General Practice and Public Health Flashcards
(168 cards)
1
Q
What are the 5 level’s of Maslow’s hierarchy of needs?
A
- Physiological needs.
- Safety needs.
- Love and belonging.
- Self-esteem.
- Self-actualisation.
2
Q
What is epigenetics?
A
The study of how genes interact with the environment.
Changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself.
3
Q
What is allostasis?
A
The process of achieving stability, or homeostasis, through physiological or behavioural change.
4
Q
What is allostatic load?
A
The wear and tear on the body that accumulates as an individual is exposed to repeated or chronic stress. The price we pay for allostasis.
5
Q
Define domestic abuse.
A
Incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16+ who are, or have been, intimate partners or family members regardless of gender or sexuality.
6
Q
Give 3 examples of domestic abuse.
A
- Emotional abuse.
- Physical abuse.
- Financial abuse.
- Sexual abuse.
- Psychological abuse.
7
Q
How can domestic abuse impact on health?
A
- Traumatic injuries following assault e.g. fractures, miscarriage.
- Somatic problems or chronic illness e.g. chronic pain, headaches.
- Psychological problems e.g. PTSD, depression, anxiety.
8
Q
Give 3 potential indications of domestic abuse.
A
- Unwitnessed by anyone else.
- Repeat attendances to GP or A+E.
- Delay in seeking help.
- Multiple minor injuries.
9
Q
What assessment tool can be used to determine someones risk of domestic abuse?
A
The DASH assessment.
10
Q
What action would you take if someone was at high risk of domestic abuse?
A
Refer to MARAC or IDVAS.
11
Q
What is Public Health?
A
The science and art of preventing disease, prolonging life and promoting health through organised efforts of society.
12
Q
Define epidemiology
A
The study of the frequency, distribution and determinants of diseases and health-related states in populations in order to prevent and control disease.
13
Q
Define incidence
A
The rate at which new diseases occur in a population in a certain time period
14
Q
Define prevalence
A
The proportion of a population found to have a disease at a point in time.
15
Q
What is person-time a measure of?
A
Person-time is a measure of risk.
It is the sum of each individual’s time at risk ie. the length of time they were followed up in the study.
It is the denominator in incidence rate calculations.
16
Q
What value is used as the denominator in incidence rate calculations?
A
Person-time
17
Q
What is absolute risk?
A
Absolute risk of a disease is your risk of developing the disease over a time period
E.g. 4 in 100 people
18
Q
What is relative risk?
A
The risk in one category relative to another, for example, the ratio of risk of disease in the exposed to the risk in the unexposed.
It tells us about the strength of association between a risk factor and a disease.
19
Q
What is absolute risk reduction?
A
Absolute risk reduction (also called risk difference) is the absolute difference in outcomes between one group (usually the control group) and the group receiving treatment.
20
Q
What is relative risk reduction?
A
The relative risk reduction is the difference in event rates between two groups, expressed as a proportion of the event rate in the untreated group.
For example, if 20% of patients die with treatment A, and 15% die with treatment B, the relative risk reduction is 25%.
21
Q
What calculation can be used to work out relative risk?
A
Incidence in exposed ÷ incidence in unexposed.
22
Q
Define attributable risk.
A
The rate of disease in the exposed that may be attributed to the exposure. It tells us about the size of effect in absoloute terms.
23
Q
How can you calculate attributable risk?
A
Incidence in the exposed - incidence in the unexposed.
24
Q
What is NNT?
A
Number needed to treat is the number of patients that need to be treated in order to have an impact on one person.
25
How can you calculate NNT?
1 / absoloute risk reduction.
26
Define bias
A systematic deviations from the true estimation of the association between exposure and outcome.
27
Name 2 forms of bias
1. Selection bias.
2. Information bias.
28
What is selection bias?
The people who choose to participate in screening programmes may be different from those who don't. Proper randomisation is not achieved.
29
What is information bias?
Information or measurement bias can be due to observer, participant or instrument error.
30
What is length-time bias?
Diseases with a longer period of presentation are more likely to be detected by screening than ones with a shorter time of presentation.
31
What is lead-time bias?
Screening identifies diseases earlier and so gives the impression that survival is prolonged but in reality survival time is unchanged.
32
Define confounding.
Confounders are associated with exposure and outcome but are not on the causal path from exposure to disease.
Confounders may affect the validity of a study.
33
What is the Bradford Hill criteria for causation?
1. Consistency.
2. Biological plausibility.
3. Temporality - cause before disease.
4. Dose response.
5. Reversibility.
6. Strength of association.
34
Name 3 types of study design.
1. Ecological.
2. Cross-sectional.
3. Case-control.
4. Cohort.
5. RCT.
35
Which type of study uses routinely collected population level date to show trends and to generate hypotheses?
An ecological study.
36
Which type of study looks at the population at a point in time?
A cross-sectional or prevalence study.
37
Which type of study compares people with a disease to those without a disease for age, sex, habits, class etc?
A case-control study. These are retrospective.
38
Which type of study follows a population over time to see if they're exposed to the agent in question and if they develop the disease?
A cohort or incidence study. These are prospective.
39
What is a RCT?
Where a population is randomised to either an interventional or a control group. Often these are blind or double-blind trials.
40
Which type of study is also known as an incidence study?
A cohort study - follows a population over time to see if they're exposed to the agent in question and if they develop the disease.
41
Which type of study is also known as a prevalence study?
A cross-sectional study. It looks at the population at point in time.
42
Define primary prevention.
Preventing a disease/condition from occurring in the first place. Eliminating RF's that contribute to the disease.
43
Give an example of a primary prevention method.
Immunisations.
44
Define secondary prevention.
Detecting a disease as soon as possible in order to alter its course and to improve health outcomes.
45
Give an example of secondary prevention.
Screening e.g. cervical smears.
46
Define tertiary prevention.
Trying to slow down disease progression, avoiding complications and helping people to manage their illness effectively.
47
Give an example of tertiary prevention.
Diabetes management - diet advice, exercise programmes, self-monitoring, annual foot checks etc.
48
What is the population approach to prevention? Give an example.
Preventative measures delivered on a population wide basis e.g. dietary salt reduction.
49
What is the high risk approach to prevention? Give an example.
Identifying individuals above a chosen cut-off and treating them. E.g. treating those with high cholesterol to avoid heart disease.
50
Describe the prevention paradox
A preventative measure that brings much benefit to the population often offers little to each participating individual.
51
Define screening.
Identifying seemingly healthy individuals who may be at increased risk of disease.
52
Give 4 different types of screening
1. Population based.
2. Opportunistic.
3. Screening for communicable diseases.
4. Pre-employment and occupational.
53
What is the Wilson and Jungner criteria for screening?
**Before Screen**
1. The condition being screened for should be an important health problem.
2. The natural history of the condition should be understood.
**Screen**
1. There should be a detectable early stage.
**Test**
1. Facilities for diagnosis and treatment need to be available.
2. There should be a suitable test.
3. The test should be acceptable to the population.
**Treatment**
1. There should be a treatment available.
2. There should be an agreed policy on whom to treat.
3. The costs of screening must be balanced against benefits.
4. Screening should be a continuous process, not just a one off.
54
Define sensitivity
The proportion of people with the disease who are correctly identified (a/a+b).
55
Define specificity
The proportion of people without the disease who are correctly excluded by the screening test; how well a test detects those without a disease (c/c+d)
56
Define PPV
The proportion of people with a positive test result who actually have the disease (a/a+c).
57
Define NPV
The proportion of people with a negative test result who do not have the disease (d/b+d).
58
What are the 4 main determinants of health?
1. Lifestyle.
2. Access to healthcare.
3. Genes.
4. Environment.
59
# Define the following:
a) Equity
b) Equality
a) Equity - what is fair and just.
b) Equality - equal shares.
60
Define horizontal equity
Equal treatment for equal need
61
Define vertical equity
Unequal treatment for unequal need e.g. someone with a common cold would need a different treatment to someone with pneumonia.
62
Give 2 factors that can affect equity.
1. Spatial factors - geographical.
2. Social factors - age, gender, class, ethnicity.
63
What are the 3 domains of public health?
1. Health promotion.
2. Health protection.
3. Improving health services.
64
Domains of public health: give examples of health promotion.
Health promotion looks at interventions e.g. immunizations, smoking cessation, screening.
65
Domains of public health: give examples of health protection.
Putting measures in place to control infectious diseases.
66
Domains of public health: what are the aims of health service improvements?
To ensure that there is delivery of organised, safe and high quality services.
67
What is health psychology?
Health psychology emphasizes the role psychological factors in the cause, progression and consequences of health and illness.
