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ESA 2 -Rhianna > PCCP2 > Flashcards

PCCP2 Flashcards

1
Q

Define harm

A

Anything you wouldn’t want to happen.

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2
Q

What is an adverse event?

A

Injury caused by medical management rather than disease

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3
Q

What is the difference between preventable and unpreventable adverse events? Give an example of each.

A

Preventable based on current medical knowledge.

  1. Drug allergy first time drug administered
  2. Operation on wrong body part
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4
Q

Describe the Swiss cheese model of error

A

There should be checkpoints along the way to an error affecting a patient. Sometimes there is a problem or a ‘hole’ in the checkpoint, for example human error. But still others should catch the error. Sometimes the holes line up and the error turns into an adverse event.

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5
Q

What processes/ policies are in place to prevent adverse events?

A 
Audit
CQC inspection
NICE quality standards
Health and Social Care Act 2012
QoF financial incentives
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6
Q

What is an audit? How might you go about implementing one?

A

A quality improvement process which aims to improve patient care through monitoring systematic criteria.

Research evidence - set criteria - first evaluation - implement change - second evaluation and back to beginning

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7
Q

What is clinical governance?

A

A framework through which the NHS are accountable for continuously improving quality and standards by creating an environment where it will flourish. They do this by following the guidance in the Health and Social Care Act 2012

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8
Q

What are four characterisations of health compliance behaviour?

A

Deniers - don’t have asthma
Distancers - don’t have proper asthma
Pragmatists - use inhaler only when asthma bad
Acceptors - follow guidance to the letter

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9
Q

What are three different ways of defining health?

A

Negative - absence of illness
Positive - wellbeing and fitness
Functional - ability to do the things you want to do

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10
Q

What is the difference between health behaviour, illness behaviour and sick role behaviour?

A
  1. Preventative
  2. Seeking a solution
  3. Formal response as a patient
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11
Q

Name six factors that may affect whether a person presents at a GP.

A 
Salience of symptoms
Extent it affects life
Frequency of symptoms 
Tolerance
Information
Cultural stoicism
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12
Q

What is the lay referral system?

A

Process by which someone seeks advice from lay people prior to (or instead of) from health professionals.

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13
Q

Name 4 examples of qualitative research methods.

A

Semi structured Interviews
Observation
Focus groups
Studying documents

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14
Q

Name 4 examples of quantitative research methods.

A

Retrospective cohort
Prospective cohort
Case control
RCT

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15
Q

What is the difference between quantitative and qualitative research methods?

A

Quantitative you are finding relationships between variables, using statistical methods to disprove a null hypothesis.

Qualitative you are trying to explain those relationships by exploring why they occur? Tend not to use statistics, but examine words instead.

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16
Q

Name an advantage and a disadvantage about using semi structured interviews as a research technique.

A

+ individual perspective

- labour intensive

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17
Q

Name an advantage and a disadvantage about using oberservational studies as a research technique.

A

+ avoid relying on what people say they do

- labour intensive

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18
Q

Name an advantage and a disadvantage about using focus groups as a research technique.

A

+ quickly get a large volume of data

- deviant views inhibited, sensitive topics inappropriate

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19
Q

Name 2 advantages and 2 disadvantages about using qualitative methods in general.

A

+ understand different perspectives
Explain relationships, rather than just identify

  • can’t find the relationship in the first place
    Limited generalisation
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20
Q

How would you identify good quality qualitative research?

A

Transparent sampling
Credibility
Relevance
Audit trail

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21
Q

What measures could you use to verify quality of care?

A

Mortality, morbidity, health related quality of life

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22
Q

What is quality of life?

A 
Effect of illness and consequent therapy on a patient as perceived by them. According to 
Physical function
Symptoms
Social
Psychological
Cognitive
Satisfaction
Global judgement of health
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23
Q

How can quality of life be measured?

A

Generic measure - SF 36

Disease specific eg Arthritis Impact Measurement

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24
Q

Give an advantage and a disadvantage of the SF 36 measure.

A

+ can be used with any population, acceptable

- no overall score, makes interpretation difficult

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25
Q

Give an advantage and a disadvantage of the Arthritis Impact Measurement.

A

+ Dimension specific, acceptable

- comparison limited

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26
Q

What is health economics?

A

The way decisions are made about the division of finite resources amongst patients.

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27
Q

What is the difference between implicit and explicit health economics? Give an advantage and disadvantage of each.

A

Implicit is decisions about resources made on an individual basis.
+ clinical freedom
- no accountability

Explicit is decisions made according to clear institutional guidelines
+ evidence based practice
- heterogeneity of patients and diseases

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28
Q

Name four methods of resource allocation.

A

Cost minimisation analysis - pick cheapest
Cost effectiveness - cost per unit change
Cost benefit - give every benefit a monetary value
Cost utility analysis - cost per QUALY

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29
Q

What is a QUALY?

A

Quality adjusted life year
A measure of disease burden including quantity and quality of life lived.
A value of 1 is given for 1 year of perfect health and is of equal value to 10 years bad health.

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30
Q

Give an advantage and 3 disadvantages of using QUALYs as a method of resource allocation.

A

Quasi utilitarian. So +ve because fairest method taking the whole of society into account.

  • ve because 1. can seem unfair to the individual.
    2. Also younger people seem to be valued more than older people.
    3. And healthier people valued more even though there is an argument that when you are sick, or terminal, your remaining life is of more value to you than other years of your life.
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31
Q

What are primary, secondary and tertiary health promotion strategies? Give examples.

A
  1. Prevent disease or injury before it occurs. Eg immunisation, legislation, education
  2. Reduce impact of disease or injury that has already occurred. Eg beta blockers to prevent further heart attack, screening programs to catch cancer early
  3. Reduce impact of disease or injury which has ongoing effects. Eg support groups, physiotherapy, stroke rehabilitation
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32
Q

Define stigma and describe the difference between 1. enacted and felt stigma and 2. discreditable and discrediting stigma.

A

The social disapproval of a person or group on the grounds of an attribute, trait or behaviour that differs from cultural norms.

  1. Enacted - real experience of prejudice discrimination and disadvantage
    Felt - fear of enacted stigma
  2. Discreditable - nothing seen but stigma would be felt if people found out eg hiv
    Discrediting - physically obvious or well know thing that sets a person apart eg wheelchair or known suicide attempt
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33
Q

How might a person’s life change in response to diagnosis of a chronic condition?

A

Daily living
Emotions
Biographical disruption - disruption to future plans and grief for loss of life taken for granted
Identity

34
Q

How might a person’s identity change in response to a diagnosis of a chronic condition?

A

Affects how you see yourself and how others see you.

Lack of independence
Pitiable
Weak
Incompetent

35
Q

Describe 4 models of conceptualising illness.

A

Medical model - need a cure
Social model - need social change
Psychological model - need to see yourself in a different light
Biopsychosocial - all three factors come together

36
Q

Describe sociological research describing relationship between identity and disability.

A

Pallesen 2014 - interview study of stroke patients over 5 years. Continually new problems which never stabilised - fatigue, decreased social relationships, dependence. Coping involved either resignation or personal growth. High risk of loneliness and depression.

Martin et al 2014 - semi structured interviews determining life goals of brain injury patients. Shifted focus on being part of things, a sense of belonging. Social identity and social inclusion are a primary concern for patients.

37
Q

What is screening?

A

Systematic attempt to identify an undiagnosed condition in an asymptomatic group.

38
Q

What are the criteria for a disease to be given a screening program?

A

Important health problem
Epidemiology understood
Early detectability

39
Q

What are the current diseases with screening programs in the uk?

A 
AAA
Bowel cancer
Breast cancer
HPV
Diabetic retinopathy
Newborn: PKU, downs, sickle cell
40
Q

What is required of a test used in a screening program?

