FOPC 2nd year

Question 1

<p>define person-centred care</p>

Answer 1

<p>Person-centered care places <strong>patient </strong>at <strong>center</strong></p>

Question 2

<p>who decides what person-centered care means</p>

Answer 2

<p>Only the <strong>patient </strong>is in a position to decide this</p>

Question 3

<p>what makes care patient centered</p>

Answer 3

<p>if it is based on the <strong>principles and values</strong> that define<strong> patient-centeredness</strong></p>

Question 4

<p>theprinciples and values of patient centered care arebrought togetherby which organisation in what declaration?</p>

Answer 4

<p>International Alliance of Patients’ Organizations (IaPO)</p>

<p>Declaration on Patient- Centered Healthcare.</p>

Question 5

<p>Name the 5 principles outlined in the Declaration on Patient- Centered Healthcare by the IaPO</p>

Answer 5

<p>1.Respect.</p>

<p>2.Choice and empowerment.</p>

<p>3.Patient involvement in health policy.</p>

<p>4.Access and support.</p>

<p>5.Information.</p>

Question 6

<p>Long-term conditions now account for what proportion of GP appointments?</p>

Answer 6

<p>50%</p>

Question 7

<p>long-term conditions are more prevalent in what two groups of people?</p>

Answer 7

<p>older people</p>

<p><strong>deprived </strong>groups</p>

Question 8

<p>what is equally as important as establishing the causes of a long term illness?</p>

Answer 8

<p>the <strong>consequences </strong>of such long-term illness</p>

Question 9

<p>define incidence</p>

Answer 9

<p>the number of <strong>new cases </strong>of a disease in a <strong>population </strong>in <strong>a specified period of time</strong></p>

Question 10

<p>define prevalence</p>

Answer 10

<p>the <strong>number </strong>of people in a <strong>population </strong>with a <strong>specific disease </strong>at a <strong>single point in time </strong>or in a defined period of time (existing cases)</p>

Question 11

<p>aetiology - name the 2 broadfactors</p>

Answer 11

<p>genetic</p>

<p>environmental</p>

Question 12

<p>define vulnerability</p>

Answer 12

<p>an individuals <strong>ability/inability</strong>to<strong> resist disease</strong>,<strong> repair</strong> damage and <strong>restore </strong>physiological <strong>homeostasis</strong></p>

Question 13

<p>describe 3 categories ofnatural historyof diseases</p>

Answer 13

<p>acute onset</p>

<p>gradual onset</p>

<p>relapsing remitting</p>

Question 14

<p>what 2 things should any treatment aim to cure/allay?</p>

Answer 14

<p>disease</p>

<p>effects of disease</p>

Question 15

<p>briefly define the burden of treatment</p>

Answer 15

<p><u><strong>patients and caregivers </strong></u>are often put under e<strong>normous demands </strong>by <strong>healthcare systems</strong></p>

Question 16

<p>give 4 examples of the burden of treatment</p>

Answer 16

<ol> <li><strong>changing behaviour</strong> (of patient) or <strong>policing </strong>behaviour (doctor) of others (i.e. to <strong>adhere </strong>to lifestyle modifications)</li> <li><strong>monitoring +managing</strong> their symptoms at <u><strong>home</strong></u></li> <li><strong>complex treatment regimens</strong> andmultiple drugs (polypharmacy)</li> <li><strong>complex administrative systems -</strong>accessing, navigating + coping with uncoordinated health and social care systems</li></ol>

Question 17

<p>define the process of biographical disruption</p>

Answer 17

<p>a long term condition leads to a<strong> loss of confidence </strong>in the body</p>

<p>there is thena l<strong>oss of confidence in social interaction </strong>or self-identity</p>

Question 18

<p>define stigma</p>

Answer 18

<p>a mark of <strong>disgrace associated </strong>with a particular <strong>circumstance</strong>, <strong>quality, or person</strong></p>

Question 19

<p>outline whystigma might exist for those with achronic illness</p>

Answer 19

<p>having a chronic illness or condition subjects a person to possible <strong>stigmatization </strong>by those <strong>who do not have the illness</strong></p>

Question 20

<p>what is the biggest decision in coping with the stigma of a condition?</p>

Answer 20

<p>the <strong>decision </strong>about whether to:</p>

<p>1) <strong>disclose </strong>the condition and suffer further stigma</p>

<p>or</p>

<p>2) attempt to <strong>conceal </strong>the condition and pass for normal</p>

Question 21

<p>the long term condition of a particular individualmayimpact what people/groups of people</p>

Answer 21

<p>patient</p>

<p>family</p>

<p>community</p>

Question 22

<p>discuss the impact of long term conditions on the individual</p>

Answer 22

<p>can be <strong>negative or positive</strong></p>

<p>negative may be <strong>denial, self-pity, apathy</strong></p>

Question 23

<p>an individual'slong-term conditioncan impact their family in what 3 broad ways?</p>

Answer 23

<p>financial</p>

<p>emotional</p>

<p>physical</p>

Question 24

<p>what might happen to an individual that has along term condition with regards totheir community</p>

Answer 24

<p><strong>isolation </strong>of that individual</p>

Question 25

<p>an observation often made by doctors/nurses who care for people with some long term conditionsis “my patient understands their disease better than I do”</p>

<p>what is this conceptknown as?</p>

Answer 25

<p>the "<strong>expert </strong>patient"</p>

Question 26

<p>name 3 conditions that typically creates a lot of these "expert patients"</p>

Answer 26

<p>diabetes mellitus</p>

<p>arthritis</p>

<p>epilepsy</p>

Question 27

<p>describe the relevance of the "expert patient" in modern care</p>

Answer 27

<p>patient's <strong>knowledge/experience</strong> has long been <strong>untapped</strong></p>

<p>could greatly <strong>benefit</strong>patientcare + quality of life</p>

<p>research/experience showstoday’s patients with <strong>chronicconditions </strong>need <strong>not be mere recipients of care</strong></p>

<p>they can become <strong>key decision-makers</strong> intreatment process</p>

Question 28

<p>the WHOdefinition of disability may be split intowhat 3 categories</p>

Answer 28

<ol> <li>Body and Structure Impairment</li> <li>Activity Limitation</li> <li>Participation Restrictions</li></ol>

Question 29

<p>define "body and structure impairment"</p>

Answer 29

<p><strong>abnormalities </strong>of structure, organ or system function (organ level)</p>

Question 30

<p>define "activity limitation"</p>

Answer 30

<p>changed <strong>fuctional performance </strong>and activity by the individual (personal level)</p>

Question 31

<p>define "participation restrictions"</p>

Answer 31

<p><strong>disadvantage </strong>experienced by the individual as a result of <strong>impairments and disabilities</strong></p>

<p>(interaction at a social and environmental level)</p>

Question 32

<p>describe 4 concepts in the medical model of disability</p>

Answer 32

<p>▪<strong>Personal cause</strong> e.g. accident whilst drunk</p>

<p>▪Underlying <strong>pathology </strong>e.g. morbid obesity</p>

<p>▪Individual level <strong>intervention </strong>e.g. health professionals advise individually</p>