It aims to put theory into practice by promoting healthy behaviors and preventing illness.
68
Give 3 types of health behaviour.
1. Health behaviour.
2. Illness behaviour.
3. Sick role behaviour.
69
Define health behaviour.
Health behaviour is aimed at preventing disease e.g. eating healthily.
70
Define illness behaviour.
Illness behaviour is aimed at seeking remedy e.g. going to the Dr's.
71
Define sick role behaviour.
Sick role behaviour is activity aimed at getting better e.g. taking medications.
72
What are health damaging behaviours?
Health damaging behaviours are often related to mortality e.g. smoking, alcohol, high risk sexual behaviours.
73
What are health promoting behaviours?
Behaviours that seek and maintain health e.g. exercise, eating healthily, having vaccines.
74
What is a meta-analysis?
A statistical technique where you pool all the results of the available evidence and look at effect.
75
Define compliance.
The extent to which a patients behavior coincides with medical advice. It is professionally focused and assumes that the doctor knows best.
76
Give 3 factors that can effect compliance.
1. Side effects of medications.
2. Patient perception of risk.
3. If the patient is asymptomatic.
4. Socioeconomic status.
77
Give 3 examples of population level interventions.
1. PH campaigns e.g. Change4Life, Movember.
2. Screening e.g. cervical smear.
3. Immunisations e.g. MMR.
78
What is unrealistic optimism?
Unrealistic optimism is when individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility.
79
Give 3 factors that contribute to unrealistic optimism e.g. factors that can influence someones perception of risk.
1. Lack of personal experience with a problem.
2. Belief that it may be preventable by personal action.
3. Belief that if not happened now, its not likely to.
4. Belief that the problem is infrequent.
5. Other reasons: health beliefs, situational rationality, cultural variability, socioeconomic factors, stress, age.
80
Why is it important to understand a patient's perception of risk?
A patient's perception of risk can impact on medication adherence and keeping appointments etc.
81
Briefly describe the NICE guidance on behaviour change.
1. Plan interventions.
2. Assess social context.
3. Educate and train.
4. Look at individual level and community level interventions.
5. Evaluate effectiveness and assess cost effectiveness.
82
What is the single greatest cause of illness and premature death in the UK?
Smoking.
83
What 3 diseases are smoking related deaths normally due to?
1. Cancers.
2. COPD.
3. CHD.
84
When does smoking prevalence peak?
In the mid 20's.
85
What is the role of NCSCT?
NCSCT supports the delivery of effective evidence-based tobacco control programmes and smoking cessation interventions provided by local services.
86
What is 'Health Needs Assessment'?
A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities.
87
Health Needs Assessment: define need.
The ability to benefit from an intervention.
88
Health Needs Assessment: briefly describe the planning cycle.
Needs assessment -\> planning -\> implementation -\> evaluation -\> needs assessment etc...
89
What is felt need?
Individual perceptions of variation from normal health.
90
What is expressed need?
When an individual seeks help to overcome variation in normal health.
91
What is normative need?
When a professional defines interventions that are appropriate for expressed need.
92
What is comparative need?
Comparison between severity, range of interventions and cost.
93
Health needs assessment: define demand.
What people ask for.
94
Health needs assessment: define supply.
What is provided.
95
Describe the difference between health need and health care need.
Health need: need for health.
Health care need: need for health care. It is more specific and looks at someone's ability to benefit from health care.
96
Name 3 different types of health needs assessment.
1. Epidemiological.
2. Comparative.
3. Corporate.
97
Give 3 negative points for epidemiological health needs assessments.
1. Required data may not be available.
2. Variable data quality.
3. Ignores felt needs.
98
Briefly describe a comparative health needs assessment.
Compares services received by one population with other populations.
99
Give 3 negative points for comparative health needs assessments.
1. Required data may not be available.
2. Variable data quality.
3. It is hard to find comparable populations.
100
Who might be involved with corporate health needs assessment?
1. Politicians.
2. Press.
3. Providers.
4. Professionals.
5. Patients.
101
Give 3 negative points for corporate health needs assessments.
1. Difficult to distinguish need from demand.
2. Groups may have vested interests.
3. May be influenced by political agendas.
102
Give one health related example of something that you consider is demanded but not needed or supplied.
Cosmetic surgery.
103
Give examples of secondary prevention methods for cardiac failure.