A 
Simple
Safe
Cost effective
Acceptable
Precise and valid
Defined cut off
41
Q

What is required of the treatment of a disease if it is to be included in a screening program?

A

Effective treatment available

Early treatment makes a difference

42
Q

Give two advantages and two disadvantages of screening programs.

A

+ Improve outcome
True negatives can for reassurance

  • false positives and false negatives
    Expense
    Victim blaming
    Changes the Dr patient relationship
43
Q

Give three difficulties of evaluating the effectiveness of a screening program.

A

Selection bias - those who attend may be types of people who tend to be compliant, stick to treatment

Length time bias - slow growing tumours more likely to be found because longer asymptomatic. These are less likely to be fatal. Suggest that screening leads to less fatality.

Lead time bias - perceived survival time is longer because screening detects earlier. But still die at the same point.

44
Q

Define sensitivity

A

Proportion who have the disease who test positive

True positive/
All who have the disease

Say I have it, will the test tell me?

45
Q

Define specificity

A

Proportion who don’t have the disease who test negative

True negatives/
All who don’t have the disease

Say I don’t have it, will the test tell me?

46
Q

Define positive predictive value

A

Probability that someone who has tested positive has the disease.

True positives/
Those who test positive

Say I test positive, do I have it?

47
Q

Define negative predictive value

A

Probability that someone who tests negative, actually doesn’t have the disease

True negatives/
All who test negative

Say I test negative, do I actually not have it?

48
Q

Which measurement of screening program test validity is affected by prevalence of the disease?

A

Positive predictive value

49
Q

Give 2 advantages and 2 disadvantages of complementary therapies.

A

+ 1. placebo effect is still an effect
2. Gets people engaged in recovery and health promotion

    1. can be harmful or interact with medicine
      1. No real evidence of effectiveness
50
Q

Give some examples of complementary therapies.

A

Chiropractic
Homeopathy
Meditation /yoga
Acupuncture

51
Q

What were the 3 main aims of the nhs when it was developed?

A

Universal
Comprehensive
Free at point of delivery

52
Q

What nhs services are chargeable?

A

Prescription
Optician
Dental

53
Q

What is the difference between commissioning and providing health care? What is the purpose of this distinction? Where is there no distinction?

A

Commissioning involves choosing and buying the service on behalf of patients.
Provider delivers the service

By having a distinction market forces are introduced, aimed at driving up quality.
No distinction in Scotland

54
Q

What were the 3 main changes set out in the Health and Social Care Act 2012?

A
  1. Commissioning undertaken by CCGs, aided by commissioning senate and commissioning support unit.
  2. Public health responsibility of local government
  3. No longer duty of Secretary of State to provide nhs, but local commissioning groups. Secretary of State must promote it.
55
Q

Name two roles of the department of health. Who does it oversee?

A
  1. Sets national standards
  2. Sets national tariff

Oversees NHS England

56
Q

Name 2 roles of NHS England. Who does it oversee?

A
  1. Authorises CCGs
  2. Commissions primary care and rare diseases

Oversees CCGs

57
Q

What is the benefit of becoming a foundation trust?

A

More autonomy over budgets.

58
Q

What is the national tariff? Give an advantage and disadvantage.

A

Set amount that providers must charge for a particular service.

+ means CCGs won’t just pick the cheapest provider. Should drive up quality.
- some services will make a profit and others won’t. Means private providers will only offer profit making ones, leaving NHS with the rest

59
Q

Give one advantage and two disadvantages of privatisation of the NHS.

A

+ should drive up quality

    1. profitable services cherry picked, leaving NHS to fund the unprofitable. Nhs no longer able to cross subsidise
      1. Can’t train doctors in certain services which are solely provided by private sector
60
Q

What is the role of Medical Director. Give 3 responsibilities they hold.

A

Board level manager who is a doctor. Responsible for quality.