<p>▪Individual <strong>change</strong>/adjustment e.g. change in behaviour</p>

Question 33

<p>describe 4 concepts in the social model of disability</p>

Answer 33

<p>▪Societal cause e.g. low wages</p>

<p>▪Conditions relating to <strong>housing</strong></p>

<p>▪Social/<strong>Political </strong>action needed e.g. facilities for disabled</p>

<p>▪Societal <strong>attitude </strong>change e.g. use of politically correct language.</p>

Question 34

<p>describe 2 legislations that have been drawn up to support those with a disability</p>

Answer 34

<p>disability discrimation acts 1995 and 2005</p>

<p>equality act 2010</p>

Question 35

<p>describe 3 rolesof a doctorin the care of those with a disability</p>

Answer 35

<ol> <li><strong>assess </strong>disability</li> <li><strong>co-ordinate </strong>MDT care</li> <li><strong>intervention </strong>with rehabilitation</li></ol>

Question 36

<p>personal reaction to a disability depends on many factors</p>

<p>give 10examples</p>

Answer 36

<ol> <li><strong>nature </strong>of disability</li> <li><strong>information base </strong>ofindividual, ie education, intelligence and access to information</li> <li><strong>personality</strong></li> <li><strong>coping </strong>strategies</li> <li>(previous) <strong>role </strong>ofindividual – loss of role, change of role</li> <li>mood and emotional <strong>reaction</strong></li> <li>reaction of <strong>others </strong>around them</li> <li><strong>support </strong>network ofindividual</li> <li><strong>additional resources </strong>available to the individual? e.g. good local self-help group, socio-economic resources</li> <li><strong>time </strong>to adapt (how long they have had the disability?)</li></ol>

Question 37

<p>consider 6 possible categories of “benefits” of illness</p>

Answer 37

<ol> <li>social</li> <li>familial</li> <li>psychological</li> <li>financial</li> <li>medications</li> <li>responsibilities.</li></ol>

Question 38

<p>outline the concept of the sick role</p>

Answer 38

<p>a concept that concerns the <strong>social aspects</strong> of becoming ill and the <strong>privileges </strong>and <strong>obligations </strong>that come with it</p>

Question 39

<p>describe 3 ways disability might cause disruption within a family</p>

Answer 39

<p>personal</p>

<p>economic/financial</p>

<p>social</p>

Question 40

<p>with regard to the epidemiology of disability:</p>

<p>give 9 different causes worldwide</p>

Answer 40

<ol> <li>congenital</li> <li>injury</li> <li>communicable disease</li> <li>non-communicable disease</li> <li>drugs-iatrogenicand/or illicit use</li> <li>mental Illness</li> <li>alcohol</li> <li>malnutrition</li> <li>obesity</li></ol>

Question 41

<p>in the uk, what proportion of those with a disability are in employment?</p>

Answer 41

<p>1/3rd</p>

Question 42

<p>what happens tothe prevalence and severity of disabilitywith age?</p>

Answer 42

<p>rises</p>

Question 43

<p>Wilson and Jungner criteria for screening</p>

<p><strong>testing/examination</strong> for a disease - 3 factors</p>

Answer 43

<ol> <li><strong><u>suitable</u> test </strong>or examination.</li> <li>test <strong><u>acceptable</u> </strong>to population.</li> <li>case finding should be <strong>continuous </strong>(not just a 'once and for all' project as there's limited evidence for single-ocasion screening).</li></ol>

Question 44

<p>Wilson and Jungner criteria for screening</p>

<p><strong>treatment</strong> of disease - 3 factors</p>

Answer 44

<ol> <li><strong>Accepted treatment </strong>for patients with recognised disease.</li> <li><strong>Facilities </strong>for diagnosis and treatment available.</li> <li>Agreed <strong>policy </strong>concerning whom to treat as patients</li></ol>

Question 45

<p>Wilson and Jungner criteria for screening:</p>

<p><strong>knowledge </strong>of the disease - list 3 factors</p>

Answer 45

<ol> <li>condition should be <strong>important</strong>.</li> <li>must be a <strong>early symptomatic stage </strong>or <strong>recognisable latent</strong>stage</li> <li>natural <strong>history</strong>should be adequately <strong>understood</strong>.</li></ol>

Question 46

<p>what proportion of people consult their GP about their health complaints</p>

Answer 46

<p>20%</p>

Question 47

<p>what proportion of patients visiting their GP are referred onto secondary care</p>

Answer 47

<p>3%</p>

Question 48

<p>define disease</p>

Answer 48

<p>symptoms, signs ⇒diagnosis</p>

<p>(bio-medical perspective)</p>

Question 49

<p>define illness</p>

Answer 49

<p>ideas, concerns, expectations – experience</p>

<p>patients perspective</p>

Question 50

<p>what proportion of GP appointments involve no disease</p>

Answer 50

<p>up to 50%</p>

Question 51

<p>list several medical and non-medical factors which may influence an individuals desire to seek medical attention</p>

Answer 51

<p><strong>Medical factors</strong> - new/visible symptoms,increasing severity, duration (e.g long)</p>

<p></p>

<p><strong>Non medical factors</strong> – crisis, peer pressure “wife sent me”, patient beliefs,lay refferal,expectations, social class, economic, psychological, environmental, cultural, ethnic, age, gender, GP practice leaflet, NHS website, media: internet, TV,newspaper</p>

<p></p>

Question 52

<p>who seeks medical attentionmore often - males or females?</p>

Answer 52

<p>females</p>

Question 53

<p>give 3 reasons a patient that feels well may not want to accept treatment</p>

Answer 53

<ol> <li><strong>believe</strong>themselves to be <strong>healthy</strong>.</li> <li>is <strong>physically fit</strong>.</li> <li><strong>proud</strong> not to be using <strong>tablets</strong>.</li></ol>

Question 54

<p>define epidemiology</p>

Answer 54

<p>study of <strong>how </strong>often diseases occur in different <strong>groups </strong>of people and <strong>why</strong></p>

Question 55

<p>what are the 3 main aims of epidemiology</p>

Answer 55

<ol> <li>description</li> <li>explanation</li> <li>disease control</li></ol>

Question 56

<p>regarding epidemiology, define description</p>

Answer 56

<p>to describe the <strong>amount and distribution </strong>of disease in human populations</p>

Question 57

<p>regarding epidemiology, define explanation</p>

Answer 57

<p>to elucidate (find out) the natural <strong>history </strong>and identify <strong>aetiological factors</strong></p>

<p>usually by <em>combining</em> epidemiological data with data from <strong>other disciplines</strong> such as biochemistry, occupational health and genetics</p>

Question 58

<p>regarding epidemiology, define disease control</p>

Answer 58

<p>data can providebasis for</p>

<ol> <li><strong>preventive measures</strong></li> <li><strong>(develop new/modify) public health practices</strong></li> <li><strong>therapeutic strategies </strong></li></ol>

