Risk Assessment and Prevention of Chronic Disease

Question 1

Secondary Prevention

Answer 1

the patient already has the disease but has not developed symptoms

examples: STD screening, mammogram, colonoscopies, case finding

RISK MANAGEMENT

Question 2

Tertiary prevention

Answer 2

the disease process has already begin, symptomatic disease is already present, this limits the physical and social consequences of the disease

example: rehabilitation of stroke patient

Question 3

What is Preventative Medicine?

Answer 3

Health promotion, disease prevention, and application of epidemiological and biostatistical principles to achieve these goals.

Focuss on individuals

(public health focuses on intervention at the population level)

Question 4

Primary Prevention

Answer 4

keeps the disease from ever occurring through eliminating the cause of the disease or increasing resistance to disease

Examples – Immunization, Fluoride in water, health promotion

Question 5

1970

Answer 5

How to Practice Prospective Medicine which was generally not accepted by the medical society

Question 6

1979

Answer 6

the Canadian Task Force on Periodic Physical Examinations recommended that the process be based on gender and age appropriate immunizations, screenings, on a periodic basis

Question 7

1980

Answer 7

CDC developed its first 31 question risk assessment tool to compute adult risk.

Question 8

What is the U.S Preventive Services Task Force

USPSTF

Answer 8

Created in 1984

an independent, volunteer panel of national experts in prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations aboutclinical preventive servicessuch as screenings, counseling services, and preventive medications

Question 9

What occured after 1998?

Answer 9

the Agency for Healthcare Research and Quality (AHRQ) has been authorized by the U.S. Congress to convene the Task Force and to provide ongoing scientific, administrative, and dissemination support to the Task Force

Question 10

What type of reports does the Task Force Report to congress?

Answer 10

that identifies critical evidence gaps in research related to clinical preventive services and recommends priority areas that deserve further examination.

Question 11

What change did the Affordable Care Act 2010 make that was implemented in 2011?

Answer 11

a required annual health risk assessment for Medicare Patients designed to improve and prevent onset of chronic illnesses

IMPROVE: 2-3 prevention

PREVENT: 1 (primary)

Question 12

What are the determinants of population health?

Answer 12

Social/social characteristics

Total Ecology

Genes and biology

health behaviors

medical care

Question 13

What are the social determinants of health?

Answer 13

Physical Environment

Socio-Economic Factors

Health Care

Health Behaviors

Question 14

Define Social deteminants of health?

Answer 14

Conditions in which people are born, grow, work, live, age, and the wider set of forces and systems shaping the conditions of daily life.

Question 15

In 2010, what was the top leading cause of death?

Answer 15

Heart disease

Question 16

Health Risk Assesment

Answer 16

1. Typically a questionnaire or computer program to elicit and evaluate information concerning individuals.
2. The assessed person received information about their life expectancy with recommended interventions that may have a positive impact on their health and longevity
3. Risk factors are combined from various epidemiologic studies with mortality statistics
4. This information is then applied toward the assessment of an individuals risk of mortality
5. •The individuals’ information is compared to one with the lowest possible risk factors to encourage positive behavior change.

Question 17

What is the process of Health Risk Assesment?

Answer 17

1. The top leading causes of death for an individuals age-sex-race group of which The 10 year expected risk of mortality for each leading cause of death is calculated.
2. This is then summed by computer algorithm to determine an overall 10 year expected risk of mortality, which is then compared to an overall risk for the general population for the individuals age-sex-group – Risk Age

Question 18

What is the typical data collected for a risk assesment?

Answer 18

• Height
• Weight
• Blood Pressure
• Cholesterol
• Past Medical History
• Family History

Question 19

What are the Critiques of the HRA?

Answer 19

• Lack of information of the individuals entering the data
• Validating the predictions
• Reference population for baseline risks

Focus on mortality vs. morbidity and quality of life

Question 20

What are the strengths of the HRA?

Answer 20

• Motivate an individual to make changes in their lifestyle
• Emphasize how nutritional and lifestyle factors affect an assessed person’s risk

Question 21

Age of the average individual who has the same risk of dying as the one being assessed is known as the?

Answer 21

Risk Age

Question 22

40 year old man with a risk age of 35 years means?

Answer 22

?

Question 23

If the risk age is greater than the chronilogical age, what does that mean?

Answer 23

Increase risk of dying

Question 24

If the risk age is less than the chronilogical age, what does that mean?

