Flashcards in Law And Ethics Audit, Public Health And Behavior change Deck (70):
What is audit all about?
It's about evaluating to ensure quality improvement
It's the quality improvement process that seeks to improve patient care and outcomes through systematic review of care against certain criteria, and then the implementation of change
Why should we audit?
It improves quality of care
It maximises resources
It's an educational tool
It encourages team work (to pass an audit)
Provides evidence to justify change
What is the audit cycle?
1)Identify a problem or issue
2) agree a criteria and set standard of what it SHOULD be
3) collect data
4) analyse data- compare it against your standards
5) implement changes that need to be made to meet the standards
6) then identify next problem
How do we select a topic for audit?
Usually a topic of interest or area of concern that's based on recommendations from a national body such as the NPSA or NICE
How many audits should a community pharmacy be doing each year?
A minimum of 2 a year
1 should be practice based
1 should be determined (the topic) by the Primary Care Trust
How many audits should hospital pharmacies do a year?
Should be doing multiple
Some of these may be mult-disciplinary (involve doctors, nurses too)
What is the definition of criteria?
Systematically developed statements that can be used to assess how appropriate specific healthcare decisions, services and outcomes are.
Criteria can be classified in three ways. What are these?
1) structure; I.e what you need so maybe number of staff, or amount of equipment, or physical space in your pharmacy
2) process; what you do; for example level of communication, dispensing audit, documentation audit
3) outcome: this is a physical and behavioural response to interventions made, people's health status as an outcome of an audit, staffs levels of knowledge after audit etc
For audit criteria to be valid, what must it be?
-Based on evidence
-Related to aspects of care
For example, an audit may be on local policies, eg evaluating your antibiotic policy in a hospital pharmacy
What are audit standards then?
The proportion of times that criteria set out should be filled.
Standards are usually expressed as a percentage, "60% of the Time blah blah should be blah blah"
Eg criteria may be:
Hospital in-patients with known allergies should wear a red wristband indicating the nature of their allergy.
Standard: 100% of hospital in patients should wear red wristbands indicating their allergy
So this criteria should be being met 100% of the time; do an audit to find out if it is!!
Criteria: The IV to oral switch should happen within 3 days
Standard: 95% of the time the IV to oral switch should be happening in 3 days
When do you have to select a study sample?
Unless you can Investigate ALL cases, you need to select a sample.
May not be able to look at all cases due to money, resources etc
What is sample size determined by?
1) the degree of confidence you want in your findings
2) resource constraints such as time, access to data, costs etc. eg. You may not have time to asses every bed in the hospital!
What is a random sample?
Pure chance determines the subjects/ cases which are chosen from a population
What is a stratified sample?
Subjects/ cases are chosen RANDOMLY but sampled from a population that has been divided up into categories.
What is an interval sample?
When data is collected over a refined period of time
Eg interval sample: 1 week duration
Eg when you can't specify a number to sample. Could reviewing of owing slips over a 1 week period (you don't know how many there will be!)
What is a purposive sample?
Selecting cases with specific characteristics relevant to the study
What is a retrospective approach to data collection?
When your event of interest has already occurred and you want to find associated factors with it, you have to trace these back in time-- a retrospective approach -retro= going back
What is a prospective approach to data collection?
If you have some baseline information available from records and you want to study the occurrence of a new event in future, you have to follow these patients in future for the occurrence of an event of your interest-- A prospective approach. Pro= looking into the future
What is a pilot study?
a small-scale experiment or set of observations undertaken to decide how and whether to launch a full-scale project.
It should be conducted BEFORE data collection begins
Aim is to identify and rectify any problems with the data collection form and methodology. Like a mini study to test it out.
How do we a analyse data?
Calculate a basic percentage to determine whether practice meets expected standards.
Eg before we said the standard stated 100% of inpatients should wear red wristbands for allergies.
Data analysis may come up with the result that 89% of patients wear red wristbands after observation.
The audit data is then analysed to identify any particular problems or trends, eg. 15 of these patients with no writsbands had a allergy to penicillin that caused sickness
After change has been implemented, what can then be done to determine whether these changes made have lead to an improvement?
Audit data is recollected using the same procedure and then analysed again.
How do we analyse re-audit data?
Comparing re-audit data against the original data collected first time round before the changes
What is public health?
Public health relates to the health of the population rather than the individual
It involves tracking illness frequency in a population to prevent illness and promote good health
Can you think of any factors that influence health?
Personal behaviors and lifestyle I.e psycho-social influences
Genetic factors/ biological influences (your build and make-up)
Environmental factors: eg housing, pollution, work conditions
These all radiate into you to determine how healthy you are!!