<p>to be developed, implemented, monitored and evaluated to help <strong>control disease.</strong></p>

Question 59

<p>epidemiology compares groups (study populations) in order to detect differences.</p>

<p>describe 3 things that may be detected/discovered</p>

Answer 59

<ol> <li><strong>aetiological</strong> clues</li> <li>scope (capacity) for<strong> prevention</strong></li> <li>identification of<strong> <u>high risk</u></strong>/priority <strong>groups</strong> in society</li></ol>

Question 60

<p>in epidemiology, give some examples of differentstudy populations (based on: )</p>

Answer 60

<p>the study population may be defined by:</p>

<ol> <li>age</li> <li>sex</li> <li>location</li></ol>

<p>(or even be the same group over time)</p>

<p>we then<strong>compare</strong> how often an event appears in one group with another</p>

Question 61

<p>data in epidemiology is converted into ratios - what does the numerator consist of?</p>

Answer 61

<p><u><strong>number of events e.g death</strong></u>/ [population at risk]</p>

Question 62

<p>data in epidemiology is converted into ratios - what does the denominator consist of?</p>

<p></p>

Answer 62

<p>[number of events]/<u><strong>population at risk</strong></u></p>

Question 63

<p>minor illnesses (e.g. a cold) typicallyhave a</p>

<p>(high/low) \_\_\_\_\_\_ incidence</p>

<p>(high/low) \_\_\_\_\_\_ prevalence</p>

Answer 63

<p>high incidence</p>

<p>low prevalence</p>

Question 64

<p>chronic illnesses (e.g. diabetes) typically have a</p>

<p>(high/low) \_\_\_\_\_\_ incidence</p>

<p>(high/low) \_\_\_\_\_\_ prevalence</p>

Answer 64

<p>low incidence</p>

<p>high prevalence</p>

Question 65

<p><em>incidence</em> is useful for investigatingwhat aspect of adisease?</p>

Answer 65

<p>aetiology of disease</p>

Question 66

<p>what does the<em>prevalence</em>of a disease tell us?</p>

Answer 66

<p>prevalence tells us something about the <strong>amount </strong>of disease in a population</p>

Question 67

<p>define relative risk</p>

Answer 67

<p>Relative risk (RR) =</p>

<p>incidence of disease in <strong>exposed </strong>group</p>

<p>/</p>

<p> incidence of disease in <strong>unexposed </strong>group</p>

Question 68

<p>what is relative risk (RR) a measure of?</p>

Answer 68

<p>the strength of<strong>association </strong>between a suspected<strong> risk factor </strong>and the <strong>disease</strong></p>

Question 69

<p>give 10sources of epidemiological data</p>

Answer 69

<ol> <li>mortality data</li> <li>hospital activity statistics</li> <li>reproductive health statistics</li> <li>cancer statistics</li> <li>accident statistics</li> <li>general practice morbidity</li> <li>health and household surveys</li> <li>social security statistics</li> <li>drug misuse databases</li> <li>expenditure data from NHS</li></ol>

<p></p>

<p></p>

Question 70

<p>define health literacy</p>

<p></p>

Answer 70

<p>having the<strong> knowledge, skills, understanding and confidence </strong>to use<u><strong> health information,</strong></u> to be <strong>active </strong>partners in their care, and to <strong>navigate </strong>health and social care systems.</p>

<p></p>

Question 71

<p>why is health literacy relevant?</p>

Answer 71

<p>health literacy is being increasingly recognised as a significant <strong>health concern </strong>around the world</p>

Question 72

<p>describedescriptive studies</p>

Answer 72

<p>descriptive studies attempt to describe the <strong>amount </strong>and <strong>distribution </strong>of a disease in a given <strong>population</strong></p>

Question 73

<p>describe the advantages and limitations of descriptive studies</p>

Answer 73

<p><u><strong>limitation</strong></u></p>

<ol> <li>does not provide <strong>definitive conclusions </strong>about disease <strong>causation</strong>,</li></ol>

<p><u><strong>advantages</strong></u></p>

<ol> <li>may give clues to possible<strong> risk factors and candidate aetiologies</strong>.</li> <li>usually <strong>cheap, quick </strong>and give a valuable initial <strong>overview </strong>of a problem.</li></ol>

Question 74

<p>what is a cross-sectional study?</p>

Answer 74

<p>in cross-sectional studies, <strong>observations </strong>are made at a <strong><u>single point</u> in time</strong></p>

Question 75

<p>what conclusions are drawn from cross-sectional studies?</p>

Answer 75

<p><strong>relationship </strong>between <strong>diseases</strong>and other <strong>variables </strong>of interest in a defined population.</p>

Question 76

<p>one strenght of a cross-sectional study</p>

Answer 76

<p>provide results <strong>quickly</strong></p>

Question 77

<p>one negative of a cross-sectional study</p>

Answer 77

<p>usually <strong>impossible </strong>to infer <strong>causation</strong></p>

Question 78

<p>what is a case controlstudy?</p>

Answer 78

<p>two groups of people are compared:</p>

<ol> <li><strong>Cases</strong> -those who have the disease of interest</li> <li><strong>Controls</strong> - those who donot</li></ol>

Question 79

<p>how are conclusions drawn from case-controlled studies (process)?</p>

Answer 79

<ol> <li>both groups have <strong>exposure </strong>to a suspected aetiological factor measured</li> <li>amount (of disease?) is<strong> compared </strong>to identify<strong> significant differences</strong></li> <li>to giveclues as to what<strong> factors elevate/reducerisk </strong>of disease being studied</li></ol>

Question 80

<p>what are the results in a case controlled study expressed as?</p>

Answer 80

<p>relative risk (RR)</p>

Question 81

<p>what is a cohort study?</p>

Answer 81

<ol> <li><strong><u>baseline data</u> on exposure</strong> collected from a groupwho do<strong> <em>not</em> </strong>have the disease under study</li> <li>group is then <strong><u>followed</u> </strong>through time until a sufficient <strong>number </strong>have <strong>developed </strong>the disease</li> <li>original group is separated into <strong>subgroups </strong>according to original <strong>exposure status </strong>andcompared to determinei<u><strong>ncidence of disease according to exposure.</strong></u></li></ol>

<p>cohort studies allow the <strong>calculation </strong>of <strong>cumulative incidence, </strong>allowing for differences in follow up time.</p>

Question 82

<p>what are trials?</p>

Answer 82

<p>trials are <strong>experiments </strong>used to test ideas about <strong>aetiology </strong>or to <strong>evaluate interventions</strong></p>

Question 83

<p>whatis the definitive method of assessing any new treatment in medicine?</p>

Answer 83

<p>the “randomised controlled trial”</p>

Question 84

<p>how is a trial assessing aetiology conducted?</p>

Answer 84

<p>two groups at <strong>risk </strong>of developing a disease are assembled</p>

<ol> <li><u><strong>intervention group</strong></u><strong></strong>- alteration made<strong></strong>(egsuspected causative factorremoved)</li> <li><u><strong>control group-</strong></u> no alteration is made</li></ol>

