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HaDSoc Flashcards

1
Q

Qualities of good healthcare?

A

SETEE

safe, effective, timely, efficient, equitable

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2
Q

Why do pt safety problems occur? how to fix

A

human error or behaviour. Fix with checklists, avoid reliance on vigilance and memory, simplify and standardise processes and procedures

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3
Q

what policies encourage quality in the NHS

A

payment for high standard, clinical governance

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4
Q

what are the NHS 5 domains of national outcomes

A

PHEET

Prevent premature death, Help pt recovery, Ensure QoL for LTCs, Ensure pt has good exps, Treat in safe environment

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5
Q

What is purpose of the nhs national outcomes framewokr

A

make nhs accountable and increase quality

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6
Q

what mechanisms can be used to improve quality of nhs care

A

standard setting, clinical commissioning, financial incentives e.g. QoF, disclosure, regulation, clinical audit, professional regulation

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7
Q

what is cquin?

A

safety and pt exp = ££

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8
Q

benefits of a systematic review?

A

decrease time to guidelines, provides up to date conclusion for docs, identify gaps in research

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9
Q

pros and cons of quantitative research?

A

pros - greater no of subjects, comparable between studies, reliable and analysable
cons - doestn reflect how ppl really feel, limited results, forces ppl into categories

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10
Q

types of qualitative research

A

focus groups, interviews, ethnography and observe

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11
Q

what are focus groups good and bad for

A

good for participation but not good for sensitive topics and individual views

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12
Q

pros and cons of qualitative research

A

pros - explains relationships betwwen variables, info not revealed in quantitative
cons - not generalisable, labour intensive

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13
Q

what is evidence based practice?

A

integrating clinical expertise with best available evidence

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14
Q

critcism of evidence based practice? practical and philosophical

A

practical - RCT not always ethical, expensive, requires pharma companies to be honest
philosophical - rule followers, population guide may not apply to individual, professional autonomy

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15
Q

difficulties in getting evidence into practice

A

funding, doctors not aware of evidence or dont want to use it

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16
Q

diversity in health according to black report?

A

income diversity, artefact, behavioural cultural, social selection

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17
Q

define inequality and inequity

A

inequality - not equal

inequity - unfair and avoidable inequality

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18
Q

where do lay beliefs come from

A

social, cultural and personal knowledge

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19
Q

what is illness behaviour

A

activity done in ill health to define illness and seek solution

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20
Q

how are lay referrals useful

A

explains why and when pts present and the services they use

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21
Q

what are determinants of illness behaviour

A

culture, threshold for tolerance, visibility of symptoms, lay referral, disruption of life

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22
Q

purpose of health promotion

A

enable people to improve control over their own health

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23
Q

critiques of public health

A

sociological - surveillance critiques, consumption critiques (lifestyle choices are tied to identity)

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24
Q

what aproaches can be taken to promote health

A

MBEES

medical and preventative, Behavioural, Education, Empowerment, Social change

25
what is primry, secondary, and tertiary prevention. give egs where relevant
primary - imunisation, decrease risk factors, decrease risk of health related behaviour secondary - screening, treat BP tertiary - minimise effects of disease
26
dilemmas of health promotion?
ethics of interfering, victim blaming, prevention paradox, reinforces negative stereotypes
27
why evaluate health promotion programmes
accountability, ethical obligation (ensure no harm), evidence based interventions
28
how do you evaluate health promotion programmes? process, impact? Problems with evaluating outcomes?
process - quantitative impact - assess immediate effects outcomes - subject to delay, expensive, hard to measure confounders
29
what is illness narratives
accounts of experiences of LTCs
30
what is involved in chronic ilness work? explain
biographical work (loss of self and grief for former life), illness work, identity work, emotional work, everday life work
31
what are the dilemmas of identity work
scrutinise others reactions, dependence on others, relationships harder to maintain, loss of social life
32
define stigma
negatively defined thing that confers deviant status
33
what is narrative reconstruction
identity reconstructed in ways that explain their illnes
34
define impairment, disability, and handicap
impairment - abnormal function + structure of body disability - loss of ability to participate handicap - broader social and psych impacts of impairments e.g. cant get a job
35
tools for measured HRQoL
morbidities, mortaility, patient based outcome
36
what are patient based outcomes useful for?
clinical audits, measure service quality, assess benefits of treatment
37
what are the components of HRQoL
physical and cognitive function, symptoms, satisfaction
38
give eg of generic HRQoL
SF-36, EQ-5D
39
pros and cons of generic HRQoL
pros - broad range, assess health of whole population | cons - 2 general, less acceptable to pts
40
what is a specific HRQoL good for? pros and cons
good for disease, site specific, dimension specific e.g. pain pros - sensitive to change, relevant cons - must have disease, limited comparison
41
what are the 3 ways of detecting a disease
opportunistic, screening, spontaneous
42
what factors are needed to have a screening programme
disease - must be detectable, treatable, important test - precise and valid, acceptable, cheap treatment - early treatment must be useful and exist
43
define sensitivity, specificity, ppv, npv
sensitivity - if ur +ve, chances test says + specificity - if ur -ve, chances test says -ve ppv - if test is +ve, chances u r + npv - if test is -ve, chances u r -ve
44
what can false +ves and -ves lead to?
false + - anxiety, stress | false -ve - false assurance, delay diagnosis
45
cons of screening?
surveillance critique, victim blaming, lag time bias, length time bias, selection bias, false + and -ves
46
what is the health and social care act 2012
creates ccgs and gives GPs power to make commissioning decisions
47
what is explicit rationing? pros and cons
defined rules and systematic allocartion pros - fair, transparent, open to debate cons - pt distress, doesnt account for individual need, complex
48
implicit rationing pros and cons?
pros - sensitive to complexity of pt | cons - abuse, social deservingness, inequality
49
How does the NHS ration healthcare?
``` 5Ds Deterrent (prescriptions), delay, deflection (referred to different institution), dilution (service offered but quality declines as cuts made), denial ```
50
what are healthcare resource groups?
payment by results. treatments put into a group that is similar and uses similar resources
51
define technical and allocative efficiency
technical - most efficient way to meet a need | allocative - choosing between many needs
52
what is cost minimilisation, utility, effectiveness, benefit analysis?
minimilisation - choose cheapest of 2 treatments with similar outcomes effectiveness - cost per health unit outcome e.g. cost to reduce 10 mmHg of BP benefit - incomes and outcomes in £s utility - focussed on quality of health outcome produced e.g. QALY
53
what is incremental cost effectiveness ratio?
cost per QALY
54
criticisms of QALY?
problems with calculation, resource not distributed according to need, may not embrace all dimensions of benefit
55
problems with complaints in nhs
no feedback, lack of confidence in a resolution, complex system
56
how are patients viewed investigated directly and indirectly
indirectly - ombudsman, pt complaints | directly - qualitative and quantitative
57
what can cause pt dissatisfaction
poor interpersonal skills, concerns not addressed
58
what are 4 approaches to pt doc relationship? criticise where necessary
functionalism - powerful vs vulnerable. Crit - some pts cant get better, assumes passive role of pt and beneficence of medicine conflict - Crit - pts can exert control via non adherence, inaccurate interpretism - emphasises meaning given to social situation patient-centred partnership
59
what are the 2 types of regulation of doctors and criticisms?
self regulation - self serving, whistleblowing discouraged, fialure of regulation managerial - less clinical autonomy

PPE (18 decks)

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