The Impact of Long Term Conditions

Question 1

What is patient centred care and who is in the position to make decisions about treatment?

Answer 1

The provision of care which places the patient at the centre ensuring that the healthcare system is designed to meet the needs and preferences of patients.

Only the patient is in a position to make a decision on what patient centered healthcare means to them, the treatments of their condition and the living of their life.

Question 2

What are the 5 principles of the IaPO Declaration on Patient-Centered Healthcare? - RICAP

Answer 2

1. Respect.
2. Information.
3. Choice and empowerment.
4. Access and support.
5. Patient involvement in health policy.

Question 3

Why have long term conditions become more common

Answer 3

Acute illnesses have become short lived and amenable to cure allowing long-term conditions to become more prevalent

Question 4

Who are long-term conditions more common in

Answer 4

Older people

More deprived groups

Question 5

What percentage of GP appointments account for long-term conditions

Answer 5

50%

Question 6

What percentage of outpatient appointments account for long-term conditions

Answer 6

64%

Question 7

What percentage of all inpatient bed days account for long-term conditions

Answer 7

70%

Question 8

What is the meaning of incidence

Answer 8

The number of new cases of a disease, in a population, in a specified period of time

Question 9

What is the meaning of prevalence

Answer 9

The number of people in a population with a specific disease at a single point in time or in a defined period of time (existing cases)

Question 10

What does incidence tell us

Answer 10

About trends in causation and the aetiology of disease so can be helpful when planning:

i.e. , if the number of new Diabetes diagnoses per year in a particular practice is known, then we can plan staffing and services for the future

Question 11

What does prevalence tell us

Answer 11

About the amount of disease in a population

Is useful in assessing the current workload for the health service but is less useful in studying the cause of a disease

Question 12

What are long-term conditions usually the end-result of? (aetiology) (2)

Answer 12

A long term, complex interaction of factors:

• genetic
• environmental
• both or neither

Question 13

What is vulnerability

Answer 13

An individual’s capacity to resist disease, repair damage and restore physiological homeostasis.

Certain organs can vary in vulnerability - i.e. liver & brain

Question 14

What are the different progressions of diseases with examples (3)

Answer 14

Acute onset - MI, stroke
Gradual with a slow or more rapid deterioration - angina
Relapse and remission - cancer

Question 15

What must be considered in the treatment of long-term diseases

Answer 15

May be aimed at the disease, or the effects of the disease
In order to treat, the chronic nature must be realised
Both patient and doctor must admit failure in cure or diagnosis

Question 16

The burden of treatment - how are patients or caregivers often put under enormous demands by the healthcare system (4) - CMTA

Answer 16

1. Changing behaviour or policing the behaviour of others to adhere to lifestyle modifications
2. Monitoring and managing their symptoms at home
3. Complex treatment regimes and multiple drugs (poly pharmacy)
4. Complex administrative systems, and accessing, navigating and coping with uncoordinated health and social care systems

Question 17

What is Bury’s meaning of biolographical disruptions

Answer 17

The experience of a long term condition (chronic illness) leads to a loss of confidence in the body, and from this follows a loss of confidence in social interaction or self-identity

Question 18

What does biological disruption reveal (4)

Answer 18

1. Brings into focus the meaning of illness for the individual
2. May involve `re-negotiating’ existing relationships at work and at home.
3. The chronically ill and disabled person also needs to be able to make some sense of their condition before they can begin the process of `adjusting’ to it.
4. Involves redefining ideas of what is good' and bad’, such that the positive aspects of their lives are emphasised, and the negative impact of the illness lessened.

Question 19

What strategies can be used to cope with the stigma of long-term conditions (2)

Answer 19

Making a decision about whether to either:

1. disclose the condition and suffer further stigma
2. Attempt to conceal the condition / aspects of the condition and pass for normal

Question 20

What are the different impacts of a long term condition (3)

Answer 20

1. On the individual – can be negative or positive. Can include denial, self pity and apathy.
2. On Family – can be financial, emotional and physical, other family members may become ill as a result.
3. Community/society. Isolation of an individual may result.