1. Regularly checking BP.
2. Regularly checking blood cholesterol.
104
Give examples of tertiary prevention methods for cardiac failure.
1. Exercise based cardiac rehabilitation.
2. Revascularisation procedures e.g. PCI, CABG.
3. Implantable defibrillators.
105
What is erectile dysfunction?
The inability to attain and maintain an erection sufficient for satisfactory sexual performance.
106
Give 3 RF's for erectile dysfunction.
1. Lifestyle factors e.g. obesity, smoking, alcohol.
2. Hypercholesterolaemia.
3. Hypertension.
4. Diabetes mellitus.
107
Give 5 potential causes of erectile dysfunction.
1. Neuro: brain injury/spinal cord disease.
2. CV disease: atherosclerosis, HTN.
3. Psychogenic: psychosexual disorders, depression, anxiety.
4. Endocrine: thyroid disease.
5. Medications: beta blockers, diuretics, anti-depressants.
108
ED: What points in a history are suggestive of a psychogenic cause?
1. Sudden onset.
2. Early collapse.
3. Problematic relationship.
109
ED: What points in a history are suggestive of an organic cause?
1. Gradual onset.
2. Normal ejaculation.
3. Normal libido.
4. RF's present.
110
What investigations might you do to determine the cause of someone's erectile dysfunction?
1. Fasting glucose.
2. HbA1c.
3. Lipid profile.
4. FSH/LH/Prolactin.
111
Briefly describe the management of ED.
1. Treat RF's.
2. Refer for counselling.
3. Phosphodiesterase inhibitors e.g. Tadalafil.
4. Vacuum devices.
5. Injections.
6. Penile prosthesis.
112
Name a phosphodiesterase inhibitor and briefly describe how they work.
Tadalafil.
They increase the blood flow to the corpus cavernosum
113
Give 3 potential side effects of phosphodiesterase inhibitors.
1. Headaches.
2. Flushing.
3. Indigestion.
4. Priapism.
5. Impaired vision.
114
Give 3 potential causes of homelessness.
Relationship breakdown due to:
1. Mental illness.
2. Domestic abuse.
3. Dispute with parents.
4. Bereavement.
115
Give 3 groups of people who are more vulnerable to homelessness.
1. Substance misusers.
2. Failed asylum seekers.
3. People who are/have been in care.
4. Ex-service men and women.
5. LGBTQ+.
116
What health problems do homeless adults face?
1. Infectious disease inc. TB and hepatitis.
2. Dental problems.
3. Respiratory problems.
4. Injuries following violence/rape.
5. Sexual health problems.
6. Serious mental illness - schizophrenia, depression.
7. Malnutrition.
117
What barriers to care do homeless people face?
1. Difficulty accessing health care.
2. Lack of integration between primary care services and other agencies.
3. People may not priorities health when there are other more immediate health problems.
4. May not know where to find help.
5. Communication difficulties.
118
Define refugee
A person granted asylum and refugee status in the UK. They have the rights of a UK citizen
119
Define asylum seeker.
A person applying for refugee status. They are entitled to £35 a week, housing and NHS care.
120
What barriers to care do asylum seekers and refugees face?
1. Language/cultural/communication problems.
2. Money/other priorities.
3. Different perceptions of care.
4. Racism, prejudice, discrimination, stigma.
5. May not understand how the NHS works.
121
What health problems do refugees and asylum seekers face?
1. Injuries from war/travelling.
2. No previous health surveillance/immunisations.
3. Malnutrition.
4. Injuries from torture and sexual abuse.
5. Blood borne and infectious disease.
6. Untreated chronic disease.
7. PTSD, depression, psychosis.
122
Define social exclusion.
The process of being shut out from any of the social, economic, political or cultural systems which determine the social integration of a person in society.
123
Give 3 causes of loneliness.
1. Poor health, sensory impairment.
2. Poverty.
3. Housing issues.
4. Fear of crime.
5. Lack of transport.
6. Discrimination.
124
Give 3 signs of loneliness.
1. Talkative, clinging.
2. Lives alone.
3. Recent bereavement or transition.
4. Mobility problems or sensory impairment.
125
Give 3 national initiatives to combat loneliness.
1. Age UK.
2. Silverline.
3. Dementia Friends.
126
Give 3 Sheffield initiatives to combat loneliness.
1. Age Better.
2. Active Sheffield.
3. Darnall Dementia Care.
127
What is the Health Belief Model (Becker 1974)?