  1. Clinical standards
  2. Strategic overview of medical staff roles
  3. Disciplinary procedures
61
Q

What is the role of clinical Director. Give 3 responsibilities they hold.

A

Responsible for a directorate eg cardiology, women’s health, radiology.

  1. Audit
  2. Medical Education
  3. Policies and guidelines
62
Q

What is meant by the professionalisation of medicine?

A

The social and historical process that has resulted in medicine being a type of occupation that can make distinctive claims about its practice and status.

63
Q

Historically what was the professional status of doctors?

A

Anglican, male, elite social background, not based on scientific knowledge

64
Q

Who is in charge of professional registration of doctors?

A

GMC

65
Q

What is socialisation of doctors?

A

Process of self regulation which relies on doctors cooperating with collective norms and standards of the profession.

66
Q

Describe how people are socialised to become doctors.

A

Medical education, informal curriculum, learning attitudes and values as well as facts.

67
Q

What is wrong with self regulation?

A
  1. Lack of objectivity - self serving
  2. Mistaken arrogance - self deceiving, leads to credibility gap
  3. Discouraged from raising concerns about each other

When there are problems they may not be identified, or they may choose to ignore them.

68
Q

What legislation/guidelines put an end to self regulation of doctors?

A

2007 white paper

Good Medical Practice 2013

69
Q

What were the outcomes of Good Medical Practice?

A

Re validation every 5 years

70
Q

What is the purpose of revalidation?

A 
Reassure patients
Maintain and improve practice
Support cpd
Identify concerns early
Drive quality and standards
71
Q

What does re validation involve?

A
  1. Appraisals
  2. Portfolio
  3. Recommendation from responsible officer -
72
Q

Give 2 advantages and 2 disadvantages of increased regulation of doctors.

A

+ increase safety
Common set of values

  • decrease clinical autonomy and individual care plans
    Increased managerial red tape
73
Q

Describe 4 approaches to the patient doctor relationship

A
  1. Paternalistic - authoritatively tells the patient what should or will be done
  2. Informative - provides information to allow patient to choose
  3. Interpretative - find out what patients values are, and direct them to appropriate action
  4. Deliberative - engage in a dialogue working together to find out appreciate action
74
Q

People who are symptomatic but do not consult contribute to which phenomenon?

A

Illness iceberg

75
Q

List four features of a measurement scale which indicate it is of good quality.

A

Test, retest reliability
Convergent evidence - Correlates with other tests
Acceptable
Face validity

76
Q

Name six factors which must be considered for safe, good quality practice.

A 
Safe
Effective
Patient centred
Timely 
Efficient
Equitable

(Saftee)

77
Q

Which DoH report investigated health inequalities in relation to socioeconomic status?

A

The black report

78
Q

How might health inequalities based on socioeconomic status be explained? Which is the most likely explanation based on the evidence?

A
  1. Artefact due to measurement
  2. Social selection
    Direction of causation is actually health changing social position
  3. Behavioural- cultural
    Inequalities due to differing choices regarding health damaging behaviours. Eg low status choose more damaging behaviours
  4. Materialist (most likely)
    Inequalities arise from differing access to material resources.
    Lack of choice in exposure to health damaging conditions.
79
Q

What is the difference between inequity and inequality?

A

Inequality - different but not necessarily unfair

Inequity - different and unfair and avoidable

80
Q

What is evidence based practice?

A

Health services are based on best available evidence of effectiveness and cost effectiveness

81
Q

Give 3 disadvantages of evidence based healthcare

A

Expensive, difficult and slow to put findings into practice
Population level findings not always relevant for the individual
Decreases professional autonomy - just follow guidelines

82
Q

What is opportunity cost? How is it measured?

A

The opportunity cost is the amount of resources that cannot be spent on anything else, once a decision has been made to spend them.

Measured by benefits foregone.

ESA 2 -Rhianna (7 decks)

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