Year 2 Flashcards
What is ‘person-centred care’?
Person-centered care is the provision of care that places the patient at the centre ensuring that the healthcare system is designed to meet the needs and preferences of patients as defined by patients themselves.
Only the person can define what it means to them
What are the five principles of patient centred healthcare?
Respect Choice and Empowerment Patient involvement in health policy Access and support Information
What percentage of GP appointments are due to long-term conditions?
50%
What is ‘vulnerability’?
An individuals capacity to resist disease, repair damage and restore physiological homeostasis can be deemed vulnerability.
What is the ‘burden of treatment’?
Demands by healthcare on patient and caregiver:
Changing behaviour or policing the behaviour of others to adhere to lifestyle modifications.
Monitoring and managing their symptoms at home.
Complex treatment regimens and multiple drugs (polypharmacy) contribute to the burden of treatment.
Complex administrative systems, and accessing, navigating, and coping with uncoordinated health and social care systems add to this.
What is ‘biographical disruption’?
A long-term health condition can cause loss of confidence in social interaction or self-identity - which can be termed biographical disruption
How does the health of people vary within different areas of Scotland?
Higher proportion of people with Good/Very Good health in North/North East/Edinburgh
Higher proportion of bad/very bad health in Glasgow City, North Lanarkshire, Inverclyde, East Ayrshire
What does the WHO define the different types of disability as?
Body and structure impairment
Activity limitation
Participation restrictions
What are the different factors in the Medical and Social Models of disability?
Medical
- individual/personal cause e.g. accident while drunk
- Underlying pathology e.g. morbid obesity
- Individual level intervention e.g. health professionals advise individually
- Individual change/adjustment e.g. change in behaviour
Social
- 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.
What factors may affect a person’s response to their disability?
Nature of the disability
Information base of the individual, ie education, intelligence and access to information
Personality of the individual
Coping strategies of the individual
Role of the individual – loss of role, change of role
Mood and emotional reaction of the individual
Reaction of others around them
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
What is ‘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.
Rights
- exempt from normal social roles
- person is not responsible for their condition
Obligations:
- should try to get well
- should seek technically competent help and cooperate with the medical professional
At what different levels does disability cause disruption?
Personal
Economic
Social
What are some causes of disability?
Congenital Injury Communicable Disease Non-Communicable Disease Alcohol Drugs-iatrogenic effect and/or illicit use Mental Illness Malnutrition Obesity
How does the prevalence of disability vary with age and what percentage of disabled people work?
Prevalence and severity rise with age
One third of those with a disability are employed
What is the Wilson/Jungner criteria for screening?
Disease
- must be important
- must have recognisable latent or early symptomatic stage
- the natural course of the disease should be understood
Test
- should be acceptable to population
- should be continuous for the population
Treatment
- should be an accepted treatment
- facilities for diagnosis/treatment available
- agreed policy over who to treat
Cost
- cost of case finding should be balanced in relation to possible expenditures on medical care as a whole
What is the difference between disease and illness?
Disease – symptoms, signs – diagnosis. Bio-medical perspective
Illness – ideas, concerns, expectations – experience. Patients perspective
Disease is underlying pathology, illness is what the patient experiences
What factors may affect a person’s decision to seek medical advice?
Peer, family, internet, TV, media
Practice leaflets, posters, website
Medical factors - new symptoms, visible symptoms, increasing severity/duration
Non-medical - beliefs, expectations, social class, economic, psychological, environmental, cultural/ethnic/age/gender
How do contact rates vary between age/gender?
Increases with age (Except high rates in <4)
Women generally more likely to see healthcare professional
What are the three main aims of epidemiology? Why is it done?
Description
Explanation
Disease control
Can help identify aetiological clues, scope for prevention, and the identification of high risk or priority groups in society
How is the relative risk of a population carried out?
Incidence of disease in exposed group divided by incidence in unexposed group
E.g. incidence of lung cancer in smokers divided by incidence of lung cancer in non-smokers
What is ‘health literacy’?
People having the knowledge, skills, understanding and confidence to use health information, to be active partners in their care, and to navigate health and social care systems.
What are the different types of studies that may be used in the making of guidelines?
Descriptive studies
Cross-sectional studies
Case control studies
Cohort studies
What is the best type of trial for assessing any new treatment in medicine?
Randomised control trial
What factors should be considered in interpreting the results of trials?
Standardisation Standardised mortality ratio vs general population Quality of data Case definition Coding and Classification Ascertainment
What biases may exist in the performing of studies?
Selection bias - study sample not representative of population
Information bias - e.g. researcher aware of whether person is case or control
Follow-up bias - certain subjects followed up more rigorously than others
Systematic error - problems with equipment, use of equipment, interviews/questionnaires
What is a ‘confounding factor’?
A confounding factor is one which is associated independently with both the disease and with the exposure under investigation and so distorts the relationship between the exposure and disease.
E.g. age, sex, social class
What are the criteria for causality?
Strength of association - as measured by relative risk or odds ratio
Consistency - Repeated observation of an association in
different populations under different circumstances.
Specificity - A single exposure leading to a single disease.
Temporality - The exposure comes before the disease. (This is the only absolute criteria)
Biological gradient - dose-response relationship. As the exposure increases so does the risk of disease.
Biological plausibility - The association agrees with what is known about the biology of the disease.