Individuals will change if they:
1. Believe that they are **susceptible** to the condition in question
2. Believe that is has serious **consequences**
3. Believe that taking action **reduces susceptibility**
4. Believe that the **benefits** of taking action **outweigh the costs**
128
What are the 4 key aspects to the health belief model?
1. Perceived benefits.
2. Perceived barriers - most important factor for addressing behaviour change!
3. Perceived susceptibility.
4. Perceived severity.
129
'Cues to action' are another important aspect of the health belief model. What is meant by this?
1. Internal cues e.g. worsening pain or breathlessness may trigger someone to want to change their behaviour.
2. External cues e.g. reminder letters or phone calls from GP.
130
Give 3 disadvantages of the health belief model.
1. Health beliefs may be affected by alternative factors e.g. outcome expectancy and self efficacy.
2. The model does not consider the influence of emotions on behaviour.
3. Cues to action are often missing in research.
4. It does not differentiate between first time and repeat behaviours.
131
The Theory of Planned Behaviour proposes that the best predictor of behaviour is intention. What are the 3 predictors of intention?
1. A persons attitudes to behaviour.
2. Subjective norm: the perceived social pressure to undertake the behaviour.
3. Perceived behavioural control: a person's appraisal of their ability to perform the behaviour.
132
Theory of Planned Behaviour: Only 50% of intentions transfer to behaviours. How can we bridge this gap?
1. Perceived control.
2. Anticipated regret.
3. Preparatory actions.
4. Implementation intentions!
5. Relevance to self.
133
Give 3 disadvantages to the Theory of Planned Behaviour.
1. Lack of temporal element and lack of direction or causality.
2. The model doesn't taken into account emotions.
3. The model doesn't explain how attitudes, intentions and perceived behavioural control interact.
4. Relies on self-reported behaviour.
5. Good for predicting intentions but not as successful for actual behaviours.
134
Describe the transtheoretical model.
1. Pre-contemplation - no intention of stopping smoking.
2. Contemplation - thinking about giving up.
3. Preparation - getting ready to quit in near future.
4. Action - engaged in giving up.
5. Maintenance - steady no smoker, state of change reached.
Relapse?
135
Give 3 advantages and 3 disadvantages of the transtheoretical model.
Advantages:
1. Acknowledges individual stages.
2. Accounts for relapse.
3. Temporal element.
Disadvantages:
1. Not all people move through every stage.
2. Change might operate on a continuum, not discreet stages.
3. Doesn't take into account habits, culture, social and economic factors.
136
Give 3 external factors that are important when thinking about behaviour change.
1. Impact of personality traits.
2. Assessment of risk perception.
3. Impact of past behaviour/habit.
4. Social environment.
137
NICE guidance suggests that there are certain transition points in a person life where they are more susceptible to behaviour change. Name 3.
1. Leaving school.
2. Entering workforce.
3. Becoming a parent.
4. Becoming unemployed.
5. Retirement and bereavement.
138
What is safety netting?
1. Verbal and/or written advice about warning signs/symptoms with a plan of action should these be noticed.
2. Arrange follow-up at a specific time and place.
3. Liaising with other health care professionals to ensure direct access should the child require it.
Advice needs to be clear and easy to follow.
139
Name 3 groups of people who are less likely to have vaccines.
1. Homeless.
2. Refugees/asylum seekers.
3. Children in care.
140
Give 3 factors that contribute to the promotion of excessive energy intake.
1. Genetics.
2. Employment e.g. shift work.
3. Advertisements.
4. Characteristics of food - energy density, macronutrient composition, portion size.
5. Reduced physical activity.
6. Sleep.
7. Psychological factors.
141
Define malnutrition.
Deficiencies, excesses or imbalances in a person's intake of energy and/or nutrients. Malnutrition covers under-nutrition and overweight.
142
If associations are not causal, what might they be due to?
1. Confounding factors.
2. Chance.
3. Bias.
4. Reverse causation.
143
When treating substance misuse, what are the treatment aims?
1. Reduce harm to user, friends and family.
2. To improve health.
3. To stabilise lifestyle and reduce illicit drug use.
4. Crime reduction.
5. Reduce risk taking behaviour and blood borne virus transmission.
144
Opioid misuse: name a drug that can be used for detoxification.
1. Buprenorphine.
145
Opioid misuse: name 2 drugs used for maintenance/stabilisation.