<p><strong>data </strong>on subsequent <strong>outcomes </strong>(egdisease incidence) are collectedfrom both groups, and the <strong>relative risk i</strong>s calculated.</p>

Question 85

<p>how is a trial assessing a new treatment conducted?</p>

Answer 85

<ol> <li><strong>intervention group</strong> receive<u>new therapy</u></li> <li><strong>control group </strong>receive current <u>standard therapy</u><em> (or placebo)</em></li></ol>

<p><strong>⇒treatment outcomes </strong>(egreduction in symptoms)<strong>compared </strong>in bothgroups</p>

Question 86

<p>what is meant by standardisation?</p>

Answer 86

<p>a set of <strong>techniques </strong>used to <strong>remove </strong>(or adjust for) the <strong>effects </strong>of <strong>differences </strong>in age, gender or other confounding variables, when comparing two or more populations.</p>

<p></p>

Question 87

<p>what is the standardised mortality ratio (SMR)?</p>

Answer 87

<p>a special kind of <strong>standardisation</strong></p>

<p>it is simply a<strong><u> standardised death rate </u></strong>converted into a ratio for easy <strong>comparison</strong></p>

<p>the figure for a standard reference population (eg, Scotland) is taken to be 100 and the standardised death rates for the comparison (study) populations (eg, Grampian) are expressed as a proportion of 100. A figure below one hundred means fewer than expected deaths, and above 100 means more. For example, an SMR of 120 means that 20% more deaths occurred than expected in the study population, allowing for differences in the age and sex structure of the standard and study populations and an SMR of 83 means 17% fewer deaths occurred.</p>

Question 88

<p>describe why the quality of data is an important factor to consider in interpreting results</p>

Answer 88

<p>mustensure data is<strong>trustworthy</strong>.</p>

<p></p>

Question 89

<p>explain what 'case defintion' means</p>

Answer 89

<p>the purpose of it is to <strong>decide </strong>whether an individual has the <strong>condition </strong>of interest <strong>or not</strong>.</p>

<p>It is importantbecause not all doctors or investigators <strong>mean </strong>the same thing when they use <strong>medical terms</strong>. <strong>Differences in incidence</strong> of disease over time or in different populations may be <strong>artefact</strong>, due to differences in<strong> case definition</strong>, rather than differences in<strong> true incidence.</strong></p>

<p></p>

<p><strong>Artefact definition:</strong><em>something observed in a scientific investigation or experiment that is not naturally present but occurs as a result of the preparative or investigative procedure.</em></p>

Question 90

<p>describe 'coding and classification'</p>

Answer 90

<p>when data isbeing collected routinely (egdeath certificates), it is normal to <strong>convert disease information </strong>to a set of <strong>codes</strong>, to assist in <strong>data storage and analysis.</strong></p>

<p><strong>rules </strong>are drawn up to dictate how clinical information is converted to a code. If these rules <strong>change</strong>, it sometimes appears that a disease has become <strong>more common, or less common</strong>, when in fact it has just been coded under a<strong> new heading</strong>.</p>

Question 91

<p>describe 'ascertainment'akaascertainment bias</p>

Answer 91

<p>Is the data <strong>complete </strong>- are any subjects missing?</p>

<p> If researchers in one country<strong> look harder </strong>for cases of a given disease than researchers in any other, it might not be surprising that they come up with<strong> higher incidence rates.</strong></p>

<p>Ascertainment bias arises when data for a study or analysis is collectedsuch that <strong>some members </strong>of the intended population are<strong> less/more likely to be included than others</strong></p>

<p></p>

<p></p>

Question 92

<p>define bias</p>

Answer 92

<p>any <strong>trend </strong>in the<strong><u> collection, analysis, interpretation, publication or review of data </u></strong>that can lead to conclusions that are<strong> systematically different </strong>from the truth</p>

Question 93

<p>name 4 types of bias</p>

Answer 93

<ol> <li>Selection Bias</li> <li>Information Bias</li> <li>Follow up Bias</li> <li>Systematic Error</li></ol>

Question 94

<p>describe selection bias</p>

Answer 94

<p><u>Selection bias</u></p>

<p>Occurs when the<strong> study sample is not truly representative</strong> of the whole study population about which <strong>conclusions </strong>are to be drawn.</p>

<p></p>

<p>For example, in a randomised controlled trial of a new drug, subjects should be allocated to the intervention (study) group and control group using a <strong>random method</strong>. If certain types of people (eg, older, more ill) were <strong>deliberately allocated t</strong>o one of these groups then the results of the trial would <strong>reflect </strong>these differences, <strong>not just </strong>the <strong>effect </strong>of the drug.</p>

Question 95

<p>describe information bias</p>

Answer 95

<p><u>Information bias</u></p>

<p>arises from <strong>systematic errors in measuring exposure or disease.</strong> For example, in a case control study, a researcher who was <strong>aware </strong>of whether the patient being interviewed was a '<strong>case</strong>' or a '<strong>control</strong>' might encourage cases more than controls to think hard about past exposures to the factors of interest. Any differences in exposure would then reflect the <strong>enthusiasm </strong>of the researcher as well as any true difference in exposure between the two groups.</p>

Question 96

<p>describe follow up bias</p>

Answer 96

<p>arises when <strong>one group of subjects is followed up more diligently than another</strong> to measure disease incidence or other relevant outcome.</p>

<p>For example, in cohort studies, subjects sometimes <strong>move address</strong> or fail to reply to questionnaires sent out by the researchers. If greater attempts are made to trace these missing subjects from the group with greater initial exposure to a factor of interest than from the group with less exposure, the resulting relative risk would be based on a (relative) underestimate of the incidence in the less exposed group compared with the more exposed group.</p>

<p></p>

Question 97

<p>describe systematic error</p>

Answer 97

<p><strong>tendency for measurements to always fall on one side of the true value.</strong></p>

<p>It may be because the <strong>instrument </strong>(egblood pressure machine) is <strong>calibrated </strong>wrongly, or because of the way a person <strong>uses </strong>an instrument. This problem may occur with interviews, questionnaires etc, as well as with medical instruments.</p>

Question 98

<p>what is a confounding factor?</p>

Answer 98

<p>factor<strong>associated </strong>independently with both the <strong>disease </strong><em>and </em>with the <strong>exposure </strong>under investigation</p>

<p>⇒<strong>distorts </strong>relationship betweenexposure and disease.</p>

<p>(in some cases the confounding factor may be the true causal factor, and not the exposure that is under consideration)</p>

Question 99

<p>give 3 examples of confounding factors</p>

Answer 99

<ol> <li>age</li> <li>sex</li> <li>social class</li></ol>

Question 100

<p>describe 5 ways around confounding factors</p>

Answer 100

<ul> <li><strong>randomisation</strong></li> <li><strong>restriction </strong>of eligibility criteria to <strong>only certain kinds </strong>of study subjects</li> <li>subjects in different groups can be <strong>matched </strong>for likely <strong>confounding factors</strong>.</li> <li>results can be <strong>stratified </strong><u>(arranged)</u><strong></strong>according to confounding factors.</li> <li>results can be <strong>adjusted </strong>(using <u>multivariate analysis</u> techniques) to take account of suspected confounding factors.</li></ul>

Question 101

<p>describe 9 factors in the criteria for causality</p>

<p>(It is difficult to prove causation between an exposure and disease. Often the best that can be achieved is to demonstrate a weight of evidence in favour of a causal relationship. A number of criteria have been devised to help investigators assess the available evidence, known as the criteria for causality)</p>

<p></p>

Answer 101

<ol> <li><u><strong>Strength </strong></u>of <u><strong>association</strong></u>:the larger the association, the more likely that it is causal.</li> <li><u><strong>Consistency</strong></u>:Consistent findings observed by different persons in different places with different samples strengthens the likelihood of an effect. </li> <li><strong><u>Specificity :</u></strong>Causation is likely if there is a very specific population at a specific site and disease with no other likely explanation.</li> <li><u><strong>Temporality</strong></u>:The effect has to occur <u>after </u>the cause</li> <li><u><strong>Biological gradient:</strong></u>Greater exposure should generally lead to greater incidence of the effect</li> <li><u><strong>Biological plausibility:</strong></u>A plausible <u>mechanism </u>between cause and effect is helpful</li> <li><u><strong>Coherence:</strong></u>Coherence between epidemiological and laboratory findings increases the likelihood of an effect.</li> <li><u><strong>Analogy </strong></u>:The effect of similar factors may be considered.</li> <li><strong><u>Experiment</u>:</strong>experimental evidence</li></ol>

Question 102

<p>list the 3 intended aims of sign guidelines</p>

Answer 102

<ol> <li><strong>Help healthcare professionals </strong>+<strong>patients understand medical evidence </strong>and <strong>use </strong>it to make <strong>decisions </strong>about healthcare.</li> <li><strong>Reduce unwarranted variations in practice</strong>+make sure patients get<strong>best care </strong>available, no matter where they live</li> <li><strong>Improve healthcare </strong>across Scotland by focusing on patient-important outcomes</li></ol>

<p></p>

Question 103

<p>What does SIGN stand for and what do they do</p>

Answer 103

<ul> <li>The <strong>Scottish IntercollegiateGuidelinesNetwork (</strong>SIGN)</li> <li>Develop<em>evidence based</em><strong> clinical practiceguidelines</strong>for the<u><strong>NHSin Scotland.</strong></u></li></ul>

Question 104

<p>adefine ageism</p>

Answer 104

<p><strong>stereotyping </strong>and <strong>discrimination</strong> against people just because of <u><strong>their age </strong></u>(not just old!)</p>

Question 105

<p>what percentage of the world population is expected to be over 60 by 2050?</p>

Answer 105

<p>22%</p>

Question 106

<p>In the period 2000 to 2050, the number of people aged 80 and older will increase \_\_ fold.</p>

Answer 106

<p>4 fold</p>

Question 107

<p>By 2050, what percentage of older people will live in low-income and middle-income countries?</p>

<p></p>

Answer 107

<p>80%</p>

Question 108

<p>what are the biggest killers in the poorest countries?</p>

Answer 108

<p>heart disease, stroke,chronic lung disease.</p>

Question 109

<p>give 4reasons for the ageing population in the UK</p>

Answer 109

<ol> <li><strong>baby boom</strong>afterWWII</li> <li>overall <strong>mortality rates</strong> continue<strong>improving (decreases)</strong></li> <li>moreemphasis on <strong>preserving health</strong> in old age⇒ elderly <strong>morehealthy</strong></li> <li><strong>ageing does not (necessarily)<u>cause</u> disease </strong>(healthierhabits ⇒ live healthier for longer.)</li></ol>

Question 110

<p>how will healthcare have to change in response to the ageing population? give 4 points.</p>

Answer 110

<ol> <li><strong><em>More geriatricians</em> </strong>+ (other care of the elderly professionals) needed</li> <li><em><strong>Morefacilities</strong></em> for elderly health care needed</li> <li>Many<strong> long-term conditions</strong> (end-stages of whichcan requireas much palliative care as cancer eg DM, CVD) are<strong>moving from 2*care to <u>1*care</u></strong></li> <li>Specific <strong>health promotion campaigns</strong> aimed at elderly.</li></ol>

Question 111

<p>what are the social implications associated with the ageing population? list 5.</p>

Answer 111

<ol> <li>elderlydependent on <strong>families/carers </strong>who are<strong> <u>also ageing</u></strong></li> <li>more <strong>demand</strong> for<strong> home carers</strong> +<strong>nursing home places</strong></li> <li>more emphasis on <strong>providing social activities </strong>for elderlywithin community</li> <li><strong>role </strong>ofelderly as <strong>grandparents</strong> (carers of grandchildren)likely to <strong>change </strong>(as may still be working)</li> <li><strong>changed housing demands</strong>as more elderly people live alone (single bedroom houses popular with elderly)</li></ol>

Question 112

<p>what are the economic implications associated with an ageing population? list 5.</p>

Answer 112

<ol> <li><strong>retirement/pension age</strong><strong><u>increases </u></strong>(already)</li> <li><strong>finding employment harder </strong>for <strong>young people</strong>(older peoplerequired to work longer)</li> <li>proportionately<strong> less </strong>people<strong>paying </strong>into<strong> tax +pension funds⇒</strong>harderto getadequate return from pension funds.</li> <li>some<strong>withoutprivate pension</strong> may find<strong>state pension inadequate</strong> ⇒<strong>poverty</strong></li> <li><strong>risingcost</strong> of “free personal care for the elderly” policy (Scotland)</li></ol>

Question 113

<p>what are the political implications/ factors associated with an ageing population? list 2.</p>

Answer 113

<ol> <li><strong>Decision making/</strong><strong>workforce planning </strong>must<strong><u>account</u></strong>forageing population</li> <li>Rising ageingpopulation could havepower to <strong>influence political decision making</strong> in relation to their specific concerns</li></ol>

Question 114

<p>What is the leading cause of death in women in England?</p>

Answer 114

<p>Dementia/Alzheimer's</p>

Question 115

<p>what is the leading cause of death in men in England?</p>

Answer 115

<p>heart disease</p>

Question 116

<p>what is increasing alongside life expectancy?</p>

Answer 116

<p><strong>healthy lifeexpectancy</strong></p>

<p>the population is now living longer <u>and</u><em>spending more years in good health</em></p>

<p></p>

Question 117

<p>how is the number of years spent in poor health varying with the number of years spent alive, in the ageing population?</p>

Answer 117

<p>life expectancyincreased<u>more</u> than healthy life expectancy, therefore:</p>