Extent of health services: inverse care law
What is the inverse care law?
The availability of good medical care tends to vary inversely with the need for it in the population served. I.e healthcare is least available to the people who need it most (rich people who don't tend to have many ailments can pay for private care, poor people have to wait for NHS services)
What was health promotion like on the 1920s to 1980s?
Mass media campaigns focused on scare tactics eg aids "don't die of ignorance" leaflets
Poor health was linked with poverty
Health promotion usually only involves medical practitioners
What's health promotion more like nowadays?
Moving away from methods that only seemed to put responsibility for bad health on the individual: i.e. due to their unhealthy lifestyle
Health promotions doesn't just involve medical practitioners (doctors): It now involves pharmacists, special clinics, etc
What does the new broader conception " New public health" focus on?
Focuses on the well being of populations not just disease prevention
Ie their lifestyle in general, providing good healthcare to people
What are the five key principles of health promotion as directed by the WHO?
1) Population as a WHOLE, their everyday life
2) ensures whole environment promotes health
3) combines things like communication, education, law
4) encourages self awareness to make people manage their own health
5) gets health professionals involved to help out with promoting health
What are "essential services" offered by a pharmacy?
PROMOTION OF HEALTHY LIFESTYLES AND PARTICIPATION IN PUBLIC HEALTH CAMPAIGNS.
SIGNPOSTING OF SERVICES (ie. pointing out where someone can go to get help)
These are things every pharmacy must provide
What are "advanced services" in a pharmacy?
Medicines use reviews
New medicines service
Used to give patients more understanding of how to use their medicines.
What are "Enhanced services" offered in a pharmacy?
These are commissioned by local Primary Care trusts
As a pharmacy in England, how can we prevent ill health?
Through smoking cessation services
Reducing teenage pregnancies and promoting sexual health
Treating minor ailments such as coughs, colds, coldsores etc
Pharmacies are now being seen and used as community based health living centres
The Darzi review is all about a major focus on health promotion
What kind of things does it target?
Vascular risk assessment programme
Control alcohol use
Improve diet and exercise
Tackling health inequality
What are healthy living pharmacies?
These pharmacies have recognised the significant role pharmacies can play in public health.
They take on extra services to improve the health of the public.
Examples include health checks, weight management, smoking etc, but also things like PGDs for STIs, a prescribing pharmacist, a consultation room
What is the MEDICAL approach to health promotion?
This sees health as the absence of disease.
Aim is to reduce morbidity and premature mortality (early death).
Primary measures: prevent the onset of disease (eg through immunisation with vaccines)
Secondary: identify a disease at its early stages, stopping disease progressing (eg. Cervical cancer screening)
Tertiary: reducing further disability and suffering in those already ill
What is BEHAVIOR change approach to health promotion?
Encourages an individual to adopt a healthy lifestyle
Assumes people are able to change, 'blames' individuals
What is the Educational approach to health promotion?
Provides knowledge and information
so that people are able to make an INFORMED choice
It doesn't try to persuade
Mass media campaigns may increase knowledge but they're not that effective at changing behaviour.
Example: SMOKING KILLs on cigarette packs
What is the Empowerment approach to public health promotion?
People identify their own concerns
They gain skills to act upon them
Individual or community (eg a certain religion/race) led
Health promoter is like a catalyst, just helps to get things going
People lead their lifestyle change on their own.
Eg mum and dad doing 5:2 diet to reduce cholesterol
What is the SOCIAL change approach to health promotion?
Focuses on the CAUSES of ill health.
Brings about changes in the physical social and economic environment.
More difficult to bring about changes
Examples: smoking ban in pubs, vending machines banned in schools
What kind of change would a meeting of the local Asian community to decide what they can do to decrease the rate of diabetes in their area be?
An empowerment change
A community is meeting up themselves, it's self led, may have the input of a health care professional to start the ball rolling
A pharmacist individually counsels an obese individual about weight loss. What kind of health promotion approach is this?
Encouraging the individual to adopt a healthy lifestyle
Can be seen as the expert blaming the patient
A pharmacist offers a cardiovascular risk service. What kind of health promotion approach is this?
A medical approach
Trying to prevent disease occurring by catching something early
Handing out a leaflet about storing medicines safely. What kind of approach to health promotion is this?
The leaflet will educate the patient on how to do something
What is the Standard Mortality ratio?
The death rate, taking into account differences in age structure compared to what would be expected in this age group if national averages were applied.
Overall average for England= 100
Standardised mortality ratio of under 100 implies LOWER mortality
What is the infant mortality rate?
Number of deaths in the first year of life per 1000 live births
Why is dental health a good indicator of how good health generally is in a certain area?