Coherence - The association does not conflict with what is known about the biology of the disease.
Analogy - Another exposure-disease relationship exists which can act as a model for the one under investigation. For example, it is known that certain drugs can cross the placenta and cause birth defects
- it might be possible for viruses to do the same.
Experiment - A suitably controlled experiment to prove the association as causal - very uncommon in human populations.
What is an audit?
Done to assess, evaluate and improve care of patients in a systematic way. Audit measures current practice against a defined (desired) standard
How have demographics changed over time, how does this vary with how developed the countries are?
In developed, aging population since 1950s
- Expected more elderly population than young in 2050 (33% 60+)
- life expectancy increasing
Less developed
- faster changing, but further behind (expected 20% 60+ in 2050)
- less time to adapt to changes, also happening in low socio-economic groups unlike the developed world
Least developed
- further behind but similar changes, will be 2100s before population more elderly
What are the two main reasons for population growth?
The baby boomers born after the Second World War will be entering their early 80s by 2031 and overall mortality rates are expected to continue to improve
Older people are increasingly healthy, and there is an increasing emphasis on preserving health and fitness into old age
What are the healthcare, social, political, and economic implications of ageing populations?
Healthcare - increased geriatricians, more facilities,
Social - dependence on families, more demand for caring (home/nursing), more need for community activities, housing demands (adaptations)
Economic - retirement age increasing, may decrease jobs for young, proportionately less people paying into pension - state pension may be inadequate = poverty
Political - elderly population can influence elections, workforce planning must take ageing population into account
How has the relative birth/death rate changed over time?
Birth rate 50% higher in 50s-70s
Now almost equal (birth slightly lower)
How is life expectancy between the two sexes changing?
Male life expectancy below that of females, but increasing faster
What is the most common cause of death in men, and in women?
Heart disease in men
Dementia/Alzheimer’s in women
Each is the second highest cause in the other group
Other highest are COPD, lung cancer, stroke
What is the healthy life expectancy of men/women? How does it vary with socioeconomic class?
Early 60s for both (63.4 vs 64.1)
Life expectancy has increased more than healthy life expectancy (years in poor healthy slightly increased)
Vs average, about 10 years less healthy life expectancy in most deprived areas (vs ~5 overall life expectancy)
Vs most affluent, difference almost 20 and ~7)
How has spending on social care changed over time?
Increasing (even adjusted for inflation)
- slight drop after financial crash
What is the definition of multi-morbidity?
The co-existence of two or more long-term conditions in an individual
This is the standard scenario in primary care patients
What are the options of care for those leaving hospital in need of care?
Living in own home with support from family
Living in own home with support from social services
Sheltered housing
Residential home
Nursing home care
What is an anticipatory care plan?
Advance and anticipatory care planning, as a philosophy, promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care
What are different aspects that should be considered in an anticipatory care plan?
Legal aspects - power of attorney (welfare/financial), guardianship
Medical - home care package, DNR, palliative care, aids/appliances
Personal - wishes regarding treatment, next of kin, consent to share information, preferred place of death, cultural/religious beliefs, family support
What are some roles of the practice nurse?
- obtaining blood samples
- ECGs
- minor and complex wound management including leg ulcers
- travel health advice and vaccinations
- child immunisations and advice
- family planning & women’s health including cervical smears
- men’s health screening
- sexual health services
- smoking cessation.
What is the role of a health visitor?
Lead and deliver child and family health services (pregnancy through to 5years)
Provide ongoing additional services for vulnerable children and families
Contribute to multidisciplinary services in safeguarding and protecting children
What is the role of a MacMillan nurse?
Macmillan nurses specialise in cancer and palliative care
- Specialised pain and symptom control
- Emotional support both for the patient and their family or carer
- Care in a variety of settings – in hospital (both inpatient and outpatient), at home or from a local clinic
- Information about cancer treatments and side effects
- Advice to other members of the caring team, for example district nurses and Marie Curie nurses
- Co‐ordinated care between hospital and the patient’s home
- Advice on other forms of support, including financial help.
Macmillan nurses do not carry out routine nursing tasks, such as personal hygiene, changing dressings and giving medicines, and do not focus on non-cancer patients.
What are some of the ‘Allied Health Professions’ involved in primary care?
Physiotherapy Occupational Therapy Dietetics Podiatry Pharmacy Counselling
What is the role of a dietician?
Interpretation and communication of nutrition science to enable people to make informed and practical choices about food and lifestyle in health and disease.
- working with people with special dietary needs
- informing the general public about nutrition
- offering unbiased advice
- evaluating and improving treatments
- educating patients/clients, other healthcare professionals and community groups.
What is the role of a physiotherapist?
Core skills include manual therapy, therapeutic exercise and the application of electro‐physical modalities. They also have an appreciation of psychological,
cultural and social factors influencing their clients
What is the role of an occupational therapist?
Assessment and treatment of physical and psychiatric conditions using specific activity to
prevent disability and promote independent function in all aspects of daily life
- physical rehabilitation
- mental health services
- learning disability
- primary care
- paediatrics
- environmental adaptation
- care management
- equipment for daily living
What legislation was put in place to integrate health and social care?
THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014
- placed a requirement on NHS boards and local authorities to integrate health and social
care budgets
What are the two systems NHS boards are allowed to use to integrate health and social care?
The integrated joint board model
or The lead agency model
