Session 2

Question 1

Why measure health?

Answer 1

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

Question 2

What are commonly used measures of health?

Answer 2

Mortality
Morbidity
Patient based outcomes

Question 3

What is a patient based outcome?

Answer 3

Attempt to asses wellbeing from patients point of view

Question 4

Why use patient based outcomes?

Answer 4

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

Question 5

How can patient based outcomes be used?

Answer 5

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

Question 6

What is PROMs?

Answer 6

Patient reported outcome measure- measures of health directly from patient

Question 7

Why was PROMs introduced?

Answer 7

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

Question 8

What procedures does PROMs follow in the NHS?

Answer 8

Hip replacement
Knee replacements
Grown hernia
Varicose veins

Question 9

Challenges of PROMs?

Answer 9

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

Question 10

What illnesses are more common in people with chronic illness?

Answer 10

Depression and anxiety

Question 11

What triggers anxiety?

Answer 11

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

Question 12

What is anxiety?

Answer 12

A feeling of intense dread or uneasiness

May be panic attack, OCD or general anxiety

Question 13

What triggers depression?

Answer 13

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

Question 14

What are the symptoms of depression?

Answer 14

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

Question 15

Why is it hard to see depression or anxiety in patients?

Answer 15

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

Question 16

What is the importance of recognising and addressing psychological problems?

Answer 16

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

Question 17

What are long-term conditions?

Answer 17

long term, large impact on life, co-morbid conditions, symptoms may very each day, controlled but not cured, increase with ageing population

Question 18

What is Rheumatoid arthritis?

Answer 18

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

Question 19

What percentage of healthcare costs go on LTCs?

Answer 19

70%

Question 20

What is an illness narrative?

Answer 20

Used with LTCs, they give a narrative of there illness for a sociological study

Question 21

What are the works for LTC suffers

Answer 21

BEEII- Biological, Everyday life, Emotional, Illness, Identity work

Question 22

What is illness work?

Answer 22

Getting diagnosed, managing the symptoms, self management

Question 23

What are the positives of the expert patient programme?

Answer 23

reduces hospital admissions, patient centred, coping and condition management skills

Question 24

What are the negatives of the expert patient programme?

Answer 24

responsibility of care placed on very ill patients, real agency and understanding? little evidence of efficacy saving

Question 25

What is coping?

Answer 25

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

Question 26

What is strategy?

Answer 26

Actions and process involved in managing the condition and its impact

Question 27

What is Every day life work?

Answer 27

Being able to cope and have a strategy and rebrand your new life as normal life

Question 28

What is emotional work?

Answer 28

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

Question 29

What is biological work?

Answer 29

loss of self, former self image crumbles away, body and identity interaction, new consciousness of body and fragility

Question 30

What is identity work?

Answer 30

affects how people see themselves, may become a defining aspect of there identity, stigma

Question 31

What is a discreditable stigma?

Answer 31

Not seen but if found out is negatively viewed e.g. Mental illness or HIV positive

Question 32

What is a discredited stigma?

Answer 32

physically visible characteristic or stigma that sets them apart e.g. physical disability or suicide attempt

Question 33

What is enacted stigma?

Answer 33

The real experience of prejudice, discrimination or disadvantage due to condition

Question 34

What is felt stigma?

Answer 34

Fear of enacted stigma and also feels shame due to condition

Question 35

What is Emotional focussed coping?

Answer 35

Behavioural (Talk to friends, drink, distract) and cognitive approach (denial, focus on positives)

Question 36

What is problem focussed coping?

Answer 36

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

Question 37

What are the ways to aid coping?

Answer 37

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

Question 38

What are the outcomes of stressful coping?

Answer 38

tolerates negative events or reality, reduce threats and enhance prospects of recovery so prepare for future, maintain a positive self image and emotional equilibrium