Tutorial 2 Flashcards
% of people consulting GP and % to hospital
20
3
Why is the hierarchy of healthcare not completely accurate?
severity of illness does not accurately parallel severity of disease
Definition of disease
signs, symptoms, diagnosis, biomedical perspective
Illness definition
ICE
4 factors affecting uptake of care
lay referral
sources of info eg peers family, TV, leaflet
medical factors - symptoms, visible, worse, duration
non medical - crisis, peer pressure, social class, beliefs, psychological etc
5 possible issues from patients point of view for starting treatment
believes himself to be healthy physically fit proud not on tablets associations will he feel better
possible issues from GP’s point of view for starting treatment
more investigations
worried about consequences for his health
info sources to educate yourself
3 main aims of providing information
description
explanation
disease control
Description (epidemiology)
Describe amount and distribution of disease in human populations
Explanation (epidemiology)
natural history
aetiological factors
epidemiological and data from other sources
Disease control (epidemiology)
provide bases on which preventative measures, public health practices and therapies developed, implemented, monitored and evaluated
What does epidemiology compare and what does this help with?
groups/populations
aetiological clues
scope for prevention
identification of high risk or priority groups
General difference between clinical medicine and epidemiology
clinical medicine - individual patient
epidemiology - populations
minor illness incidence and prevalence
high incidence but low prevalence
Other illness eg chronic incidence and prevalence
low incidence
high prevalence
Relative risk
strength of association between associated risk factor and disease under study
How to calculate relative risk
incidence in exposed/incidence in unexposed
Sources of epidemiological data
mortality data reproductive health stats cancer stats accident stats GP morbidity health and household surveys hospital activity stats social security stats drug misuse database expenditure data from NHS
Health literacy
having the knowledge, skills, understanding and confidence to use heath information to be active partners in their care and navigate health and social care systems
Risk calculators
CHADS2 - AF stroke
bleeding
SIGN guidelines
systematic review of literature
help health and social care professionals and patients
reduce variation in care
improve healthcare
Descriptive studies
Describe the amount and distribution of a disease in a given population
What do descriptive studies give clues about and what do they not?
does not = causation
does - possible risk factors and candidate aetiologies
Advantages of descriptive studies
cheap, quick, valuable initial overview of problem
When are descriptive studies useful?
identifying emerging public health problems
assessing effectiveness of measures
assess needs for planning
hypotheses about aetiology
Cross sectional studies
frequency survery, prevalence study
observations at single point in time
Conclusions from a cross sectional study
relationship between disease and variables of interest in a defined population
Strength of cross sectional studies
quick results, but cannot do causation
Case control studies
compare 2 groups
cases - have disease
controls - do not have disease
In a case control study what is data gathered on?
exposure to suspected aetiological factor
Cohort studies
baseline data on exposure collected from group of people who do not have the disease and followed until some of them do
Trials
experiments used to test ideas about aetiology or evaluate interventions
Definitive method for assessing any new treatment
randomised controlled trial
6 factors to consider in interpreting results
standardisation standardised mortality ratio quality of data case definition coding and classification ascertainment
Bias
any trend in collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth
4 types of bias
selection
information
follow up
systematic error
Cofounding factor
associated independently with both disease and exposure under investigation
best way possible to prove causation between exposure and disease
demonstrate a weight of evidence in favour of a casual relationship
Only absolute criterion for causality
temporality
Temporality
The exposure comes before disease
AUDITs - could do own or others?
need to set criteria and standards to measure
time consuming and need research
utilise others - guidelines
Interventions before repeat audit?
inappropriate prescribed and tell them not to do it again
present audit results to practice
circulate current guideline summary to gps
Limitations of audit?
only of those prescribed
misses patients who should have received drug but did not