Question 21

What is an expert patient

Answer 21

Where a patient understands more about their disease than the doctors, nurses and other health professionals who undertake long-term follow-up and care them

• i.e. diabetes mellitus, arthritis or epilepsy
• “my patient understands their disease better than I do.”
• They can become key decision-makers in the treatment process.

Question 22

Dictionary definition of disability

Answer 22

Lacking in one or more physical powers such as the ability to walk or coordinate ones movements

Question 23

Legal definition of disability

Answer 23

Difficulty can be physical, sensory or mental. A disability that makes it difficult for them to carry out normal day to day activities, ongoing for more than 12 months

Question 24

WHO Definition of disability: ICIDH – International classification of Impairments, Disability and Handicap. (3)

Answer 24

Body and Structure Impairment - abnormalities of structure, organ or system function (organ level)

Activity Limitation - changed functional performance and activity by the individual (personal level)

Participation Restrictions - disadvantage experienced by the individual as a result of impairments and disabilities (interaction at a social and environmental level)

Question 25

Medical models of disability (4)

Answer 25

1. Individual/personal cause e.g. accident whilst drunk
2. Underlying pathology e.g. morbid obesity
3. Individual level intervention e.g. health professionals advise individually
4. Individual change/adjustment e.g. change in behaviour

Question 26

Social models of disability (4)

Answer 26

1. Societal cause e.g. low wages
2. Conditions relating to housing
3. Social/Political action needed e.g. facilities for disabled
4. Societal attitude change e.g. use of politically correct language.

Question 27

What legislations have been drawn up for disability rights (2)

Answer 27

1. Disability Discrimination Acts 1995 and 2005 - sets out the rights of people with disabilities in relation to employment, education, access to goods & services, buying or renting property
2. Equality Act 2010 - age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage and civil partnership, and pregnancy and maternity are now to be known as ‘protected characteristics’

Question 28

Why are doctors not spectators of disability (3)

Answer 28

We assess disability
We coordinate the multi-disciplinary care team
We intervene in the form of rehabilitation

Question 29

What does the personal reaction to disability depend on? (10)

Answer 29

1. The nature of the disability
2. The information base of the individual, ie education, intelligence and access to information
3. The personality of the individual
4. The coping strategies of the individual
5. The role of the individual – loss of role, change of role
6. The mood and emotional reaction of the individual
7. The reaction of others around them
8. The support network of the individual
9. Additional resources available to the individual e.g. good local self-help group, socio-economic resources
10. Time to adapt i.e. how long they have had the disability

Question 30

The sick role, describe the different benefits of illness (6)

Answer 30

Social - social interaction and company 
Familial - more attention from family 
Psychological - sympathy feel better
Financial - benefits
Medications - access to drugs 
Responsibilities - don't have to work

Question 31

Where does disability cause disruption within the family (3)

Answer 31

Personal - getting ill because of stress
Economical - not working because spending time caring
Social - loss of interaction with friends and hobbies

Question 32

Epidemiology of Disability, what are the different cause worldwide? (9)

Answer 32

Congenital
Injury
Communicable Disease
Non-Communicable Disease
Alcohol 
Drugs-iatrogenic effect and/or illicit use
Mental Illness
Malnutrition
Obesity

Question 33

How many of those with a disability are in employment

Answer 33

One third

Question 34

What are Wilson and Junger’s Criteria for screening (4)

Answer 34

Knowledge of disease:

• The condition should be important.
• There must be a recognisable latent or early symptomatic stage.
• The natural course of the condition, including development from latent to declared disease, should be adequately understood.

Knowledge of test:

• Suitable test or examination.
• Test acceptable to population.
• Case finding should be continuous (not just a ‘once and for all’ project).

Treatment for disease:

• Accepted treatment for patients with recognised disease.
• Facilities for diagnosis and treatment available.
• Agreed policy concerning whom to treat as patients.

Cost considerations:
- Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole.