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Flashcards in HADSOC REVIEW Deck (49):

what does any system ensuring quality need to do?

set standards
monitor performance
have change mechanisms in place


a clinical audit is a way in which the NHS improves quality, what are its components?

research topic
criteria and standards based on research evidence
1st evaluation
implement change
2nd evaluation


why are systematic reviews useful to clinicians?

reduce delay between research discoveries and implementation
ensure quality control and increased certainty
up to date, generalisable and authoritative conclusions
save clinicians having to locate and appraise information for themselves


Aim of using QALYs?

maximise amount of health gain in the population


8 domains in SF-36?

general health
mental health
bodily pain
physical functioning
social functioning
physical role functioning
emotional role functioning


founding principles of NHS?

free at point of service
open to whole pop.
access solely on basis of need
funded by general tax revenues


function of secretary of state for health?

overall accountability for NHS


functions of DOH?

sets national standards
shapes direction of NHS and social services
sets 'national tariff'- fee for services charged by service providers, so comissioners find best provider rather than cheapest as tariff means fixed price


functions of NHS England?

authorises CCGs
supports, develops and performance-manages comissioning


who now comissions general primary care services?

NHS England


who leads clinical directorates and what are these?

clinical directors
way of organising hospital trusts, usually based on speciality or group of specialities


role of clinical director?

induction of new drs
provide continuing medical education and other training
ensure clinical audit carried out and results translated into improvements
develop management guidelines and protocols for clinical procedures
design and implement directorate policies on junior drs' hrs of work, supervision, tasks and responsibilities


roles of medical director?

approves job descriptions, interview panels and equal opportunities
disciplinary processes
leads on organsiation's clinical policy and clinical standards
strategic oview of medical staff's role in organisation
sits on organisation's board of directors- key link between senior management and medical staff


what are the 3 types of health perceptions?

Negative Definition
 Health is the absence of illness
 More commonly held belief in lower socioeconomic groups
Functional Definition
 Health is the ability to do certain things- more common in elderly
Positive Definition
 Health is a state of wellbeing and fitness
More commonly held belief in higher socioeconomic groups


what are determinants of health?

range of factors that have a powerful and cumulative effect on the health of the population as they shape behaviours and environmental RFs


global determinants of health?

the 4 main social causes of ill health globally:
social exclusion
poor housing
poor health systems


prevention is used in health promotion, what is primary prevention?

aims to prevent onset of disease or injury by reducing exposure to RFs


examples of primary prevention?

stop smoking
immunisation against measles
prevention of contact with asbestos to prevent mesothelioma


define secondary prevention?

aims to detect and treat a disease (or its RFs) at early stage, so prevent progression


examples of secondary prevention?

screening for cervical cancer
monitoring BP
screening for glaucoma


define tertiary prevention

aims to minimise effects of established disease


examples of tertiary prevention?

renal transplants- prevent someone dying of renal failure
steroids for asthma to prevent asthma attacks
beta blockers for hypertension to prevent strokes


5 approaches to health promotion?

medical or preventive- primary, second and tert prevention
behaviour change
empowerment- patient is asked how they want to be helped to change a behaviour
social change


5 dilemmas of health promotion?

ethics of interfering in people's lives
victim blaming
fallacy of empowerment
reinforcing of -ve stereotypes
unequal distribution of responsibility
the prevention paradox


describe the ethics of interfering in people's lives as a dilemma in health promotion?

potential psych. impact of health promotion messages
state interventions in individual's lives- nanny state- lose right to do something, liberal do-gooders, rights and choices
people have the right to make their own choices


problem of victim blaming in health promotion

individual behaviour change is focused on, playing down wide social determinants of health e.g. poor housing, high perceived costs of eating a healthier diet, lack of safe green spaces for exercise


problem of fallacy of empowerment in health promotion?

giving people the info doesn't give them the power, other factors to consider e.g. socio-econ constraints
unhealthy lifestyles not due to ignorance but due to adverse circumstances and wider SE determinants of health


problem of reinforcing -ve stereotypes in health promotion?

