Year Two Flashcards
The international alliance of patients’ organisation (IAPO) ‘s declaration of patient centred healthcare defines patient centred healthcare as based on these principles and values…
Respect Choice and empowerment Patient involvement in health policy Access and support Information
The definition of incidence
and what it is used for
The no. of new cases of a disease in a population in a specified period of time
Tells us about trends in causation and aetiology
Can help with planning when and where extra care and provisions will be needed
The definition of prevalence
and what it is used for
The no. of people in a population with a specific disease at a single point in time or a defined period of time
Useful in assessing current workload for the health service
Vulnerability definition
An individual’s capacity to resist disease, repair damage and restore physiological homeostasis
(varies between organs)
Examples of the “burden of treatment” on patients and carers
Charging their behaviour for lifestyle modifications
Monitoring and managing symptoms at home
Adhering to complex treatment regimes
Navigating complex administrative systems
Biographical disruption definition
A loss in confidence in social interaction or self-identity due to a loss in confidence in the body from a long term condition
may involve having to “renegotiate” existing relationships
Who do chronic conditions impact
The individual (denial, self-pity, apathy) The family (physical, emotional, financial) The community/ society
Legal definition of disability
a physical, sensory or mental difficulty that makes it difficult for them to carry out day to day activities ongoing for more than 12 months
The WHO “international classification of functioning, disability and health”
divides disability into 3 levels…
- Body and structure impairment
- organ level (e.g. damage to leg)
- abnormalities of structure, organ or system function - Activity limitation
- personal level (e.g. mobility difficulty)
- changed functional performance and activity by the individual - Participation restrictions
- social and environmental level (e.g. difficulty participating in sports)
- disadvantage experienced by the individual as a result of impairments and disabilities
the 2 different models of disability
Medical model
- individual/ personal cause
- underlying pathology
- individual level intervention
- individual change/ adjustment
Social model
- social cause
- social/ political action needed
- societal attitude change
” examples of disability legislation
Disability discrimination acts 1995 and 2005
Equality act 2010
Personal reaction to disability depends on…
The nature of the disability The information base of the individual The personality of the individual The coping strategies of the individual The reaction of others around them The support network of the individual Additional resources available to the individual Time to adapt
Causes of disability
Congenital Injury Communicable disease Non-communicable disease Alcohol Drugs (iatrogenic or illicit) Malnutrition Obesity
The Wilson and Junger criteria for screening
Knowledge of the disease
- it must be important, recognisable early and well understood
Knowledge of the test
- it must be suitable, acceptable to the population and continuous
Treatment of the disease
- must be acceptable, available and have an agreed policy on who to treat
Cost considerations
The difference between disease and illness
Disease - to do with signs, symptoms and diagnosis, the medical perspective
Illness - to do with ICE and experience, the patient perspective
(e.g. HT is often a disease without illness)
(in up to 50% of GP appointments there is no disease)
Factors affecting uptake of care
Lay referral
Sources of information
Medical factors (what the symptoms are)
Non-medical factors (ICE, beliefs, age, class, gender, culture…)
Aims of epidemiology
Description (of amount and distribution of disease)
Explanation (of natural history and aetiological factors)
Disease control (the basis for preventative measures)
Epidemiological studies try to point to…
Aetiological clues
The scope for prevention
Identification of high risk/ priority groups
Calculating incidence
Events / Population at risk
Everyone in the denominator must have the possibility of entering the numerator.
