Socpop phase2 Flashcards

Question

Reasons why inequity in health care should be addressed?

Answer 1

o justice & fairness o equitable access contributes to reductions in health inequalities o stopping widening of health inequalities o duty under Equality Act 2010: (all public sector bodies)

Answer 2

``` Soceioeconomically deprived areas have o less referrals for hip and knee replacements o less dyspepsia referrals o less Lung cancer active treatment o less Breast reconstruction ``` Older people o Less hip and knee replacement South Asian o Less coronary angiographs Disabled o Higher number of avoidable deaths

Answer 3

o Availability of access (appointment times, ability to register) o Geographical access (rural, car ownership, ability to drive) o Financial costs (prescriptions and dental charges) o Cultural access (interpreters, LGBT & female led services) o Navigation o Clinical attitude o Lack of responsive services

Answer 4

Define sex: o The characteristics between males and females that are biologically determined Define gender: o The social and cultural meanings assigned to being male and female

Answer 5

o Umbrella term that relates to the private dimension in which people live out their sexual, intimate and/or emotional desires. o Complex and fluid o Experience and expressed by (all or some of) beliefs, acts, behaviour, desires, values, practices, relationship and identities o Influenced by historical, social, cultural, political. Legal, religious, spiritual aspects of society o WHO: “central aspect of being human…encompasses sex, gender identity, sexual orientation, eroticism, pleasure, intimacy and reproduction. “

Answer 6

o Naturalist: sexuality is biologically determined with minimal influence from societal structures. Traits are fixed and there is no variation. Sexuality is concerned with reproduction. Uses anatomical differences between sexes to claim there is biological basis to sexuality. Heterosexuality is normal expression, presumed to have no cuase as it is viewed as natural. o Nurture: sexuality is constructed and influenced by societal structures. Gives us a potential for choice, change and diversity. Sexuality is complex, people’s reasons for engaging in sexual behaviour are varied. Sexuality is “made”, people are experts in their own lives.

Answer 7

o Prohibited discrimination in providing goods facilities and services

Answer 8

o Be aware and challenge discrimination o Do not make assumptions about a person’s sexuality o Ask open questions o Develop a language of sexual expression and be able to talk about sexuality comfortably and explicitly o Reflect on your on personal attitudes values and beliefs; personal unease about human sexuality is not acceptable reason to remain ill-informed

Answer 9

o 107k people with HIV in the UK o 25% unaware of infection o 6k incidence per year o MSM at highest risk

Answer 10

o 440k diagnoses of STIs in 2014 in England o most common is chlamydia – 207k o biggest increases for syphilis & gonorrhoea o mostly MSM

Answer 11

``` o Increased sexual activity o People more aware of STIs o Easier access to servies o Better diagnostic tests o Artefact ```

Answer 12

o To protect the patient from re-infection o To offer sexual partners tests for STIs o To offer sexual partners treatment o To inhibit further spread

Answer 13

o GUM users tend to perceive themselves at risk o Attenders expect questions about sex o Testing can be anonymous in GUM – won’t appear in patient notes o GP may be more accessible, more supportive o GP can provide more care at same time

Answer 14

``` o Male: o IHD o Stroke o COPD o Female: o Stroke o IHD o LRTI ```

Answer 15

``` Male: o IHD o Stroke o COPD Female: o Stroke o IHD o LRTI ```

Answer 16

``` o HTN o Tobacco o High cholesterol o Underweight o Unsafe sex o High BMI o Physical inactivity o Alcohol o Indoor smoke from solid fuels o Iron deficiency ```

Answer 17

Primary o Removing primary causative agent o Interrupting transmission of infective agent o Protecting individual from environmental hazards o Improving host resistance Secondary o Early detection of pre-clinical disease (screening) o Treatment to prevent progression Tertiary o Treatment to prevent complications or relieve distress

Answer 18

``` Population strategy o Aimed at everyone o Aimed at small reduction of risk factor in everyone o Reduces incidence and prevalence o Eg reduction of BP or cholesterol ``` High risk strategy o Treats those with defined disease status o Does not produce lasting population changes

Answer 19

Diet o Fatty foods, process foods o Soft drinks o Sodium: regarding HTN (5g per day Na reduction, reduces stroke by 23%) Physical activity o Obesity o Car ownership o Cultural changes Tobacco

Answer 20

``` regulation and marketing control taxation reformulation labelling social marketing primary care advice ```

Answer 21