Answer 24

Lower risk of dying than someone else the same chronological age

Question 25

TRANSTHEORTICAL MODEL –STAGES OF CHANGE

Answer 25

1. Pre-contemplation: no intention on changing behavior * Consciousness raising * dramatic relief * environmental re-evaluation 2. Contemplation: Aware problem exist but with no commitment to action * self-reevaluation 3. Preperation: intent on taking action to address the problem * Self and social liberation 4. Action: Active modification of behavior * Using and fosterinf social support and caring relationships * Contigency management * Counter conditioning 5. Maintenance: Sustained change; new behavior replaces old * Continue positive reinforcement and social support * Stimulus control * Maintain self efficacy 6. Relapse: fall back into old patterns of behavior

Question 26

5 A's Behavior Change Model

Answer 26

1. **Assess**: Belief, behavior, and knowledge 2. **Advice**: Provide specific information about health risk and benefits of change 3. **Agree**: Collaborately set goals based on patient's interest and confidence in their ability to change behavior 4. **Assist**: Identify personal barriers, stratagies, problem-solving techniques and social/environmental support 5. **Arrange**: Specify plan for follow-up

Question 27

What should be part of the personal action plan?

Answer 27

1. List Specific goals in behavioral terms 2. List barriers and strategies to address barriers 3. Specify follow-up plan 4. Share plan with practice team and patients social support

Question 28

What are the 3 factors part of the social cognitive theory?

Answer 28

1. Personal Factors 2. Environmental factors 3. Behavioral factors

Question 29

Wha does the interaction between the person and the environments involve?

Answer 29

Involves beliefs and cognitive competence developed and modified by social influences

Question 30

What does the interaction between the environment and their behavior involve?

Answer 30

Involves the person's behavior determining their environement, which in turn, affects their behavior

Question 31

What is the interaction between person and their behavior inflenced by?

Answer 31

Influence by their thoughts and actions

Question 32

Health Belief Model

Answer 32

1. THE DESIRE TO AVOID ILLNESS, OR CONVERSELY GET WELL IF ALREADY ILL; AND, 2. THE BELIEF THAT A SPECIFIC HEALTH ACTION WILL PREVENT, OR CURE, ILLNESS. ULTIMATELY, AN INDIVIDUAL'S COURSE OF ACTION OFTEN DEPENDS ON THE PERSON'S PERCEPTIONS OF THE BENEFITS AND BARRIERS RELATED TO HEALTH BEHAVIOR. ## Footnote **The HBM is more descriptive than explanatory, and does not suggest a strategy for changing health-related actions.** **For the most effective use of the model it should be integrated with other models that account for the environmental context and suggest strategies for change.**

Question 33

What should be included in a successful Health Risk assessment counseling session?

Answer 33

provider introduction and orientation to the session - identify risk (HRA and patient comments) - identify patient’s readiness to change - identify patient’s goal(s) - identify patient’s incentives and barriers to changing now - design a detailed plan ahead - state any needed follow up or referrals - briefly summarize and close the session with patient agreement

Question 34

Patient Centered Interview

Answer 34

Question 35

Core Skills

Answer 35

OARS Opens Questions Affirmations Reflections Summaries LOOK AT IMAGE

Question 36

What is Motivational interviewing?

Answer 36

uses empathy rather than confrontation. It acknowledges that the patient, not the physician, is responsible for changing behavior.

Question 37

What are the components of Motivational Interviewing?

Answer 37

**F** = Feedback—Compare the patient's risk behavior with nonrisk behavior patterns. She may not be aware that what she considers normal is risky. **R** = Responsibility—Stress that it is her responsibility to make the change. **A** = Advice—Give direct advice (not insistence) to change the behavior. **M** = Menu—Identify "risk situations" and offer options for coping. **E** = Empathy—Use a style of interaction that is understanding and involved. **S** = Self-efficacy—Elicit and reinforce self-motivating statements such as "I am confident that I can stop drinking." Help the patient to develop strategies, implement them, and commit to change.

Question 38

What is NURS?

Answer 38

EMPATHY - **NAME** **UNDERSTAND** **RESPECT** **SUPPORT** * Establish an emotional focus by using emotion-seeking skills, the patient's emotional story * address the emotion example Dr: . . . So you get mad when he gets on you? [N] Pt: Yeah, he really gets me mad. I just get so furious I could scream sometimes (clenches fist and strikes table firmly). Dr: . . . It sure makes sense. [U] It seems like you’ve done so much there to help and all you get is grief from him. [R] I appreciate the way you’re able to talk about it. [R] He sure gets you mad . . . [N] Pt: He sure does. Just talking about it gets me upset and gives me a headache right now. Dr: I can imagine. [U] You’ve put up with a lot. [R] Let’s work on this together. [S]