The denominator must be specific
Calculating relative risk (RR)
incidence in exposed group / incidence in unexposed group
Measures the strength of an association between a suspected risk factor and the disease being studied
Sources of epidemiological data
Mortality data Hospital activity statistics Reproductive health statistics Cancer statistics Accident statistics General practice morbidity Health and household surveys Social security statistics Drug misuse databases Expenditure data from NHS
Health literacy is
Having the knowledge, skills, understanding and confidence to…
Use health information
Be active partners in their care
Navigate health and social care systems
SIGN guidelines intend to…
Help health and social care professionals and patients understand medical evidence and use it to make decisions
Reduce unwarranted variations in practice to make sure patients get the best care available, no matter where they live
Improve healthcare across Scotland by focusing on patient-important outcomes
(they aim to aid the translation of new knowledge into action)
Descriptive studies
Attempt to describe the amount and distribution of disease in a given population
does not provide definitive conclusions about causation
Do not test hypotheses
Usually quick and cheap
Cross-sectional studies
Observations are made at a single point in time
Provides results quickly
Conclusions are drawn about the relationship btw diseases and other variables in a defined population
Usually impossible to infer causation
e.g. venous reflux scanned and a questionnaire about risk-factors given to participants to assess risk factors for venous reflux
Case-control studies
A group of individuals with the disease (cases) are compared to a control group
Data is gathered on each individual to determine if they have been exposed to each aetiological factor
Results are expressed as relative risks, sometimes with P values (confidence intervals)
Types of analytic studies
Cross-sectional studies
Case control studies
Cohort studies
Cohort studies
Baseline data is collected from a group of people who do not have the disease
This group is followed until enough of them have developed the disease to allow analysis
- the group is split into subgroups with different exposures
Results are usually expressed as relative risks with confidence intervals (p values)
Trials
Experiments used to test ideas about aetiology or to evaluate interventions
The definitive method of assessing any new treatment in medicine is…
The randomised controlled trial
The randomised controlled trial
Two groups at risk of developing a condition are assembled
An alteration is made to the intervention group (e.g. stop smoking)
The control group has no intervention
Data is collected on subsequent outcomes and relative risk is calculated
Factors to consider when interpreting results
Standardisation
- a set of techniques used to remove the effects of differences in age, sex etc…
Standardised mortality ratio (SMR)
- a standardised death rate converted into a ratio
- SMR 120 = 20% more deaths than expected
Quality of data
- you must be sure data is trustworthy
Case definition
- important to know exactly what terms mean
Coding and classification
- must understand codes used in data storage and analysis
Ascertainment
- is the data complete (are subjects missing etc…)
Bias definition
Trends in data collection, analysis, interpretation, publication or review that can lead to conclusions that are different from the truth
Types of bias
Selection bias
information bias (happens when trial is not double blind)
Follow-up bias (one group is followed up more assiduously)
Systematic error (tendency for measurements to fall one side of the true value)
Confounding factor definition
A factor that is Independently associated with the disease and the risk-factor under investigation so distorts the relationship (e.g. age, sex, social class)
Confounding factors are dealt with using…
Randomisation
Restriction of eligibility
Results can be stratified
Results can be adjusted
Criteria that prove causality
Strength of association (measured by relative risk/ odds ratio)
Consistency (under different circumstances)
Specificity (single exposure leading to single disease)
*Temporality (exposure comes before disease)
Biological gradient (risk increases as exposure increases)
Biological plausibility (agrees with known biology)
Coherence (doesn’t conflict with known biology)
Analogy (another relationship can act as a model)
Experiment (can be proven by controlled experiment - rare in humans)
*only absolute criterion
Healthy life expectancy is defined as…
The number of years spent in self-assessed good health
Since 2000, the number of years spent in poor health has increased but the proportion has remained stable
Responsibilities of carers
Practical help such as cooking, laundry, shopping
Keeping an eye on them
Keeping them company
Taking them out
Help with finances
Help them deal with care services and benefits
Help with aspects of personal care
Being a carer impacts on the person’s…
Finances
Personal health
Relationships with friends and family
Multi-morbidity definition
The co-existence of two or
more long-term conditions in an individual
(the norm in primary care patients)
(complex as the preferred treatment for one condition may worsen another)
Options for care
Living in a family member's home Living in own home with support from family Living in own home with support from social services Sheltered housing Residential home Nursing home Specialist unit Admission to hospital
Purpose of advance and anticipatory care planning (ACP)
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
Aspects of advance and anticipatory care planning (ACP)
Legal aspects
- welfare power of attorney
- financial power of attorney
- guardianship
Personal aspects
- wishes regarding treatment
- next of kin
- consent to pass info to others
- who else to consult/ inform
- preferred place of death
- current level of support
Medical aspects
- potential problems
- home care package
- DNA CPR
- details of “just in case” medicines
- assessment of capacity/competence
- current aids and appliances
Roles of the practice nurse…
