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Flashcards in The Impact of Long Term Conditions Deck (34):
1

What is patient centred care and who is in the position to make decisions about treatment?

The provision of care which places the patient at the centre ensuring that the healthcare system is designed to meet the needs and preferences of patients.

Only the patient is in a position to make a decision on what patient centered healthcare means to them, the treatments of their condition and the living of their life.

2

What are the 5 principles of the IaPO Declaration on Patient-Centered Healthcare? - RICAP

1. Respect.
2. Information.
3. Choice and empowerment.
4. Access and support.
5. Patient involvement in health policy.

3

Why have long term conditions become more common

Acute illnesses have become short lived and amenable to cure allowing long-term conditions to become more prevalent

4

Who are long-term conditions more common in

Older people
More deprived groups

5

What percentage of GP appointments account for long-term conditions

50%

6

What percentage of outpatient appointments account for long-term conditions

64%

7

What percentage of all inpatient bed days account for long-term conditions

70%

8

What is the meaning of incidence

The number of new cases of a disease, in a population, in a specified period of time

9

What is the meaning of prevalence

The number of people in a population with a specific disease at a single point in time or in a defined period of time (existing cases)

10

What does incidence tell us

About trends in causation and the aetiology of disease so can be helpful when planning:

i.e. , if the number of new Diabetes diagnoses per year in a particular practice is known, then we can plan staffing and services for the future

11

What does prevalence tell us

About the amount of disease in a population

Is useful in assessing the current workload for the health service but is less useful in studying the cause of a disease

12

What are long-term conditions usually the end-result of? (aetiology) (2)

A long term, complex interaction of factors:
- genetic
- environmental
- both or neither

13

What is vulnerability

An individual's capacity to resist disease, repair damage and restore physiological homeostasis.

Certain organs can vary in vulnerability - i.e. liver & brain

14

What are the different progressions of diseases with examples (3)

Acute onset - MI, stroke
Gradual with a slow or more rapid deterioration - angina
Relapse and remission - cancer

15

What must be considered in the treatment of long-term diseases

May be aimed at the disease, or the effects of the disease
In order to treat, the chronic nature must be realised
Both patient and doctor must admit failure in cure or diagnosis

16

The burden of treatment - how are patients or caregivers often put under enormous demands by the healthcare system (4) - CMTA

1. Changing behaviour or policing the behaviour of others to adhere to lifestyle modifications

2. Monitoring and managing their symptoms at home

3. Complex treatment regimes and multiple drugs (poly pharmacy)

4. Complex administrative systems, and accessing, navigating and coping with uncoordinated health and social care systems

17

What is Bury's meaning of biolographical disruptions

The experience of a long term condition (chronic illness) leads to a loss of confidence in the body, and from this follows a loss of confidence in social interaction or self-identity

18

What does biological disruption reveal (4) MRSaRgb

1. Brings into focus the meaning of illness for the individual

2. May involve `re-negotiating' existing relationships at work and at home.

3. The chronically ill and disabled person also needs to be able to make some sense of their condition before they can begin the process of `adjusting' to it.

4. Involves redefining ideas of what is `good' and `bad', such that the positive aspects of their lives are emphasised, and the negative impact of the illness lessened.

19

What strategies can be used to cope with the stigma of long-term conditions (2)

Making a decision about whether to either:
1. disclose the condition and suffer further stigma
2. Attempt to conceal the condition / aspects of the condition and pass for normal

20

What are the different impacts of a long term condition (3)

1. On the individual – can be negative or positive. Can include denial, self pity and apathy.

2. On Family – can be financial, emotional and physical, other family members may become ill as a result.

3. Community/society. Isolation of an individual may result.

21

What is an expert patient

Where a patient understands more about their disease than the doctors, nurses and other health professionals who undertake long-term follow-up and care them

- i.e. diabetes mellitus, arthritis or epilepsy
- “my patient understands their disease better than I do.”
- They can become key decision-makers in the treatment process.

22

Dictionary definition of disability

Lacking in one or more physical powers such as the ability to walk or coordinate ones movements

23

Legal definition of disability

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

24

WHO Definition of disability: ICIDH – International classification of Impairments, Disability and Handicap. (3)

Body and Structure Impairment - abnormalities of structure, organ or system function (organ level)

Activity Limitation - changed functional performance and activity by the individual (personal level)

Participation Restrictions - disadvantage experienced by the individual as a result of impairments and disabilities (interaction at a social and environmental level)

25

Medical models of disability (4)

1. Individual/personal cause e.g. accident whilst drunk
2. Underlying pathology e.g. morbid obesity
3. Individual level intervention e.g. health professionals advise individually
4. Individual change/adjustment e.g. change in behaviour

26

Social models of disability (4)

1. Societal cause e.g. low wages
2. Conditions relating to housing
3. Social/Political action needed e.g. facilities for disabled
4. Societal attitude change e.g. use of politically correct language.

27

What legislations have been drawn up for disability rights (2)

1. Disability Discrimination Acts 1995 and 2005 - sets out the rights of people with disabilities in relation to employment, education, access to goods & services, buying or renting property

2. Equality Act 2010 - age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage and civil partnership, and pregnancy and maternity are now to be known as 'protected characteristics'

28

Why are doctors not spectators of disability (3)

We assess disability
We coordinate the multi-disciplinary care team
We intervene in the form of rehabilitation

29

What does the personal reaction to disability depend on? (10)

1. The nature of the disability
2. The information base of the individual, ie education, intelligence and access to information
3. The personality of the individual
4. The coping strategies of the individual
5. The role of the individual – loss of role, change of role
6. The mood and emotional reaction of the individual
7. The reaction of others around them
8. The support network of the individual
9. Additional resources available to the individual e.g. good local self-help group, socio-economic resources
10. Time to adapt i.e. how long they have had the disability

30

The sick role, describe the different benefits of illness (6)

Social - social interaction and company
Familial - more attention from family
Psychological - sympathy feel better
Financial - benefits
Medications - access to drugs
Responsibilities - don't have to work

31

Where does disability cause disruption within the family (3)

Personal - getting ill because of stress
Economical - not working because spending time caring
Social - loss of interaction with friends and hobbies

32

Epidemiology of Disability, what are the different cause worldwide? (9)

Congenital
Injury
Communicable Disease
Non-Communicable Disease
Alcohol
Drugs-iatrogenic effect and/or illicit use
Mental Illness
Malnutrition
Obesity

33

How many of those with a disability are in employment

One third

34

What are Wilson and Junger's Criteria for screening (4)

Knowledge of disease:
- The condition should be important.
- There must be a recognisable latent or early symptomatic stage.
- The natural course of the condition, including development from latent to declared disease, should be adequately understood.

Knowledge of test:
- Suitable test or examination.
- Test acceptable to population.
- Case finding should be continuous (not just a 'once and for all' project).

Treatment for disease:
- Accepted treatment for patients with recognised disease.
- Facilities for diagnosis and treatment available.
- Agreed policy concerning whom to treat as patients.

Cost considerations:
- Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole.