indicated treatment for depression and anxiety disorders
What are long-term conditions?
long term, large impact on life, co-morbid conditions, symptoms may very each day, controlled but not cured, increase with ageing population
What is Rheumatoid arthritis?
Chronic, progressive, inflammatory, autoimmune disease of unknown cause, insidious onset (slow), Usually arises between ages of 40 and 60, but may occur at any age, Signs and symptoms include – joint tenderness and swelling, anaemia, pain, fatigue, muscle atrophy, osteoporosis, Marked by exacerbations and remissions
What percentage of healthcare costs go on LTCs?
70%
What is an illness narrative?
Used with LTCs, they give a narrative of there illness for a sociological study
What are the works for LTC suffers
BEEII- Biological, Everyday life, Emotional, Illness, Identity work
What is illness work?
Getting diagnosed, managing the symptoms, self management
What are the positives of the expert patient programme?
reduces hospital admissions, patient centred, coping and condition management skills
What are the negatives of the expert patient programme?
responsibility of care placed on very ill patients, real agency and understanding? little evidence of efficacy saving
What is coping?
the sum of cognitive and behavioural efforts, which are constantly changing, that aim to handle particular demands, whether internal or external, that are viewed as taxing or demanding
What is strategy?
Actions and process involved in managing the condition and its impact
What is Every day life work?
Being able to cope and have a strategy and rebrand your new life as normal life
What is emotional work?
Work that people do to protect the emotional wellbeing of others e.g. present a cheery self, downplay pain, impact on role may be devastating as be more dependant on people
What is biological work?
loss of self, former self image crumbles away, body and identity interaction, new consciousness of body and fragility
What is identity work?
affects how people see themselves, may become a defining aspect of there identity, stigma
What is a discreditable stigma?
Not seen but if found out is negatively viewed e.g. Mental illness or HIV positive
What is a discredited stigma?
physically visible characteristic or stigma that sets them apart e.g. physical disability or suicide attempt
What is enacted stigma?
The real experience of prejudice, discrimination or disadvantage due to condition
What is felt stigma?
Fear of enacted stigma and also feels shame due to condition
What is Emotional focussed coping?
Behavioural (Talk to friends, drink, distract) and cognitive approach (denial, focus on positives)
What is problem focussed coping?
change the problem or the resources e.g. reduce the demands of stressful situations and expand resources to deal with it
May be more effective but not always possible
What are the ways to aid coping?
social support to manage stress, help patients to increase social support (e.g. social services, community resources, religion, patient groups) personal control (e.g. pain management, psychological therapies, self management programmes) prepare for stressful events, consider special cases
What are the outcomes of stressful coping?
tolerates negative events or reality, reduce threats and enhance prospects of recovery so prepare for future, maintain a positive self image and emotional equilibrium
