The Impact of Longterm Conditions

Question 1

What is patient centred care?

Answer 1

Placing the patient at the centre of their care… duh

Question 2

The International Alliance of Patients’ Organisation’s (IaPO) Declaration on Patient Centred Care outlines what five principles?

Answer 2

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

Question 3

Describe the importance of long term conditions since the birth of the twentieth century?

Answer 3

Increasingly important

Question 4

Why is the importance of long term conditions since the birth of the twentieth century increasing?

Answer 4

Acute conditions are now often curable and short lived - with its demise a whole cohort of long term conditions have become increasingly prevalent

Question 5

In what demographic of people are long term conditions more prevalent?

Answer 5

Older people and in more deprived areas

Question 6

What percentage do long term conditions make up of total GP appointments?

Answer 6

50%

Question 7

What percentage do long term conditions make up of total outpatient appointments?

Answer 7

64%

Question 8

What percentage do long term conditions make up of total inpatient days?

Answer 8

70%

Question 9

What is the definition of incidence?

Answer 9

The number of new cases of a disease in a population oer a specific period of time

Question 10

What is the definition of prevalence?

Answer 10

The number of people in a population with a single disease at a single point in time/time period

Question 11

How many people in the UK are there over the age of 16?

Answer 11

81.2 million

Question 12

Approximately how many new people between 1993 and 2002 describe themselves as having at least one long-standing disease?

Answer 12

4 million

Question 13

Longstanding diseases are usually the end result of a long-term and complex interaction between which factors?

Answer 13

Genetics and environmental

Question 14

What is the Burden of Treatment?

Answer 14

Patients and caregivers are often put under enormous stress/demands by healthcare systems

Question 15

In what ways might a healthcare system increase the burden of treatment?

Answer 15

1. Changing/policing lifestyles (e.g. smoking cessation)
2. Monitoring/managing symptoms at home
3. Complex treatments regimes (polypharmacy)
4. Complex administrative systems

Question 16

How can biographical disruption occur in longterm disease?

Answer 16

A long term condition leads to loss of confidence in the body

A loss of confidence in social interaction/self-identity possibly resulting in re-negotiating of relationships at work and at home

Question 17

What does biographical disruption highlight with patient centred care?

Answer 17

The meaning of illness for the individual

Question 18

What stigmas may be faced with longterm conditions?

Answer 18

Less obvious conditions may be subject to some stigma

Question 19

Explain the concept of ‘the expert patient’

Answer 19

A patient with a longstanding condition may well have a deeper understanding and more personal knowledge - this can be a resource to the clinician

Question 20

What is the dictionary definition of disability?

Answer 20

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

Question 21

What is the legal definition of disability?

Answer 21

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

Question 22

What is the WHO definition of disability?

Answer 22

Refers to International Classification of Impairments, Disability and Handicap (ICIDH):

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 restriction: Disadvantage experience by the individual (interaction at social/environmental level)

Question 23

What is the medical model of disability

Answer 23

1. Individual or personal cause leading to a change in circumstances
2. Individual intervention leading to a change/adjustment in life to compensation for new circumstances

Question 24

What is the social model of disability?

Answer 24

1. Societal causes e.g. low wage
2. Conditions relating to housing
3. Social/poiitical actions needed e.g. facilities for disabled
4. Societal attitude change e.g. use of politically correct language

Question 25

What legislation surrounds the fair treatment of the disabled?

Answer 25

Disability Discrimination Acts of 1995 and 2005

Equality Act of 2010

Question 26

What responsibiity does a doctor have when dealing with a patient with a long term condition?

Answer 26

Listen to your patient

Be aware your own age and culture will affect your views

Question 27

What factors may determine a patients reaction to a disability?

Answer 27

Nature of the illness
Education of the patients
Coping strategies in place 
Mood and emotions of the patient 
Time to adapt

Question 28

What are the Wilson and Junger criteria for effective screening?

Answer 28

Knowledge of disease - disease should be important, recognisable early stage, natural course should be well understood

Knowledge of test - suitable and acceptable

Treatment - established plan with available facilities

Financial - cost of case finding should outweigh costs that the healthcare system would incur if caught at a later stage