Lecture 5- Improving health at the population level Flashcards Preview

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Flashcards in Lecture 5- Improving health at the population level Deck (26)
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1

3 domains of public health

health protection

health improvement

healthcare public health

2

What is health improvement?

Health improvement can mean different things to different people

  • “Lifestyle medicine”
  • “Social prescribing”
  • “Health prevention”
  • “Health education”
  • “Health promotion”
  • “Population health medicine”

About physical, mental and emotional wellbeing

3

Cycle of public health

 

Takes a long time to see economical benefit

4

2 ways to improve health

 

  1. Whole population approach -shift whole populations health to the right
  2. Improve health of high risk individuals to reduce their risk

5

health is multifactorial

think of the determinants of health

6

5 levels of intervention (health promotion)

poppy can see her reflection

  • personal skills
  • community action
  • supportive environments
  • healthy public policy
  • reorient health services

7

health needs assessment

8

logic model with example

A logic model is a graphic which represents the theory of how an intervention produces its outcomes. It represents, in a simplified way, a hypothesis or ‘theory of change’ about how an intervention works. Process evaluations test and refine the hypothesis or ‘theory of change’ of the int

9

Gibbs cycle of behaviour change (Prochaska and Diclemente’s)

10

intevrentions can be expert or community driven

11

Types of prevention ( a form of health improvement)

primordial

primary

secondary

tertiary

12

primordial

targets the general population

aim to eliminate risk factors

e.g. health promotion and immunisation

13

primary prevention

susceptible population

aimt o reduce the risk of developing the disease

e.g. screening, immunisation, more health promotion

14

secondary prevention

asymptomatic populations

try to slow down disease progression

e.g. screening/start treatment

15

tertiary prevention

symptomatic population

aim to try and minimise the consequences of the disease/treat the patient

e.g. treatments

16

screening 

secondary prevention

17

issues with screening

lead time bias

length time bias

volunteer bias

18

Lead time bias

 

 

Lead time is the length of time between the detection of a disease and its usual clinical presentation and diagnosis. It is the time between early diagnosis with screening and the time in which diagnosis would have been made without screening

 

Lead time bias refers to the phenomenon where early diagnosis of a disease falsely makes it look like people are surviving longer

19

Length time bias

 

 

Length time bias is an overestimation of survival duration due to the relative excess of cases detected that are asymptomatically slowly progressing, while fast progressing cases are detected after giving symptoms. 

20

lead time vs length time bias

Lead-time bias: Overestimation of survival duration due to earlier detection by screening than clinical presentation.

 

Length-time bias: Overestimation of survival duration due to the relative excess of cases detected that are slowly progressing.

- Imagine all 12 cases below are the same disease. Instead of being seen as rapidly progressive 50% of the time, rapidly progressive disease is only detected in 33% of positive screens.

21

 

Volunteer bias

 

Those who sign up to screening are more likely to be concerned about their health and live healthier lifestyles

22

Risk assessment questions for patients to help give lifestyle changes to become healthier

 

Lifestyle:

  • Alcohol
  • Smoking
  • Exercise levels
  • Diet

Relevant Past Medical History

  • Diabetes
  • CVD
  • CKD
  • AF
  • Rheumatoid arthritis

Family History

  • CVD
  • Diabetes

 

FURTHER ASSESSMENT

  • Weight and height (calculate BMI)
  • Blood tests?
    • Lipids
    • HbA1c
    • U&E
    • LFTs

23

What is social prescribing?

 

“a means of enabling health professionals to refer people to a range of local, non- clinical services”

24

 

How a referral of social prescribing works

 

  • 30 minute appointment with a Link Worker.
  • Person-centred consultation
  • Not “what’s the matter with you”, but “what matters to you”?
  • Link worker has access to directory of local voluntary services and organisations

25

social prescribing can provide

Can provide

  • Social interaction
  • Increase exercise
  • Life given meaning
  • Structure to a week
  • Feeling part of a community

26

Can use a risk of CVS disease to help put things into perspective

QRISK

 

NOT AN URGENT DECISION!

  • Bob will be back!
  • Give the information in a way the patient can understand (decision aids)
  • Give him some time to think
  • Pros and cons of any intervention
  • How much is Bob willing to do to help himself?
  • How can you facilitate that?