Obtaining blood samples ECGs Minor + complex wound management including leg ulcers Travel health advice and vaccinations Child immunisations and advice Family planning and women's health (in. cervical smears) Men's health screening Sexual health services Smoking cessation
Roles of the district nurse
Visit people in their own homes/ residential homes
provide direct, complex care
Teaching + support role with patients and carers
Keep hospital admissions and readmissions to a minimum
Assess healthcare needs
Monitor the care patients are receiving
Professionally accountable for the delivery of care
Roles of the midwife
Provide care during all stages of pregnancy, labour and early post-natal period
Work in the community (GP, children’s centres, women’s homes, local clinics) and hospital
Roles of the health visitor
Child and family health services from pregnancy to 5 years
Ongoing additional services for vulnerable children and families (practical support, referral)
Safeguard and protect children
Support and advice on minor illnesses, feeding and weaning, dental health, physical development checks, post-natal depression)
Roles of the Macmillan nurse
Specialised pain + symptom control
Emotional support for patient, family and carers
Care in a variety of settings
Info on cancer treatments and side effects
Advice to other members of the caring team
Advice on other forms of support including financial
Roles of the pharmacist
Expert in medicines and their use
Ensure patients gat maximum benefit from medicines
Advise other staff on selection and appropriate use of medicines
Provide info to patients on how to manage medicines
May undertake additional training to be able to prescribe for specific conditions
Roles of the dietician
Working with people with special dietary needs
Informing the general public about nutrition
Offering unbiased advice
Evaluating and improving treatments
Educating patients and other healthcare professionals
Roles of the physiotherapist
Help and treat people with physical problems caused by illness, accident or ageing
Maximise movement through health promotion, preventative healthcare, treatment and rehabilitation
Core skills include:
- manual therapy
- therapeutic exercise
- application of electrophysical modalities
- appreciation of physiological, cultural and social factors influencing their clients
Roles of the 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
Help people overcome the effects of disability (maximise independence)
work in many areas including:
- physical rehabilitation
- mental health services
- learning disability
- primary care
- paediatrics
- environmental adaptation
- care management
- equipment for daily living
Roles of the care manager
Experts in working with individuals to identify their goals and locate the specific support services that enhance well-being
Provide support to find the best solutions
Highly trained social workers who work with the patient to advise on social and financial support services
Challenges affecting the PHCT
Economic factors
- larger buildings often owned by private companies
Political pressure
- to reduce costs of treatment
Development
- Development of new and extended professional roles
Ageing patients
“The forum on teamworking in primary healthcare” recommends guidelines for establishing a successful PHCT.
The team should…
Recognise and include the patient, carer or representative as an essential member of the PHCT
Establish a common agreed purpose
Agree set objectives and monitor progress towards them
Agree teamworking conditions, including a process for resolving conflict
Ensure each team member understands and acknowledges the skills and knowledge of colleagues
Pay particular attention to the importance of communication btw its members including the patient
Select the team leader for their leadership skills
The integration of health and social care aims to…
reduce unnecessary admissions to hospital + reduce delayed discharges
Make more efficient and affective use of limited resources
The integration of health and social care aims to…
reduce unnecessary admissions to hospital + reduce delayed discharges
Make more efficient and effective use of limited resources
The legislative framework for integrating health and social care was set out in…
The public bodies (Joint working) (Scotland) Act 2014
2 frameworks for integrating health and social care services
Integrated joint board (body corporate) model
Lead agency model
which is more important, actual risk or relative risk?
Actual risk
Purpose of the odds ratio
Approximated the relative risk
Relative risk can only be properly calculated from…
prospective studies
The audit cycle
Set standards
Measure current practice
Compare results of practice to standards set
Reflect, plan change and implement change
Re-audit
An audit asks…
“Are we actually doing the right thing and in the right way?”
They should be transparent and non-judgemental
Audits can be used to evaluate…
Structure of care (e.g. clinic availability)
Process of care (e.g. waiting times)
Outcome of care (e.g. success rates)
The royal college of GPs states (about audits) …
They should be full cycle
There should be at least one complete audit in each 5 year revalidation cycle
They must be undertaken by several GPs working as a team
The description of an audit should include…
Title
Reason for choice
Dates of 1st and 2nd data collection
Criteria to be audited and standards set with justification
Results of first data collection and comparison with standards
Summary of plan of change agreed
Changes implemented
Results of 2nd data collection and comparison with standards
Quality of improvements achieved
Reflection of audit on principles of good medical practice
Criteria definition
A definable, measurable item of healthcare
e.g. the number of people with IHD who have their lipids checked per year
Standards definition
The level of healthcare to be achieved for a specific criterion
e.g. 80% (often described as a statement)
Different types of standards
Minimum standard = lowest acceptable standard of performance
Ideal standard = care that should be possible under ideal conditions
Optimum standard = lies between the minimum + ideal, the standard most likely to be achieved under normal conditions