<p><strong>number of years lived in poor health has also increased</strong></p>

<p></p>

Question 118

<p>describe the concept of inequity</p>

Answer 118

<p><strong>life expectancy</strong> can vary depending on <strong>socioeconomic status</strong></p>

Question 119

<p>give an example of a third sector organisation that help patients live healthier and better quality lives</p>

Answer 119

<p>'Age Concern'</p>

Question 120

<p>how is the number of carers changing?</p>

Answer 120

<p>increasing</p>

Question 121

<p>what proportion of people will be carers at some point in their lives?</p>

Answer 121

<p><strong>3 in 5 people</strong>(<u><strong>60%</strong></u>) will be carers at some point</p>

Question 122

<p>how many people provide over 50 hours of unpaid care per week?</p>

Answer 122

<p>1.4 million</p>

<p></p>

Question 123

<p>what % of carers were in receipt of disability living allowance as a result of their own disability/ill health?</p>

Answer 123

<p><strong>27% </strong>of carers in receipt of Disability Living Allowance due totheir own disability/ill health</p>

Question 124

<p>give 7 examples of work that carers do</p>

Answer 124

<ol> <li><strong>practical help</strong> (meals, laundry, shopping)</li> <li><strong>keep an eye</strong> onperson</li> <li><strong>keep them company</strong></li> <li><strong>take the personout</strong></li> <li>helpwith <strong>financial matters</strong></li> <li>help deal with <strong>care services/benefits</strong></li> <li>help with<strong>personal care</strong></li></ol>

Question 125

<p>give some examples of the peoplecarers may care for (i.e. what relations might the carer have to them)</p>

Answer 125

<p><strong>majority of carers care for <u>relatives</u></strong></p>

<ol> <li>40%parents/parents-in-law</li> <li>26%spouse/partner.</li> <li><em>Other</em>: disabled children under 18,grandparents,other relative.</li></ol>

<p></p>

<p>1 in 10 care for a friend or neighbour.</p>

<p></p>

<p></p>

Question 126

<p>what are the proportions of carers that care for one person, two people or more?</p>

Answer 126

<p>83%care for just one person</p>

<p>14% care for two people</p>

<p>3%carefor at least three people</p>

<p></p>

<p></p>

Question 127

<p>discuss theimpact that caring has on carers</p>

<p>i) financial (5)</p>

<p>ii) social (2)</p>

<p>iii) health (1)</p>

Answer 127

<p><u>Financial</u></p>

<ol> <li>May live in<strong>household</strong> where <strong>no-one is in paid work</strong></li> <li><strong>Drop </strong>in<strong> househould income </strong>by£20,000+ p/a</li> <li><strong>Cut back on essentials</strong>like food and heating</li> <li>Financial circumstances<strong>affecting <u>their</u> health</strong></li> <li><strong>Missingout on financial support</strong> due tonot gettingright information</li></ol>

<p></p>

<p><u>Social</u></p>

<ol> <li>Impact on<strong>relationships </strong>with friends/family</li> <li>Many feel <strong>society does not think about them</strong> at all</li></ol>

<p></p>

<p><u>Health</u></p>

<ol> <li>Carers providing round theclock care over<strong></strong>2xmore likely to be in<strong> bad health</strong> than non-carers</li></ol>

Question 128

<p>define 'multi-morbidity'</p>

Answer 128

<p><strong>“the co-existence of two or more long-term conditions in an individual"</strong></p>

<p>(<em>the norm</em> in primary care patients)</p>

Question 129

<p>how does multi-morbidity add complexity to management?</p>

Answer 129

<p>preferred <strong>treatment for one condition</strong> may <strong><u>worsen another</u></strong></p>

Question 130

<p>give 5 different options for care for elderly patients that are being discharged from hospital</p>

Answer 130

<ol> <li>Living in <strong>own home </strong>with <strong><em>support from family</em></strong></li> <li>Living in <strong>own home</strong> with <strong><em>support from social services</em></strong></li> <li><strong>Sheltered</strong> Housing (accomodationfor elderly)</li> <li><strong>Residential</strong> Home</li> <li><strong>Nursing Home</strong> Care</li></ol>

Question 131

<p>define 'anticipatory care plans (ACP)'</p>

Answer 131

<p><strong>discussions</strong> in which individuals, care providers andrelativesmake<strong> decisions </strong>with respect to<strong>futureaspects of care</strong> (health/personal/practical)</p>

Question 132

<p>when should ACP be done?</p>

Answer 132

<p>any time in life that seems <strong>appropriate</strong></p>

<p>continuously</p>

Question 133

<p>who should do ACP?</p>

Answer 133

<p>anyone with an <strong>appropriate relationship</strong> topatient</p>

<p></p>

Question 134

<p>how should ACPbe done?</p>

Answer 134

<p><u><strong>carefully </strong></u>thinking ahead +making plans</p>

<p><strong>write it down</strong></p>

Question 135

<p>how can ACP be shared?</p>

Answer 135

<p><strong>- KIS (Key Information Summary)</strong></p>

<p>- Other communication mehtods</p>

<p>The electronicKey InformationSystem (KIS) is a communication tool that conveysACP information from Primary Care to Out of Hours services (111)</p>

Question 136

<p>give 3examples of <em>legal</em> ACP</p>

Answer 136

<ol> <li>Welfare power of attorney</li> <li>Financial power of attorney</li> <li>Guardianship</li></ol>

Question 137

<p>give up to 8examples of <em>personal</em> ACP</p>

Answer 137

<ol> <li><strong>advance directive - </strong>what actions should be taken if deterioration</li> <li><strong>next of kin </strong>(closest relative)</li> <li><strong>consent </strong>to <strong>pass on information</strong> to relevant others</li> <li>preferences +priorities regarding <strong>treatment</strong></li> <li><strong>who else to consult/</strong>inform</li> <li>preferred <strong>place </strong>of <strong>death</strong></li> <li><strong>religious/</strong>cultural beliefs (death)</li> <li>current level of <strong>support</strong></li></ol>

Question 138

<p>give up to 9examples of <em>medical</em> ACP</p>

Answer 138

<ol> <li>Potential <strong>problems</strong></li> <li><strong>Home care</strong> package</li> <li>Wishes about<strong>DNA CPR</strong></li> <li>Scottish <strong>Palliative Care</strong> Guidelines</li> <li><strong>Communication </strong>which has occurred with other professionals</li> <li>Details of <strong>“just-in-case” medicines</strong></li> <li><strong>Electronic </strong>care summary</li> <li><strong>Assessment of capacity</strong>/competence</li> <li><strong>Current aids</strong> and appliances (helps assess current functional level)</li></ol>

Question 139

<p>give up to 8reasons for the ageing population that are <em><u>not</u> due to improved healthcare</em></p>

