What is the patient being at the centre of care known as?
Patient centred care
Who is the only person in the position to make decisions on what patient centred care means to them?
What are the principles and values that define patient-centreness brought together by?
International Alliance of Patients’ Organisation (IaPO) declaration
What are the 5 principles of the International Alliance of Patients’ Organisation (IaOP) declaration?
Choice and empowerment
Patient involvement in health policy
Access and support
Is the prevalence of long term conditions increasing or decreasing?
What can the handicaps of long term conditions impact in terms of well-being?
Physical, social and psychological well-being
Who are chronic conditions most prevalent in?
Older people and deprived groups
In terms of GP appointments, outpatient appointments and inpatient bed days, what percentage do chronic conditions account for?
50% of all GP appointments
64% of all outpatient appointments
Over 70% of all inpatient bed days
What is incidence?
Number of new cases of a disease in a population in a specified period of time
What is prevalence?
Number of people in a population with a specific disease at a signle point in time or in a defined period of time (existing cases)
What does incidence tell us about?
Trends in aetiology of diseases and can plan for the future (such as increasing staffing for more clinics)
What does prevalence tell us about?
Amount of disease in a population and is useful in assessing the current workload
What is chronic disease usually the end result of?
Long term complex interactions between genetic and environmental factors (could be both or neither)
In terms of chronic disease, what is meant by vulnerability?
Someone’s capacity to resist disease, repair damage and restore physiological homeostasis can be deemed vulnerable
What is an example of an organ that repairs well, and one that does not?
The liver repairs well, the brain does not
How can the natural history of diseases vary?
May have acute onset
May be gradual with a slow or more rapid deterioration
May be relapse and remission
What are examples of diseases with an acute onset?
Stroke or MI
What is an example of a disease with a slow or more rapid deterioration?
What is an example of a disease with relapse and remission?
What can treatment be aimed at?
The disease, or the effect of the disease
What is meant by the “burden of treatment”?
Patients and caregivers are often put under enormous demands by healthcare systems
What kind of things cause “the burden of treatment”?
Changing behaviour or policing the behaviour of others to adhere to lifestyle modifications
Monitoring and managing their symptoms at home
Complex treatment regiments and multiple drugs (polypharmacy) contribute to the burden of disease
Complex administrative systems, and accessing, navigating and coping with uncoordinated health and social care systems
What is biographical disruption?
Long term conditions lead to loss of confidence in the body
There is then loss of confidence in social interactions, or self-identity
What is a consequence of biographical disruption?
People need to adapt to their condition, which involves redifining the ideas of what is good and bad such as positive aspects of their lives being emphasized
What must be remembered about the visibility of long term conditions?
Some are visible and some are invisible, and some are both
What can be said about the stigma of long term conditions?
Having a chronic condition subjects a person to possible stigmatisation by those who do not have the illness
What does coping with stigma involve?
A variety of strategies including decision about whether to disclose the condition or attempt to conceal the condition or aspects of the condition and pass for normal
Who can the impact of chronic conditions be on?
What are examples of the impact of chronic conditions on the individual?
Can be negative or positive, could include denial, self-pity and apathy
What are examples of the impact of chronic conditions on the family?
Can be financial, emotional and physical
Other members could become ill as a result
What is the patient becoming very knowledgable about their chronic condition, perhaps even moreso than some doctors, called?
The expert patient
What are the different definitions of disability?
Lacking on one or more physical powers such as the ability to walk or coordinate ones movements (dictionary)
Difficulty can be physical, sensory or mental. A disability that makes it difficult for them to carry out normal day to day activities ongoing for more than 12 months (legal, Disability Discrimination Act)
International Classification of Impairments, Disability and Handicap (ICIDH), updated with ICF which removes the terms disability and handicap
What does ICF stand for?
International Classification of Functioning, Disability and Health
What does ICF consider disability to be?
Body and structural impairment
What does ICF mean by body and structure impairment?
Abnormalities of structure, organ or system function (organ level)
What does ICF mean by activity limitation?
Changed functional performance and activity by the individual (personal level)
What does ICF mean by participation restriction?
Disadvantage experiences by the individual as a result of impairments and disabilities (interactions at a social and environmental level)
What are the 2 different models of disability?
Medical and social
What is in the medical model of disability?
Individual/personal cause (such as accident whilst drunk)
Underlying pathology (such as morbid obesity)
Individual level intervention (such as health professionals advice individually)
Individual change/adjustment (such as change in behaviour)
What is the social model of disability?
Societal cause (low wages)
Conditions relating to housing
Social/political action needed (such as facilities for the disabled)
Societal attitude change (such as use of politically correct language)
What legislation protects people with disabilities?
Disability Discrimination Acts (1995 and 2005), only applies in N. Ireland now as has been replaced by the Equality Act 2010 in the rest of the UK
What are your responsibilities as a doctor towards disability?
Recognise your attitudes will pass onto your patients and those who you treat
Listen to your patients and learn
Recognise your own age and culture may affect your views
Co-ordinate the MDT
Intervene in the form of rehabilitation