Tutorial 1 Flashcards
Why may a patient whose GP has recently retired not have attended the practice?
Retirement - longstanding relationship, trust
Has been well
worrying symptoms that concerned her and is avoiding presenting due to the worry of a problem being found
What is person centred care?
Provision of healthcare placing the patient at the centre ensuring the healthcare system is designed to meet needs of patients defined by them
Who is the only person in a position to make a decision on what patient centred healthcare means?
the patient - as an individual, in terms of treatments and their condition and living of their life
When can treatment options, therapies and models of care be said to be patient centred?
based on principles and values that define patient centredness
What document are the principles and values of patient centred care brought together?
International alliance of patients organisations (IaPO) declaration on patient centre healthcare
5 principles of IaPO declaration
respect access and support information choice and empowerment patient involvement in health policy
Why are long term conditions more prevalent?
acute illnesses short lived and amenable to cure
acute illness demise
LTC more prevalent
What type of people are LTC more prevalent in?
older and deprived
% of LTC of all GP appoinments?
50
% of LTC of all outpatient appointments
64
% of LTC of all inpatient bed days?
70
Why is concern as much to do with the causes and consequences of LTC?
degenerative chronic disorders are increasingly prominent and major sources of disability
Incidence
The number of new cases of a disease in a population in a specified period of time
Prevalence
The number of people in a population with a specific disease at a single point in time or in a defined time period
What does incidence tell us about?
trends in causation and aetiology
Why can incidence be helpful?
planning
Prevalance - what does it tell us?
amount of a disease in population and useful for assessing current work load
What is prevalence less useful for?
studying causes of diseases
LTC - long term complex interaction of what 3 factors?
genetic
environmental
both or neither
Vulnerability
An individuals capacity to resist disease, repair damage and restore physiological homeostasis
Can certain organs vary in vulnerability?
yes - repair to a different extent
3 natural histories of diseases
acute onset
gradual with slow/rapid deterioration
relapse and remission
4 examples of “burden of treatment”
Changing behaviour or policing behaviour of others to adhere to lifestyle modifications
Monitoring and managing their symptoms at home
complex treatment regimens and polypharmacy
complex administrative systems and accessing, navigating and coping with unco-ordinated health and social care systems
Biographical distribution
LTC –> loss of confidence in body
Leads to loss of confidence in social interaction or self identity
Why are LTC not simply personal?
biographical distribution
re-negotiating existing relationships at work and home
What does the patient or disabled person need to do to adjust to their LTC?
make sense of condition
redefine ideas
positive aspects of life are emphasised
negative impact lessened
Coping with stigma
deciding to disclose condition and suffer further stigma
conceal condition or aspects of condition and pass for normal
Impact of LTC on 4 groups of people and explanation
individual - negative or positive and can include denial, self pity and apathy
family - financial, emotional, physical
other family members ill as a result
community/society - isolation
What can the success of a community be based on?
how it looks after infirm members
Dictionary definition of disability
Lacking in 1 or more physical powers eg ability to walk
3 publications which define disability
dictionary
WHO
legal
Legal definition of disability
Disability discrimination act
more than 12 months
difficult to undertake normal activities
WHO disability
ICIDH –> updated with ICF
3 parts of WHO disability definition
body and structure impairment
activity limitation
participation restriction
Body and structure impairment
Abnormality of structure, organ or system function (organ level)
Activity limitation
changed functional performance and activity by the individual (personal level)
Participation restriction
disadvantage experiences by individual as a result of impairment or disability
interaction at social and environmental level
Medical model of disability
individual/personal cause eg accident whilst drunk
underlying pathology eg morbid obesity
individual level intervention
individual change/adjustment
Social model of disability
societal cause eg low income
conditions relating to housing
social/political action needed
societal attitude changes
Legislations
disability discrimination acts 1995 and 2010
equality act 2010
3 ways doctors are not spectators
we assess disability
we co-ordinate MDT
we intervene - rehab
10 things personal reaction to disability relies on
nature of disability reaction of others around them personality mood and emotional reaction support network information base of individual coping strategies additional resources available to patient time to adapt role of individual
The sick role
possible benefits of illness
eg social, family, psychological, financial, medications, responsibilities
3 levels of disruption of disability and the family
personal
economical
social
epidemiology of disability worldwide causes
congenital injury communicable non-communicable obesity malnutrition mental illness drugs - iatrogenic alcohol
what fraction of those with a disability are in employment?
1/3
Criteria for screening name?
Wilson junger
Wilson junger criteria for screening
condition latent or early stage suitable test or exam accepted treatment facilities available cost