Answer 139

<ol> <li><strong>Decrease </strong>in <strong>birth/fertility rates</strong></li> <li>Better <strong>housing</strong></li> <li>Better <strong>water supplies</strong></li> <li>Better <strong>sanitation</strong>/sewerage systems</li> <li>Better <strong>nutrition</strong></li> <li>Better<strong> safety</strong>/reduction of injury</li> <li><strong>Migration </strong>(some areas only)</li> <li><strong>War</strong>/genocide (some areas only)</li></ol>

Question 140

<p>Define ageing population</p>

Answer 140

<p>Population agingis an <strong>increasing median age</strong> in the populationof a region due to <strong>declining fertility rates </strong>and/or <strong>rising life expectancy.</strong></p>

Question 141

<p>list 10 members of the primary healthcare team</p>

Answer 141

<ol> <li>GP partners</li> <li>GP assistants and other salaried doctors</li> <li>GP registrars</li> <li>Practice nurses</li> <li>Practice managers</li> <li>Receptionists</li> <li>Community nurses</li> <li>Midwives</li> <li>Health visitors</li> <li>Nurse practitioners</li></ol>

Question 142

<p>describe the role of the GP partner</p>

Answer 142

<ul> <li><strong>first point of contact</strong> for most patients.</li> <li>bulk of work =<strong>consultations +home visits</strong></li> <li>mostare <strong>independent contractors</strong> to NHS (responsible for providing adequate premises to practise from andemploying own staff)</li></ul>

<ol> <li><strong>providecomplete spectrum of care</strong> incommunity - dealing with problems often withphysical, psychological and social components</li> <li><strong>helppatientstake responsibility </strong>for their own health.</li> <li><strong>work in teams</strong> with other professions</li></ol>

Question 143

<p>describe the role of the practice nurse</p>

Answer 143

<p><em>Work as one of several or on their own.</em></p>

<p>May be <strong>involved in most aspects of patient care,</strong>including:</p>

<p>blood samples, ECGs, wound management (eg leg ulcers),travel health advice + vaccinations, child immunisations, family planning, women’s health (including cervical smears),men’s health screening, sexual health, smoking cessation.</p>

<p></p>

<p>(GPnurses mayhave direct supervision of healthcare assistants at the practice)</p>

Question 144

<p>describe the role of the district nurse</p>

Answer 144

<p><strong>Visit people inown homes</strong>:</p>

<ol> <li><strong>Direct patient care </strong>- Assess healthcare needs⇒ providecomplex care⇒ monitorquality of care</li> <li><strong>Teaching and support role</strong>-enablepatientsto care for themselves orteachfamily how tocare</li></ol>

<p></p>

<p><em>District nurses helpkeep<strong>hospital admissions lower </strong>+ensurepatients<strong>return home</strong>as soon aspossible</em></p>

<p>-</p>

<p></p>

<p>(Note: they are accountable for their own patient caseloads)</p>

Question 145

<p>describe the role of the midwife</p>

Answer 145

<p>provide care during all stages of <strong>pregnancy, labour</strong> and<strong>early postnatal period.</strong></p>

<ol> <li>C<em>ommunity based</em>- at home,clinics, children's centres, GP surgeries.</li> <li>H<em>ospital based</em> -antenatal, labour,postnatal wards, neonatal units.</li></ol>

Question 146

<p>describe the role of the health visitor</p>

Answer 146

<p><em>Qualified nurse or midwife</em>working in<u>community</u> with families to give pre-school-age <u>children</u> best possible start in life.</p>

<ol> <li><strong>V</strong><strong>isitparents</strong>with<strong> new babies</strong>/young children inown home</li> <li><strong>Child +family health </strong>services (pregnancy-5 yrs)</li> <li><strong>A</strong><strong>dditional </strong>services for<strong> vulnerable </strong>children/families</li> <li><strong>Safeguarding +protecting </strong>children</li></ol>

Question 147

<p>describe the role of a macmillan nurse</p>

Answer 147

<p><em><strong>specialise in cancer +palliative care</strong></em></p>

<p>support patients/relatives/carers from<u>diagnosis</u> <u>onwards</u>either in hospital,at home or alocal clinic:</p>

<p></p>

<p><em><strong>Rolesinclude:</strong></em></p>

<p>pain/symptom control, emotional support, info recancer treatments/side effects, advising other MDT members(e.g.district nurses), co-ordinated care between hospital and patient's home, advice on other forms of support, including financial help.</p>

Question 148

<p>describe the term 'allied health professionals' and give 6 examples</p>

Answer 148

<p>Professions<strong>distinct</strong> from <strong>nursing</strong> and <strong>medicine</strong></p>

<ol> <li>Physiotherapy</li> <li>Occupational Therapy</li> <li>Dietetics</li> <li>Podiatry</li> <li>Pharmacy</li> <li>Counselling</li></ol>

Question 149

<p>describe the role of the pharmacist</p>

Answer 149

<p><u><em><strong>Expert in medicines</strong></em></u></p>

<p>Work in a<strong>pharmacy</strong>(hospital,community, primary care) to:</p>

<ol> <li>Ensure patients receive<strong> maximum benefit</strong> fromthem</li> <li><strong>Advise </strong>medical + nursing <strong>staff </strong>on appropriate use</li></ol>

<p></p>

<p><em>Note: can undertake additional training to be able to prescribe for specific conditions.</em></p>

Question 150

<p>describe the role of the dietitcian</p>

Answer 150

<p>Helppeoplemake<strong> informed choices </strong>about <strong>food/lifestyle</strong></p>

<ul> <li><strong><em>Most</em> </strong>employed in<strong> <u>NHS</u> </strong>- (hospitalorcommunity)</li> <li>Some work infood <strong>industry</strong>, <strong>education</strong>, <strong>research</strong> or <strong>freelance</strong></li></ul>

<p></p>

<p><em><strong><u>Wide range of responsibilities including:</u></strong></em></p>

<p>working with people with special dietary needs, informinggeneral public about nutrition, offeringunbiased advice, evaluating and improving treatments, educatingpatients/clients, other healthcare professionals andcommunity groups.</p>

Question 151

<p>describe the role of the physiotherapist</p>

Answer 151

<p><strong></strong>Treat people with<strong> <u>physical problems</u> </strong>caused by illness, accident or ageing.</p>

<p></p>

<ul> <li><strong>See movement as central to health <em>-</em></strong>maximisingthrough health promotion, preventive healthcare, treatment, rehabilitation.</li> <li><strong>Appreciate -</strong>psychological, cultural, social factors</li></ul>

<p></p>

<p><u>Core skills:</u>manual therapy, therapeutic exercise,electro-physical modalities.</p>

<p></p>

Question 152

<p>describe the role of the occupational therapist</p>

Answer 152

<p><u><strong>Assessment</strong></u> +<strong><u>treatment</u> </strong>of physical/psychiatric<strong> </strong>conditions<strong></strong>⇒</p>

<ol> <li><strong><em>Prevent</em></strong> disability</li> <li>Help<strong><em>overcome effects</em> </strong>of <strong><em>disability</em> </strong>(physical, psychological,accident)</li> <li>Promote <em><strong>independentfunction</strong></em> in all aspects of daily life.</li></ol>

