Tutorial 1 Long Term Conditions Flashcards
What is meant by person centred care?
Only the patient is in a position to make a decision on what patient centred healthcare, means to them, as an individual, in the treatments of their conditions and the living of their life
What are the 5 principles of patient centred healthcare?
- Respect
- choice and empowerment
- Patient involvement in health policy
- Access and support
- Information
Who are long-term conditions most prevalent in?
Older people and in more deprived groups
Long-term conditions now account for about
__ per cent of all GP appointments?
50%
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 period of time (existing cases)
Why is incidence important?
Incidence tells us about trends in causation and the aetiology of disease
It be be helpful when planning (staffing and services)
Why is prevalence important?
Prevalence tells us about the amount of disease in a population
It is useful in assessing the current workload for the health service but is less useful in studying the causes of diseases
What are long-term (chronic) conditions usually the end result of?
Long-term complex interaction of three factors:
- There may be genetic factors
- There may be environmental factors
- There might be both or neither
What is vulnerability?
An individuals capacity to resist disease, repair damage and restore physiological homeostasis can be deemed vulnerability
Even certain organs can vary: to an extent the liver repairs well, whereas the brain does not
What is the natural history of diseases?
Some may have an acute onset such as stroke or MI
Some may be gradual with a slow or more rapid deterioration e.g. angina
There may on the other hand be relapse and remission e.g. cancer
What may treatment be aimed at?
The disease or the effect of the disease
Patients and caregivers are often put under enormous demands by healthcare systems, what are some examples of this?
- Substantially changing their behaviour and policing the behaviour of others in order to adhere to recommended lifestyle modifications
- Patients or their caregivers often have to monitor and manage their symptoms at home
- Adhering to complex treatment regimens and coordinating multiple drugs can also contribute to the burden of treatment
- Complex administrative systems, and accessing, navigating, and coping with uncoordinated health and social care systems can further add to the burden
What is biographical disruption?
A long-term condition leads to a loss of confidence in the body.
There is then a loss of confidence in social interaction or self-identity; this process is termed ‘biographical disruption’
How might biographical disruption be managed?
It may involve ‘re-negotiating’ existing relationships at work and at home
What is important for the chronically ill and disabled person?
They need to be able to make some sense of their condition before they can begin the process of ‘adjusting’ to it
This can involve redefining ideas of what is ‘good’ and ‘bad’, such that the positive aspects of their lives are emphasized, and the negative impact of the illness lessened
What is happening with acute illness and long-term conditions?
With the demise of acute illness, a whole cohort of long term conditions have become increasingly prevalent
What is the stigma of long-term conditions (chronic illness)?
Some long-term conditions are visible while others are invisible
Still others are both visible and invisible
Having a chronic illness or condition subjects a person to possible stigmatization by those who do not have the illness
Coping with stigma involves a variety of strategies including the decision about whether to disclose the condition and suffer further stigma, or attempt to conceal the condition or aspects of the condition and pass for normal
Impact of long term condition on the individual?
Can be negative or positive
Can include denial, self pity and apathy
Impact of long term condition on the family?
Can be financial, emotional and physical
Other family members may become ill as a result
Impact of long term condition on the community/society?
Isolation of an individual may result
It has been said that the success of a community can be judged on how it looks after its infirm members
What is meant by the expert patient?
A patient who is expert in their condition
They can become key decision-makers in the treatment process
Disability definition (dictionary)?
Lacking in one or more physical powers such as the ability to walk or coordinate ones movements
Disability definition (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
Disability definition (WHO)?
ICIDH – International classification of Impairments, Disability and Handicap. Updated with ICF. Removes the terms disability and handicap.
What does ICF stand for?
International Classification of Functioning, Disability and Health
What does the ICF state?
- 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)
What are the pieces of legislation that have been drawn up surrounding a disabled person rights?
Disability Discrimination Acts (DDA) 1995 and 2005
Equality Act 2010
What are the 2 different approaches to management of a disability?
Medical and social
List 5 things that the personal reaction to disability depend on
- The nature of the disability
- The personality of the individual
- The role of the individual: loss of role, change of role
- The reaction of others around them
- The information base of the individual i.e. education, intelligence and access to information
What is meant by the sick role?
The sick role is a concept that concerns the social aspects of becoming ill and the privileges and obligations that come with it.
“benefits” of illness: social, familial, psychological, financial, medications, responsibilities
Disability causes disruption at different levels, what are these levels?
Personal
Economic
Social
List 6 different causes of disability worldwide?
Congenital Injury Communicable disease Non-communicable disease Obesity Alcohol
Mental illness
Malnutrition
Drugs: Iatrogenic effect and/or illicit use
What happens with disability and age?
In the UK the prevalence and severity of disability rise with age
One third of those with a disability are in employment
What is used to assess for screening need?
Wilson’s criteria
What does Wilson’s criteria include?
- The condition should be important
- Test acceptable to population
- Accepted treatment for patients with recognised disease
- Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole
