Year 2 FoPC Flashcards
Why might a patient not attend their appointment after their GP has retired?
Had longstanding relationship with previous GP.
Trusted old GP
Worried about new relationship with GP.
Might have felt well.
May have developed symptoms that are worrying her and doesn’t want to come incase problem is found.
What is patient centred care?
Patient is at centre of decision making making regarding their health. Only they can decide what it means to them as in individual, in the treatment of their condition and living their life.
What are the 5 principles outline in the Declaration on Patient centred care by the International Alliance of Patients’ Organizations (IaPO)?
Respect. Choice and empowerment. Patient involvement in health policy. Access and support. Information.
What are some examples of Long term conditions?
Osteoarthritis
Diabetes Mellitus
COPD
Crohn’s etc
What are some statistics about the prevalence of Long term conditions?
50% of all GP appointments
64% of all outpatient appointments.
70% of all inpatient bed days.
Long term conditions are more prevalent in older people and more deprived groups.
Define Incidence
The number of new cases of a disease in a population in a specified period of time.
Define Prevalence
The number of people in a population with a specific disease at a single point in time or a defined period of time.
Define Vulnerability
An individuals capacity to resist disease, repair damage and restore physiological homeostasis.
What are some features of the ‘Burden of treatment’?
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.
Complex admin systems, accessing, navigating and coping with uncoordinated health and social care systems.
What is Biological disruption?
Loss of confidence in social interaction or self-identity due to a long term condition causing a loss of confidence in the body.
What is the impact of Long Term conditions?
Individual - denial, self pity, apathy etc.
Family - financial, emotional, physical, may become ill as a result.
Community - isolation of an individual.
What is meant by the “expert patient”?
Patient understands their disease better than healthcare professional because it is long term and they live with it everyday.
What is the dictionary definition of Disability?
Lacking in one or more physical powers such as the ability to walk or coordinate ones movements.
What is the legal definition of Disability?
Difficulty can be physical, sensory or mental. Something that make sit difficult for them to carry put normal day to day activities, ongoing for >12months.
What is the WHO definition of disability?
Body and structure impairment - abnormalities of structure, organ or system function.
Activity limitation - changed functional performance and activity by the individual.
Participation restrictions- disadvantage experienced by the individual as a result of impairments and disabilities.
What is a Medical model of disability?
Individual or personal cause e.g accident whilst drunk.
Underlying pathology e.g morbid obesity.
Individual level intervention e.g health professionals advise individually.
Individual change/adjustments e.g change in behaviour.
What is a social model of disability?
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 effect a persons reaction to disability?
Nature of disability Education Intelligence Access to info Personality Coping strategies of the individual. Loss or change of role of individual. Mood and emotional reaction. Reactions of others' around them. Support network. Resources available Time to adapt.
What are some causes of disability worldwide?
Congenital Injury Communicable disease Non-communicable disease Alcohol Drugs Mental illness Malnutrition Obesity
What is Wilson’s Criteria for screening?
Knowledge of disease:
Condition is important.
Recognisable latent or early symptomatic stage.
The natural course of the condition should be adequately understood.
Knowledge of test:
Suitable test or examination.
Test acceptable to population.
Case finding should be continuous.
Treatment for disease:
Accepted treatment for patients with recognisable disease.
Facilities for diagnosis and treatment available.
Agreed policy concerning whom to treat.
Cost considerations:
Costs of case finding economically balanced in relation to possible expenditures on medical care as a whole.
Define disease
Diagnosed condition that has symptoms and signs. Bio-medical perspective.
Define illness
The patient’s experience/perspective of the disease. Ideas, concerns, expectations.
What is an example of a disease without illness?
Hypertension
What are some factors that affect the uptake of care?
Peers Family Internet TV Booklets etc Lay referral - "granny knows best". New symptoms Visible symptoms Increasing severity/duration Peer pressure - "wife sent me" Beliefs Expectations Social class Psychological Environmental, Age etc.
What are the 3 main aims of Epidemiology?
Description - describe the amount and distribution of disease in human populations.
Explanation - elucidate the natural history and identify aetiological factors for disease using data from other sources e.g OT, biochemistry, genetics.
Disease Control - to provide basis on which preventive measure, public health practices and therapeutic strategies can be developed, implemented, monitored and evaluated for disease control.
What is the ratio used in epidemiology?
Events/Population at risk
At risk part is crucial as everyone in denominator must have possibility of entering numerator.
What is relative risk?
Measure of the strength of an association between a suspected risk factor and the disease being studied.
Incidence of disease in exposed group/incidence of disease in unexposed group.
What are some sources of Epidemiological data?
Mortality data Hospital activity stats Reproductive health stats Cancer stats Accident stats GP morbidity Health and household surveys. Social security stats Drug misuse databases Expenditure data from NHS.
What is Health Literacy about?
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 is a CHA2DS2-VASc?
clinical prediction rules for estimating the risk of stroke in patients with non-rheumatic atrial fibrillation. Determines whether treatment is required with anticoagulation or antiplatelets.
High score corresponds to a greater risk of stroke.
What is the aim of SIGN guidelines?
Help health and social care professionals and patients understand medical evidence and use it to make decisions about healthcare.
Reduce unwarranted variations in practice and make sure patients get the best care available, no matter where they live.
Improve healthcare across Scotland by focusing on patient-important outcomes.
What is a descriptive study?
Attempt to describe the amount and distribution of a disease in a given population.
Does not provide definitive conclusions about causation but gives clues to possible risk factors.
Cheap, quick.
What is a Cross-sectional study?
Observations made at a single point in time. Conclusions are drawn about relationship between disease and other variables of interest in defined pop.
Quick
What is a case control study?
2 groups of people are compared:
cases = group of individuals who have the disease of interest.
controls = group of individuals who do not have the disease.
Average exposure to risk factors is compared.
What is a cohort study?
Baseline data on exposure is collected from a group of people who do NOT have the disease under study.
The group is then followed until significant number have developed the disease to allow analysis.
What is a trial?
Experiments used to test ideas about aetiology or to evaluate interventions.
What is the definitive method of assessing any new treatment in medicine?
Randomised controlled trial.
What are some factors to consider when interpreting results?
Standardisation Standardised Mortality ratio Quality of data Case definition Coding and classification Ascertainment
What is Bias?
Any trend in collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth.
What is selection bias?
Study sample is not truly representative of the whole study population about which conclusions are to be drawn.
What is information bias?
Arises from systematic errors in measuring exposure of disease.
What is Follow up bias?
Arises when one group of subjects is followed up more closely than another to measure disease incidence or other relevant outcomes.
What is a Systematic Error?
Form of measurement bias where there is a tendency for measurements to always fall on 1 side of the true value.
What is a confounding factor?
A factor which is associated independently with both the disease and with the exposure under investigation.
What are some examples of confounding factors/
Age
Sex
Social class
Ethnicity
What are some methods of dealing with confounding variables?
Randomisation.
Restriction of eligibility criteria to only certain kinds of study subjects.
Subjects in different groups can be matched for likely confounding variables.
Results can be stratified.
Results can ab adjusted to take into account suspected confounding factors.
What is the Criteria for Causality?
Strength of association Consistency Specificity Temporality - exposure comes before the disease. (only absolute criterion). Biological gradient Biological plausibility Coherence Analogy Experiment
Define Ageism
A process of systemic stereotyping and discrimination against people just because they are old.
What is the expected percentage of world pop >60years in 2050?
22%
What will the increasing elderly population mean for Health and social care?
Increased number of geriatricians and health professional involved in care of elderly will be required.
Increased facilities for elderly will be required.
The care of long term conditions is moving from secondary to primary care.
Will need specific health promotion campaigns aimed at elderly.
Increasing dependence on family/carers.
Increasing demand for home carers and nursing home places.
Housing demands are likely to change as more elderly live alone.
Increasing demand for activities for the elderly within community.
Role of grandparents as carers for grandchildren likely to change.
How will the increasing elderly population affect the economy and politics?
Retirement/pension age increasing.
Finding employment may be more difficult for young people.
Current decision making and workforce planning must consider ageing pop.
What are some stats on carers?
82% provide practical help e.g preparing meals, laundry, shopping.
76% keep an eye on the person they care for.
68% keep them company
62% take the person they care for out.
49% help the person they care for with financial matters
47% help the person deal with care services and benefits.
38% help with aspects of personal care
Define multimorbidity
The co-existence of 2 or more long-term conditions in an individual.
What are some options for care settings?
Living in own home with support of family.
Living in own home with support from social services.
Sheltered housing
Residential Home
Nursing Home Care.
What is Anticipatory Care planning?
Discussion between individuals, their care provider and often those close to them to make decisions with respect to their future health or personal and practical aspects of care.
What are some examples of things discussed within anticipatory care planning?
Legal - welfare/financial power of attorney, guardianship.
Personal - next of kin, preferred place of death, religious/cultural beliefs, statement of wishes regarding treatment.
Medical - Wishes re DNA CPR, Home care package, Current aids and appliances, assessment of capacity/competence, potential problems etc
What are some traditional members of the Primary Healthcare Team?
GP partners GP assistants and other salaried doctors. GP registrars Practice Nurses Practice Manage Receptionists Community nurses Midwives Health visitors Nurse practitioners
What is the role GP partner?
First point of contact for most patients.
Complete spectrum of care.
Deal with physical, psychological and social components.
Majority are also independent contractors to the NHS so are responsible for providing adequate premises and employing their own staff.
What is the role of a Practice Nurse?
Work in GP surgeries. Might be involved in most aspects of patient care e.g Blood sampling ECGs Minor and complex wound management. Travel health advice and vaccinations. Child immunisation Family planning and women" health including cervical smears. Men's health screening. Sexual health services. Smoking cessation.
What is the role of the District Nurse?
Visit patients in their own homes or residential homes, providing increasingly complex care for patients and supporting family.
Teaching and support role working with patients to enable to care for themselves or teaching family members hoe to give care.
Accountable for their own case loads.
Assess the needs, monitor the quality and are professionally accountable for delivery of care.
What is the role of the Midwife?
Provide care during all stages of pregnancy, labour and the early postnatal period.
Many work within local community.
Can also be hospital based.
What is the role of the health visitor?
Lead and deliver child and family health services (pregnancy to 5 years).
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?
Specialise in cancer and palliative care, providing support and info to people with cancer, their families, carers and friends, from point of diagnosis onwards.
Specialised pain and symptom control. Emotional support. Care in a variety of settings Info about treatment and side effects. Advice to other members of caring team.
What are some examples of Allied Health Professionals?
Physiotherapists Occupational therapy Dietetics Podiatry Pharmacy Counselling
What is the role of a pharmacist?
Expert in medicines and their use.
They advise medical staff on the selection and appropriate use of medicines. Provide info to patients on how to manage their medicines to ensure optimal treatment.
Some undertake additional training to prescribe.
What is the role of a Dietician?
Trained in hospital and community settings.
Work with patients who have special dietary needs.
Inform general public about nutrition.
Offer unbiased advice.
Evaluate and improve treatments.
Educate patients/healthcare professionals.
What is the role of a physio therapist?
Help and treat people with physical problems caused by illness, accident or ageing.
Want to maximise movement.
Preventive, treatment and rehabilitation.
What is the role of an Occupational Therapist?
Work with patients to overcome effects of disability. Physical rehab. Mental health services Learning disabilities Primary Care Paediatrics Environmental adaption Care management Equipment for daily living.
What is the role of a care manger?
Highly trained social workers who work with patient to advise on social and financial support services.
What are some factors driving changes which affect the Primary Healthcare team?
Economic factors - enlarging premises, additional services on 1 site.
Political pressure - reduce cost, provide more where patients live.
Development of new roles - extended role of pharmacists, nurses prescribing etc.
Growing number of ageing patients - more long term conditions, greater demand.
What are the principles of good teamwork outlines in the Forum on Teamworking in Primary Healthcare?
Recognise and include patient/carer as an essential member.
Common agreed purpose
Set objectives and monitor progress towards them.
Agree team working conditions and have a process for resolving conflict.
Ensure each team member is aware of their role.
Select a leader
Take active steps to facilitate inter-professional collaboration.
What is an aim of the new integrated Health and Social Care team?
Reduce unnecessary admissions to hospital and delayed discharges.
Improve quality and consistency of services.
Ensure resources are used effectively and efficiently.
What is the integrated Joint Board Model?
Integration joint board is set up.
Plans and resources service provisions for delegated adult and social care services.
Decides how to use the delegated budget for resources.
Must be 3 memebers from the local authority and the NHS board. Must also include a carer representative, GP rep, nurse rep, secondary medical care practitioner, service user rep, staff-side rep, 3rd sector rep and the chief officer and chief social worker.
What are some implications disability might cause for Parents
May not be able to combine work and caring demands. Financial strain. Guilt as having causative gene. Psychological strain. Detrimental to their own health. Marital problems. Over-protection of disabled child. Strong advocate for their child.
What are some implications disability might have on siblings?
Resentment at time parents spend caring for their disabled child.
Resentment at restrictions to normal family life.
May have to develop carer role.
Grow up with greater understanding of disability.
What are some implications disability may have on peers?
May “look out” for disabled child.
Friend may be stigmatised along with disabled child.
May grow up with greater understanding of disability.
May need to adapt activities to include disabled friend.
Teasing by other peers.
What are some implications disability may have on teachers?
May have lack of understanding of disability/lack of training.
May have tendency to over-protect disabled child.
May be lack of willingness to integrate in mainstream activities.
May be additional challenges in personalising education for disabled child.
Stress of managing both mainstream and additional support needs pupils in the same class.
What is meant by the term expert patient?
Patient/carer has an in-depth knowledge of their condition, sometimes exceeding that of healthcare professionals.
Utilising the knowledge of the patient/carer (mutual decision making about management of the condition) is likely to greatly benefit the patient’s care and quality of life.
Historically, the knowledge and experience held by the patient/carer has been an under-recognised resource.
What are some reasons not directly related to improvements in healthcare provision for trends in population pyramids showing increasing numbers of older people?
Decrease in birth/fertility rates. Improvements in housing. Improvements in water supplies. Improvements in sanitation/sewerage systems. Improvements in nutrition. Improved safety and reduction of injury. Migration (some areas only) War/genocide (some areas only).
List 4 possible financial implications of being a carer?
1/3 of carers had to cut back on essentials like heating or food.
45% of carers said their financial circumstances were affecting their own health.
42% of carers have miss out on financial support as a result of not getting the right advice and info.
30% of carers have seen a drop £20,000 or more a year in their household income as a result of caring.
What is the role of a home carer?
Provide help with practical tasks such as bathing and dressing.
What is the role of the Community Psychiatric Nurse?
Assessment and management of low mood.
What is the role of GMED/NHS-24?
Out of hours care for unexpected deterioration/new condition.