<p></p>

<p><em><u>​</u></em><em><u>Work may include:</u></em></p>

<p><em></em>physical rehabilitation, mental health, learning disability, primary care, paediatrics, environmental adaptation, care management, equipment for daily living</p>

Question 153

<p>describe the role of a care manager</p>

Answer 153

<p>Helppeople<strong>identifygoals</strong>+<strong>locate specific support services</strong> toenhance wellbeing:</p>

<p></p>

<ol> <li>Help find<strong>solutions</strong>when faced with many<strong>choices</strong>/challenging decisions</li> <li>Advise on <strong><em>social +</em></strong><strong><em>financial </em></strong>support services (highly trained social workers)</li></ol>

Question 154

<p>give a few other examples of professions involved in health</p>

Answer 154

<p><strong>Complimentary therapists</strong>-acupuncture, homeopathy</p>

<p><strong>Social services</strong>-social workers, social care workers</p>

<p><strong>Health promotion</strong>- gyms, education</p>

Question 155

<p>describe 2 political pressures on the PHCT</p>

Answer 155

<p><strong>Reduce cost</strong> of <strong>treatments.</strong></p>

<p>Provide more treatments <strong>closer</strong> to where <strong>patients live</strong></p>

Question 156

<p>give 2 examples of the expanding roles of some members of the PHCT</p>

Answer 156

<p><strong>Pharmacist:</strong>extended role of in medicinesmanagement and minor illness</p>

<p><strong>Nurse:</strong> prescribing and triage.</p>

Question 157

<p>give 2 problems posed by the growing number of ageing patients on the PHCT.</p>

Answer 157

<p><strong><u>more</u> long term conditions </strong></p>

<p><strong><u>greater demand</u> for healthcare </strong>generally</p>

<p></p>

<p><em>(both of these aremanaged largely in primary care)</em></p>

Question 158

<p>What was formed as a result of a joint initiativebetween the Royal Pharmaceutical Society, the British Medical Association, the Royal College of Nursing, the National Pharmaceutical Association and the Royal College of General Practitioners?</p>

Answer 158

<p><strong>The Forum on Teamworking in Primary Healthcare</strong></p>

<p></p>

<p>Outlinesrecommendationsfor establishing a successful PHCT.</p>

Question 159

<p>The recommendationsfor establishing a successful PHCT are laid out in the'Forum on Teamworking in Primary Healthcare' - describe up to 14of these.</p>

Answer 159

<ol> <li><strong>Recognisepatient/careras essential member</strong> of PHCT</li> <li>Establish<strong> common agreed purpose</strong></li> <li><strong>Agree set objectives</strong> +monitor progress towards them.</li> <li><strong>Agree teamworking conditions,</strong> includingprocess for resolving conflict</li> <li><strong>Members</strong><strong>acknowledge</strong>skillsof team <strong>colleagues</strong>.</li> <li>Importance of<strong> communication</strong></li> <li>Ensurepractice<strong> population understandshowteam works</strong> within community</li> <li><strong>Select team leader forleadership skills</strong> (rather than on status, hierarchy,availability)</li> <li>Include in the membership of the team all the relevant professions serving a practice population.</li> <li><strong>Promote teamwork</strong></li> <li><strong>Evaluateteamworking initiatives</strong> onbasis of sound evidence</li> <li>Ensure <strong>sharing of patient information </strong>within team<strong> complies with current legalrequirements.</strong></li> <li>Take active steps to <strong>facilitate inter-professional collaboration</strong> and understanding through joint conferences, education and training initiatives.</li> <li><strong>Be aware of other measures</strong> involving national organisations, educational measures, research and general guidance which impact on teamworking.</li></ol>

Question 160

<p>define the 'health and social care team' and explain why it is called this</p>

Answer 160

<p>There is an <strong>NHS team</strong> around the patient but also <strong>c</strong><em><strong>arers/social care</strong></em></p>

<p>Scottish Government recognisedneed for bothto <strong>work together</strong>solaunched a program to <u>i</u><u>ntegrate</u> Health and Social Care.</p>

<p></p>

<p>The PHCT is often now referred to as the <u><strong>Health and Social Care Team.</strong></u></p>

Question 161

<p>describe the 2 primary aims of the new integrated agenda</p>

Answer 161

<p><u><em>Reduce:</em> </u></p>

<ol> <li><strong>Unnecessary admissions</strong></li> <li><strong>Delayed discharges</strong>.</li></ol>

<p></p>

<p>(Integration makesmore effective use of limited resources andimprovesoutcomes for patients)</p>

Question 162

<p>In 2011,the Scottish Government’s plan to integrate adult health and social care was announced.</p>

<p>what was it called?</p>

Answer 162

<p>THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014</p>

Question 163

<p>briefly describe 3 of the key points of theTHE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014.</p>

Answer 163

<ol> <li><strong>Created new public organisations</strong> (integration authorities)to breakdown barriers to joint working between NHS boards +local authorities</li> <li><strong>Integration </strong>ofhealth/social care<strong> budgets </strong>byNHS boards/local authorities</li> <li>Form<strong>nationally agreed outcomes </strong>andrequirement on partnerships to strengthen role of care professionals, along withthird and independent sectors, inplanning and delivery of services.</li></ol>

Question 164

<p>describe the demands of the 2014 act on integrated services</p>

Answer 164

<p>The 2014 Act <u>required</u>NHS boards + local authorities to:</p>

<ol> <li><strong>Integrate governance, planning </strong>and<strong> resourcing</strong> ofadult social care/primary care, community health andhospital services.</li> <li><strong>Jointly submit integration scheme for each area</strong>- detailing which functions will be delegated to theintegration authority. These schemes are intended to achieve the National Health and Wellbeing Outcomes.</li></ol>

Question 165

<p>the 2014 act set out a framework for creating the integration authorities.</p>

<p>It allowed NHS boards and local authorities to integrate health and social care services in <u>two</u> ways - name them</p>

Answer 165

<ol> <li>integrated joint board model</li> <li>the lead agency model.</li></ol>

Question 166

<p>describe the 'Integrated Joint Board' (IJB) model</p>

Answer 166

<p>NHS board and local authorities <strong><u>delegateresponsibility</u></strong> to IJB:</p>

<p><strong></strong></p>

<p><b>1)</b><strong>Responsibility </strong>for<strong> planning/resourcing </strong>service<strong>provision </strong>for adult health and social care services.</p>

<p>2)<strong>Budgets -</strong>IJB then decides how to use the resources.</p>

Question 167

<p>list up to 10professionals the IJB must include</p>

Answer 167

<ol> <li>carer representative</li> <li>GP representative</li> <li>nurse representative</li> <li>secondary medical care practitioner</li> <li>service user representative</li> <li>staff-side representative</li> <li>third sector representative</li> <li>officer who is responsible for financial administration</li> <li>the Chief Officer</li> <li>the Chief Social Worker .</li></ol>