Places that are more deprived ten to have a population with worse state teeth eg more fillings etc as they may not look after their teeth as well, may be more likely to smoke
Height and Weight are also good indicators
Name some health behavior indicators of health status of an area?
Number of people smoking,
What kind of environmental factors can effect health?
Air and water quality
Housing type, housing density
What are PROMs (Patient reported outcome measures) ?
Standardised, validated QUESTIONNAIRES that are completed by patients to measure their perceptions of their own functional status and well-being e.g to determine how healthy they think they are.
These may be done before or after Elective surgery
Healthy living pharmacies achieve ____ quits on average over 5 months
This is a higher quit rate than GPs manage!(in a Sheffield study)
What chronic diseases may be managed in healthy living pharamcies?
What do Healthy Living pharmacies offer in relation to Substance Misuse?
Needle exhange- reduces costs to NHS as if they use clean needles they are less likely to get Hepatitis C or aids
Note that there's not enough evidence to support this service in saying it improves patients outcomes
What services offered by Healthy living pharmacies have not got enough evidence yet to show benefits?
Chlamydia testing and screening
Immunisation and vaccinations (eg Hepatitis and Flu)
Minor ailment services: relieve burden off GP, but not fully shown to improve health YET
Attitude toward behavior vs. outcome expectancy
The theory of planned behavior: According to this model, people's evaluations of, or attitudes toward a behavior change are determined by their accessible beliefs about the behavior, where a belief is defined as the subjective probability that the behavior will produce a certain outcome.
For example attitude towards behavior, 2 types of outcome expectancies:
Changing my diet will mean I can no longer eat all the foods I love
Changing my diet will allow me to loose weight and lower my cholestrol- positive thinking.
WHat is Subjective Norm?
Subjective norm: an individual's perception about the particular behavior, which is influenced by the judgment of significant others (e.g., parents, husband, friends, teachers).
Eg my family will approve if I loose weight
Perceived behavioural control can be split into two categories: internal and external control factors. What are these?
Internal control factors are where you think about "If you have it in you" to make a change e.g lose weight. Comes from within. For example "I don't think I can diet, it won't work I've tried it so many times before I don't think I have it in me"
External control factors is where someone thinks about their everyday life and what is around them that may influence their ability to do something. For example, "I work away so I eat hotel food during the week, so it's hard to be healthy for me"
How does outcome expectancies differ to outcome values?
Outcome values is more thinking about what it will mean to YOU I.e why is it important that you make this change. Eg "it's important to me that I am healthy and to do this I need to loose weight and lower my cholesterol"
Outcome expectancies is what you're expecting to actually Happen if you try or change eg "I won't be able to eat the food I want" or "I will be able to loose weight and lower cholesterol"
What are outcome expectancies, Outcome values, normative beliefs, motivation to comply, and perceived internal and external control factors all part of?
The Theory of Planned Behaviour model
What does the theory of planned behaviour model NOT consider?
People may engage in unhealthy behavior because of problems in their lives and the unhealthy behavior helps them cope (eg comfort eating, smoking, alcohol)
It doesn't go into how people manage to change their behavior.
What three stages of the transtheoretical model (stages of change) are people at when you're assessing How ready are people to change?
What is Ambivalence?
The simultaneous existence of both positive and negative attitudes towards a subject/ object.
"I know I really need to quit smoking for my health, but I really enjoy smoking" if a person doesn't either want to Quit, or carry on smoking, both options are important to this person, and they enter a state of "Ambivalence"
What does using your OARS stand for in reference to interaction techniques?
What are affirmations?
Statements that show you recognise a patients strengths in dealing with a change such as quitting smoking, these must be genuine statements to encourage the patient. It's giving them confirmation and assurance they can do it.
What is reflective listening?
Listen to what the patient says and then reflect on it and re-state what they have said to you. Eg "you said you could maybe try reducing down to 5 a day, maybe you could try this...."
As a pharmacist you should support self efficacy. What does this mean?
Support the patients beliefs that a change is possible for them.
Provide them with options on how to achieve the change (e.g several quit smoking products) but the choice of HOW to do it is up to the patient.
What does "roll with resistance" mean when applied to working with people undergoing a change?
If someone doesn't want to do something, avoid arguing with them as this will increase resistance.
Resistance is a sign that a patient feels like they're not being heard or forced to do something when they're not ready to.
You should aim to develop a discrepancy when helping a patient carry out a change. What does this mean?
Show them the difference between where they are now and where they want to be.
It can help them decide what to do if they're 'ambivalent about changing'
Encourage patients to explore WHY they're uncertain so they can start a behavior change at their own pace.