EBM and Audit Flashcards Preview

GP > EBM and Audit > Flashcards

Flashcards in EBM and Audit Deck (29)
Loading flashcards...
1

What is 5 step process of EBM

Ask - an answerable question
Acquire - best evidence
Appraise - critically
Apply - high quality evidence to patient care
Assess - how you perform

2

How do you form a question

PICO
Patient/ population
Intervention
Comparison
Outcome

3

What categories do PICO questions come under and what study is used to assess

Diagnosis - cross-sectional
Prognosis - cohort
Therapy - RCT
Harm - cohort or case control

4

Look at type of questions

OK
Quantitative (numerical) = PICO model
Qualitative

Diagnosis - cross sectional
Prognosis - cohort
Therapy - RCT
Harm - cohort or case control

5

What are observational studies

Case control
- Compare people with and without disease and look at exposure to RF
Prospective Cohort
- People without disease and follow up to see if they develop and compare exposure
Retrospective cohort
- People with disease and look back at exposure
Cross sectional
- Measures prevalence of disease and exposure in given point in time and compare to gold standard

6

What are interventional studies

Controlled clinical trial
- Effects of specific intervention against a control

7

Where can you get evidence

Textbook
SIGN guidelines
Cochrane - RCT + systematic review
Pubmed

8

What are sign guidelines and what are best levels of evidence to worst

Evidence based clinical guidelines
Put medical knowledge into practice
Reduce variation in practice and outcome
Based on critical appraisal of scientific literature
- SIGN provide checklist to critically appraise
Rates level of evidence
Different checklist for different studies

Best to worst
High quality meta-analysis or systematic review of RCT
Well conducted
High quality systematic review of cohort or cast control
Well conducted
Non-analytic studies
Expert opinion

9

What are determinants of health and health inequality

Lifestyle - smoking / diet / exercise / alcohol
Socio-cultural environment
Poverty and social deprivation
Psychological
Biological and conventional healthcare

10

What is socio-cultural environment

Health related behaviour linked to underlying social and economic circumstance - poverty / unemployment / poor housing

11

What is destitution

Absence of minimum basic resources for physical survival

12

What is an audit

Systematic approach to reviewing provision of healthcare and quality
Highlight area of improvement

13

What is audit cycle

Set standard
Measure current practice
Compare results with current standards
Reflect, plan and change
Re-audit

14

What are Scottish health survey's

Provide info about lifestyles and health in Scotland
Monitor trends in RF / health behaviour
Annual
Representative of population

15

What do surveys collect info

General / mental health
Recent Dx
Prescribed medication
Smoking
Alcohol
Fruit / veg
Activity
BP
BMI
Education
Employment
Ethnicity

16

What is data used for

Measure prevalence of RF
Compare health differences with different countries
Monitor trends

17

What are routine data collection in primary care

Scottish Primary Care Information Resource (SPIRE)

Prescribing Information System for Scotland (PRISM)

Data from Quality Outcomes Framework (QOF)

Data from uptake of immunisation and cervical screening

18

What is SPIRE

Info about consultations representative of population in terms of age, gender, deprivation, urban, rural

19

What is PRISM

Data on prescribed medicines dispensed into community
Used to enhance safe prescribing and reduce poly pharmacy

20

What is data from QOF used for

Pay GP practices for care they provide
Measure achievement of practice against evidence based indicate

21

What is clinical governance

A framework through which NHS organisation responsible for improving quality of services and safeguarding high standards of care

Providing high quality NHS care
Maintain high standards and continuously improve services patients receive
Identify and response to poor practice

22

What does clinical governance include

Clinical effictiveness
Clinical audit
Guidelines e.g. SIGN
Use of routine info about patient outcomes
Progressional development
Profressional regulation and revalidation

23

What is clinical effectiveness

Ensuring individual patients are offered treatment based on best available evidence
Also equity
Patients should have equal access according to need
NO postcode prescribing

24

What is SMC

Advises Scottish health boards about the effectiveness of all newly licensed medicines

25

Type of bias

Recall
- Answer questions that happened in the past
Selection
- Under-represent or over groups of population
Observational
- Aware being observed by scientists which alters answers
Confirmation
- Look for information in data that confirms ideas or opinions
Publishing
- Studies with - ve findings less likely to be published

26

What is discrimination

Unjust or prejudicial treatment of different categories of people

27

What is inequity

Lack of fairness

28

What is prejudice

Opinion not based on experience or reason

29

What is stereotype

Views of every person of group