1. Methadone.
2. Buprenorphine.
Titrate up from a low starting dose.
146
Describe the mechanism of action of heroin.
Acts at opiate receptors. Addictive because it is high reward for minimal effort.
147
Describe the mechanism of action of cocaine.
Cocaine blocks re-uptake of mood enhancing neurotransmitters at the synapse leading to feelings of intense pleasure.
148
How could you treat a heroin (opioid) addiction?
Provide a substitute e.g. methadone.
149
How could you treat a cocaine addiction?
There is no substitute available therefore harm reduction is key e.g. advice on risky behaviour, safe sex, BBV advice, Hep B/C testing.
150
Opioid misuse: how could you prevent relapse?
1. Provide plenty of support.
2. Naltrexone tablets can prevent relapse.
3. Stabilise and offer maintenance therapy.
151
When assessing the quality of health services, Maxwell’s classification lists six dimensions. What are they?
1. Effectiveness.
2. Efficiency.
3. Equity.
4. Accessible.
5. Acceptable.
6. Appropriate.
152
Although using measures of health outcomes is desirable in evaluation of health services, there are potential limitations. Explain why it may be difficult to attribute a health outcome to the service provided.
1. Other factors may be involved.
2. There may be a time lag between service and outcome.
3. Large sample sizes may be needed.
4. Data may be unavailable or there may be issues with data quality.
153
Give 4 criteria for negligence.
1. Duty of care.
2. Breach in duty of care.
3. Patient harmed.
4. Patient was harmed due to breach in duty of care.
154
What is an NHS never event.
A serious, largely preventable patient safety incident that should never happen if the available preventable measures have been implemented e.g. checklists.
155
Give an example of an NHS never event.
1. Patient misidentification.
2. Misplacement of an NG tube.
156
Clinical errors can be managed using a systems approach and a persons approach. Describe the persons approach.
Errors are due to wayward mental processes e.g. negligence, inattention, distraction. Focuses on unsafe acts of staff on the front-line e.g. nurses, doctors.
157
Clinical errors can be managed using a systems approach and a persons approach. Describe the systems approach.
Adverse events are the product of many causal factors - a whole system is to blame (swiss cheese). Implementation of standardised working and developing error free processes.
158
What is Donebedian's evaluation of health care?
1. Structure
2. Process
3. Output
4. Outcomes
159
"Structure, process, outcome” is a useful framework to use when carrying out evaluation of health services. Explain what is meant by “structure”.
Structure looks at what there is - buildings, staff, equipment. E.g. no. of ICU beds per 1000 or no. of vascular surgeons per 1000 or no. of locations screening takes place.
160
"Structure, process, outcome” is a useful framework to use when carrying out evaluation of health services. Explain what is meant by “process”.
What is done?
E.g. number of patients seen in A&E, number of operations performed, process of going to A&E
161
"Structure, process, outcome” is a useful framework to use when carrying out evaluation of health services. Explain what is meant by “outcome”.
Classically classified as mortality, morbidity, quality of life and patient satisfaction
Or by the 5Ds: Death, Disease, Disability, Discomfort, Dissatisfaction
162
What are Lohr (1988) 5D's of healthcare outcome?
1. Death
2. Disease
3. Disability
4. Dis-satisfaction
5. Discomfort
163
What are Maxwell's dimensions of quality??
1. **Effectiveness**: Does the intervention/service provide the desired effect?
2. **Efficiency:** Is the output maximised for a given input
3. **Equity**: Are patients being treated fairly?
4. **Acceptability:** How acceptable is the service offered to the people needing it
5. **Accessibility:** Is the service being provided? E.g. geographical access, cost, waiting times, information available
6. **Appropriateness:** Is the right treatment being given to the right people at the right time?
164
What is a QALY?
one year at perfect health
165
What two parts comprise a QALY?
1. Number of lives expected to gain
2. Quality of life of those years
166
What are the different parts of health economics?
1. Opportunity cost
2. Economic efficiency
3. Economic equity
4. Economic evaluation
167
What are the different types of economic evaluation?
What are they measured in?
1. Cost-effectiveness (natural units, cost per life year gained)
2. Cost-utility (measured in QALYs)
3. Cost-benefit (measured in monetary units)
4. Cost-minimisation (Outcomes same in both treatments so just minimise cost)
5. Incremental analysis
168
What is a DALY?
Disability adjusted life years
1 DALY = 1 year lost at complete health