``` Patient-centred o Demographic ♣ The older, the better concordance ♣ If married, better concordance ♣ Ethnicity, gender, education: equivocal ``` o Psychological ♣ Patient beliefs and motivation ♣ Patient attitudes towards therapy ``` o Patient-prescriber relationship ♣ Communication ♣ Trust ♣ Empathy of prescriber ♣ Multiple prescribers ``` ``` o Health literacy o Patient knowledge o Other ♣ Smoking & alcohol ♣ Forgetfulness ``` ``` Therapy related o Route of adminisation (PO best) o Complexity of dosing o Side effects o Degree of behaviour change needed ``` Social & economic o Time commitment for appointments o Prescription costs o Social support system Healthcare system o Availavility of appointments o Waiting times o Quality of consultations Disease o Fluctuation symptoms – concordance reduces o Absent symptoms (HTN) – concordance reduces o Marked improvement of symtpoms – concordance increases o perceived poor health status – concordance increases

Answer 22

o Attributes, behaviours or pathological states that set people apart from others, that mark them as less acceptable or inferior beings in some way

Answer 23

o Medical labels are also social labels (affect people’s identity) o Medical diagnoses is helpful for access to treatment, but can also have serious and unwelcome social consequences for patients when conditions are stigmatising

Answer 24

Enacted stigma o Real experience of negative attitudes Felt stigma o Fear that prejudice or discrimination may occur Discreditable stigma o Condition that is not immediately obvious eg mastectomy Discrediting stigma o Obvious & visible condition

Answer 25

o When well, may experience felt and discreditable stigma | o When ill, may experience enacted and discrediting stigma

Answer 26

o Passive absorption – very negative effect o Normalisation o Withdrawal o Active – seeking support (often from others with same condition) can challenge stigma and change social values. Doctors can help with challenging stigma

Answer 27

o A systematic method of identifying unmet health and healthcare needs of a population and making changes to meet these unmet needs

Answer 28

o Exists when an individual has an illness for which these is effective and acceptable treatment or care. Ie a population’s capacity to benefit from healthcare

Answer 29

o Epidemiological o Epidemiology of health condition & RFs o What Tx works o Description of current services o Comparative o Compare service between different populations o Corporate o Ask stakeholders what they would like included

Answer 30

Epidemiological o Epidemiology of health condition & RFs o What Tx works o Description of current services Comparative o Compare service between different populations Corporate o Ask stakeholders what they would like included

Answer 31

1. Traditional rational planning: where are we, where do we want to be, how do we get there? 2. Plan, do, study, act 3. Knox planning cycle o Situation analysis o Setting objectives o Deciding strategies o Operational plan o Plan implementation o Evaluation

Answer 32

o 3 As: Ask, Advise, Act o Ask: about smoking status o Advise: on how to stop – combination of support and medication (referral to in-house or local NHS cessation services and offer prescription) o Act: offer help. If patient doesn’t want smoking cessation services, medication is acceptable(better with support) but book follow up appointment. Signpost NHS smoke-free website and helpline. Prescribe Champix and Nicotine Replacement Therapy. Return every two weeks for 2-3 months.

Answer 33

o Alcohol Identification and Brief Advice (IBA) 1. Initial screening (AUDIT-C) (3 questions) 2. Ask the remaining 7 questions of AUDIT (10 questions in total) 3. Delivering brief advice to patients who are drinking above the low-risk levels 4. Referring or signposting possible dependent drinkers to GP or local alcohol support service

Answer 34

0-4 is low risk, explain, congratulate 5-10 is increasing and higher risk, explain, advise on cutting down 11 or 12 is dependence - refer

Answer 35

o Have several ‘drink-free’ days, when you don’t drink at all o When you do drink, set yourself a limit and stick to it o Quench your thirst with non-alcohol drinks before and in-between alcoholic drinks o Avoid drinking in rounds or in large groups o Eat when you drink -have your first drink after starting to eat o Switch to lower alcohol beer/lager o Avoid going to the pub after work o Plan activities and tasks at those times you would usually drink o When bored or stressed do something physical instead of drinking o Avoid or limit the time spent with “heavy” drinking friends

Answer 36

``` o Feedback on risk o Responsibility o Advise o Menu (give options) o Empathy Self-efficacy ```

Answer 37

* belief in our own ability to carry out a particular action * expectation that a particular goal will be achieved

Answer 38

1. agenda setting 2. goal setting 3. goal follow-up

Answer 39

1. agenda setting (clinic can send agenda sheet in advance) 2. goal setting (small and achievable - mastery experiences build momentum for bigger success) 3. goal follow-up (within 14 days)

Answer 40

* Behavioural beliefs * Subjective beliefs * Control beliefs & self-efficacy * Depression, obesity, poor mobility, fatigue, communication, family, pain, finances

Answer 41

``` o Injury, intentional or unintentional o Neglect or abuse o Default on social role o Property damage o Toxic effects eg FAS o Loss of peace of mind ```

Answer 42

o CV deaths o Unintentional injuries o GI disease

Answer 43

o Men & women should not drink >14 units per week and spread over at least 3 days, with alcohol free days o Single episode: limit total amount, drink slowly, avoid risky places o Pregnant women: no alcohol o New evidence of cancer risk, and CV protection evidence is now weaker (previous studies prone to confounding and selection bias)

Answer 44

• A condition of arrested or incomplete development of the mind, which is especially characterized by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence ie cognitive, language, motor and social abilities.