E.g. leaflets aimed at HIV prevention in drug users can reinforce that drug users only have themselves to blame for their situation


problem of unequal distribution of responsibility in health promotion?

o Unequal distribution of responsibility
Implementing health behaviours is often left up to womenE.g. task to get family to eat more fresh fruit/less processed food


problem of the prevention paradox in health promotion?

Interventions that make a difference at population level may not have much effect on the individual
E.g. Reduction in smoking will decrease lung cancer rates ~10 years later, but the individual who gives up smoking might still die of cancer and some non-smokers get lung cancer


evaluation difficulties in health promotion due to?

design of intervention
timing of evaluation can influence outcome: delay- some interventions take a long time to have an effect, decay- some wear off rapidly
many potential intervening or concurrent confounding factors
high cost of evaluation research- studies likely to be large scale and LT


how can lay beliefs influence effectiveness of health promotion interventions?

Candidacy: If people don’t see themselves as a ‘candidate’ for a disease they may not take on board the relevant health promotion messages.

Awareness of anomalies and the ‘randomness’ of heart attacks- still occur in healthy population so how will their behaviour change help?


why are patient based outcomes necessary?

-increase in conditions where aim is relieving rather than curing
-biomedical tests inadequate alone
-can measure health status of pops
-patient-centered care- need to focus on concerns
-can compare 2 or more interventions in clinical trial
-can be used clinically
-can be used in clinical audit
-can assess benefit in relation to cost
-need to recognise iatrogenic effects of care
-used as a measure of quality of services


dimensions of HRQoL?

physical function
global judgements of health
psych well-being
social well-being
cognitive functioning
satisfaction with care
personal constructs


brief description of implicit and explicit rationing?

care is limited in both cases, but in implicit, neither the decisions nor the bases of these decisions are clearly expressed, whereas in explicit, limited care based on defined rules of entitlement.


define a clinical audit

quality improvement process which seeks to improve patient care and outcomes through systematic review of care against criteria and the implementation of change


why might people from low SE groups be less likely to attend screeening?

more likely to have -ve definition of health so manage health as a series of crises and don't perceive need for preventative services
can't mobilise resources required to attend
lack of cultural alignment


why is it important for drs to understand lay beliefs?

may influence health behaviour
may influence illness behaviour
help understand compliance/non-compliance with tments


why does a patient-centered relationship with a dr help a patient with a chronic illness?

dr can engage with patient's social and psychological experience of illness


what research was triggered by the black report?

psychosocial perspectives- PS pathways assoc with relative disadvantage
income distribution


describe the wilkinson theory of income distribution post black report

relative income and not average income affects health
countries with greater income inequalities have greater health inequalities
not richest but most egalitarian societies- those where everyone is equal so all have same income, have best health
theory that social cohesion is important in health


challenges in evaluating dr's performance?

time-consuming, expensive revalidation process?
drs feel they have insufficient evidence to report poor performance of another dr
drs fear of reporting on another's drs behaviour and how that would be seen by other drs
not always obvious who is at fault
whistleblowers not always believed


patterns of health service use in more deprived groups in society?

increase use of emergency services
under use of specialist services
under use of preventative services
higher rates of use of GP services


explanations as to why access to hcare is different between people of different SE status?

lower SE status:
view health as a series of crises
normalise ill-health
difficulty marshalling resources needed for negotiation and engagement with health services


explanations for diversity and access to health services?

Language; social networks; alienation by culturally
discordant organisations; stigmatisation and
Association with SES (e.g. re BME groups)
Cultural expectations (e.g. re gender)
Differing needs of difference groups
Variations between and within minority groups; be
careful to avoid simplistic classifications


what influences our illness behaviour?

stoical attitude
lay referral
frequency and persistence of symptoms
visibility of symptoms and extent to which they disrupt life
tolerance threshold
info and understanding
availability of resources


define the lay referral system

The chain of advice-seeking contacts which the sick make with other lay people prior to – or instead of – seeking help from health professionals.


what are the 3 types of health promotion evaluation?

process- how the programme is implemented
impact- what effect did it have
outcome- what has it achieved in the longer term


what are the key points of HRQOL?

emphasis on patient's own views, on therapy as well as illness and functional effects