Tutorial 1: Long Term Conditions

Question 1

What 5 principles and values define patient-centeredness?

Answer 1

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

Question 2

Long-term conditions are more prevalent in which groups?

Answer 2

Elderly, and in more deprived groups (e.g. poorest social class).

Question 3

Define incidence.

Answer 3

The number of new cases of a disease in a population in a specified period of time. Incidence helps to interpret trends in causation and the aetiology of disease. Helpful in planning e.g. staffing & services can be adjusted if the practice knows no. of new cases in their area.

Question 4

Define prevalence.

Answer 4

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). Useful in assessing the current workload for the health service but is less useful in studying the causes of diseases.

Question 5

What are the aetiology factors of long-term conditions?

Answer 5

Long-term complex interaction of factors such as:
- genetic factors
- environmental factors
There might be both or neither of the above factors.

Question 6

Define Vulnerability.

Answer 6

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

Question 7

What is the natural history of long-term conditions?

Answer 7

Varies:
Some have acute onset (e.g. stroke or MI).
Some have gradual onset with a slow or more rapid deterioration (e.g. angina).
Some follow relapse and remission cycle (e.g. cancer, MS).

Question 8

How are long-term conditions treated?

Answer 8

Treatment:

• Resolve disease or treat symptoms
• Realising the chronic nature and coming in terms with it.
• Admittance of failure in diagnosis/cure by doctor and patient (payoff = better management).

Question 9

What is the burden of treatment endured by patients and caregivers?

Answer 9

Enormous demands by healthcare system e.g.:

• substantially changing their behaviour & policing the behaviour of others in order to adhere to recommended lifestyle modifications.
• Monitoring & managing their symptoms at home (e.g. collecting & inputting clinical data).
• adhering to complex treatment regimens and multiple drugs (polypharmacy) adds to burden.
• To secure eligibility for services patients are often faced with complex administrative systems. Accessing, navigating, and coping with uncoordinated health and social care systems can further add to the burden.

Question 10

What is biographical disruption (termed by Bury)?

Answer 10

An 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 (this process = ‘biographical disruption’).

Question 11

What id the impact of long-term condition on individual, family, and community/society?

Answer 11

Individual: can be negative or positive. Can include denial, self pity and apathy.
Family: can be financial, emotional, & physical. Other family members may become ill as a result (contagious).
Community/society: isolation of individual might result.

Question 12

What are the dictionary, legal and WHO definitions of disability?

Answer 12

Dictionary: Lacking in one or more physical powers such as the ability to walk or coordinate one’s movements.
Legal: Disability Discrimination Act - 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.
WHO (ICF):
1. Body and Structure Impairment (Abnormalities of structure, organ or system function - organ level)
2. Activity limitation (Changed functional performance and activity by the individual (personal level))
3. Participation restrictions (Disadvantage experienced by the individual as a result of impairments and disabilities (interaction at a social and environmental level))

Question 13

What are the medical models of disability?

Answer 13

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

Question 14

What are the social models of disability?

Answer 14

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

Question 15

What piece of legislation protects disabled rights?

Answer 15

Disability Discrimination Acts (DDA) 1995 and 2005: Northern Ireland now only.
Equality Act 2010: Rest of the UK.

Question 16

What are the responsibilities of health care providers towards patients with long-term conditions (and in general)?

Answer 16

●	Attitude
●	Listen to patients and learn
●	Take into account how your own age and culture affect your views.
●	Ensure empathy 
●	Don't spectate:
-Assess disability 
-Coordinate MDT
-Intervene in form of rehabilitation

Question 17

What does patient’s reactions to disability depend on?

Answer 17

• The nature of the disability
• The information base of the individual, i.e. education, intelligence and access to information
• The personality of the individual
• Coping strategies of the individual
• The role of the individual – loss of role, change of role
• The mood and emotional reaction of the individual
• The reaction of others around them
• The support network of the individual
• Additional resources available to the individual e.g. good local self-help group, socio-economic resources
• Time to adapt i.e. how long they have had the disability.

Question 18

What are the responsibilities associated with sick role?

Answer 18

The sick role is a concept that concerns the social aspects of becoming ill and the privileges and obligations that come with it.
Rights:
-The sick person is exempted from carrying out some or all of normal social duties (e.g. work, family).
-Not responsible for condition
Obligations:
-should try to get well (the sick role is only a temporary phase)
- in order to get well, person should seek professional help and cooperate.

Question 19

What is the epidemiology of disability?

Answer 19

Different Causes Worldwide:

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

Question 20

What is Wilson’s (and Jungner) criteria for screening?

Answer 20

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.