Answer 45

* Difficulties in understanding new information * Difficulties in communication * Difficulties in learning new skills (impaired intelligence all above) * Reduced ability to cope independently (impaired social functioning) * Must be present from childhood and have lasting effect * Higher rates of certain physical problems

Answer 46

85 and over 70-84 50-69

Answer 47

85 and over 70-84 50-69 less than 20

Answer 48

Unknown in majority Inherited chromosomal o Fragile X syndrome o Down’s syndrome Acquired o Antenatal: Neural tube defect, infection, FAS o Perinatal: hypoxia, hypoglycaemia, LBW o Postnatal: Malnutrition, injury, infections

Answer 49

``` Patient o Cognitive o Communication o Heatlh literacy o Phobia o Sensory imp o Late presentation ``` ``` Clinician o assumption of QOL o educational needs o communication skills with PWLD o reasonable adjustments lack ``` Service o institutional discrimination o accessibility – reasonable adjustment o long enough appointments - reasonable adjustment user friendly information – reasonable adjustment

Answer 50

• Clinical audit is a quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes.

Answer 51

* Research is designed to derive new knowledge, to test an hypothesis, addresses a clearly defined question. Research involves allocating patients to intervention groups and requires Ethics review * Service evaluation asks what standard does this service achieve? Measures this without a reference to a pre-established standard.

Answer 52

preparation and planning measuring performance implementing change sustaining improvement through re-audit

Answer 53

• Probability that a hazard will give rise to harm

Answer 54

Risks need to be communicated with the patient to enable them to make informed decisions. Communication is highly correlated with patient adherence.

Answer 55

Relative risk reduction • The reduction of risk in the intervention group relative to the risk in the control group Absolute risk reduction • The difference between risk in the intervention and control group

Answer 56

• The number of patients who need to be treated to prevent one additional adverse outcome

Answer 57

* Mismatched framing * Ratio bias (using bigger denominators) * Emotional tactic

Answer 58

clinical (93 indicators) public health (18 indicators) patient experience (1) quality and productivity (9)

Answer 59

``` Physical Emotional Psychological Social/spiritual Information Control Out of hours Living with illness Aftercare / bereavement ```

Answer 60

``` o Advanced disease for which prognosis is limited and focus of care is QOL o AND one or more of: ♣ Uncontrolled symptoms ♣ Specialised nursing requirements ♣ Complex psycho needs ♣ Complex family issues ♣ Difficult decision making ```

Answer 61

when they are likely to die within the next 12 months. This includes people whose death is imminent (expected within a few hours or days) and those with: • Advanced, progressive, incurable conditions • General frailty and co-existing conditions that mean they are expected to die within 12 months • Existing conditions if they are at risk of dying from a sudden acute crisis in their condition • Life-threatening acute conditions caused by sudden catastrophic events.

Answer 62

gold standards framework

Answer 63

SPICT TOOL Supportive and Palliative Care Indicators Tool Look for two or more general indicators of deteriorating health:- • Performance status poor or deteriorating, with limited reversibility. (Needs help with personal care, in bed or chair for 50% or more of the day). • 2 or more unplanned hospital admissions in the past 6 months. • Weight loss (5 – 10%) over the past 3 – 6 months • Persistent, troublesome symptoms despite optimal treatment of any underlying condition(s). • Lives in a nursing care home or NHS continuing care unit, or needs care to remain at home. • Patient requests supportive and palliative care, or treatment withdrawal.

Answer 64

recommended summary plan for emergency care and treatment (purple)

Answer 65

RESPECT, DNACRP decision, ACP documentation

Answer 66

Check the understanding of the patient and their family and address any concerns. This may involve: • Giving bad news to patient/family member • Discussing shift in management approach • Discussing important EOL decisions such as place of death • Discussing home/hospice referral • Discussing DNACPR status if not already done • Discussing difficult issues (e.g. fluids and food, death rattle)

Answer 67

* 1/4 cancer * 1/3 frailty / dementia * 1/3 organ failure

Answer 68

- less infectious death - lower birth rate - longer lives