75yr old has stopped visiting GP as regularly after her usual GP has retired.
Why might she not have attended recently?
- Due to retirement of previous GP; longstanding relationship, trust, person centred approach and might worry about new relationship with GP
- Might have been well
- Might have developed symptoms that concerned her and is avoiding presenting due to the worry about a concerning problem being found
What is person centred care?
It is the provision of care that places the patient at the centre ensuring that the healthcare system is designed to meet the needs and preferences of patients as defined by patients themselves.
What does it mean in person centred care when it states that only the Pt themselves define their care?
Only the patient is in a position to make a decision on what patient centred healthcare means to them, as an individual, in the treatments of their condition and the living of their life.
Treatment options, therapies and models of care can be said to be patient-centered if they are based on the principles and values that define patient-centeredness.
What organisation have created the principles of patient centred care?
International Alliance of Patients’ Organisations (IaPO): Declaration on Patient- Centred Healthcare
What are the 5 principles of the International Alliance of Patients’ Organisations (IaPO): Declaration on Patient- Centred Healthcare?
- Choice and empowerment.
- Patient involvement in health policy.
- Access and support.
What is the impact of long term illness on daily life?
Sufferers may endure multiple handicaps that affect physical, social and psychological well-being.
Constraints on family life, failure to re-establish the functional capacity to work and unremitting physical discomfort (often chronic pain).
In what groups of people are long term conditions most prevalent in?
Prevalent in older people; 58% > 60yrs compared to 14% < 40yrs
More deprived groups; people in the poorest social class have a 60% higher prevalence than those in the richest social class and 30% more severity of disease
What is the percentage of GP appointments used for longterm conditions?
What is the percentage of outpatients appointments used for longterm conditions?
What is the percentage of inpatient bed days used for longterm conditions?
Give examples of degenerative disorders which have become increasingly prominent
Parkinson’s disease, MS and Arthritis
What are the two concerning factors of a long term condition?
Consequences of such long-term illness and establishing the causes
The number of new cases of a disease in a population in a specified period of time
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)
What does incidence indicate about a longterm illness?
Trends in causation and the aetiology of disease.
It be be helpful when planning. For exampple, if we know the number of new diagnoses of Diabetes per year in a particular practice, then we can plan staffing and services for the future.
What does prevalence indicate about a longterm illness?
The amount of disease in a population. It is useful in assessing the current workload for the health service but is less useful in studying the causes of diseases.
Long term conditions (chronic diseases) are usually the end result of a long term complex interaction of which three factors?
- Both or neither
An individuals capacity to resist disease, repair damage and restore physiological homeostasis
Describe three different possible natural history progression of diseases
Some may have an acute onset (stroke or MI)
Some may be gradual with a slow or more rapid deterioration (i.e. angina)
There may be relapse and remission (i.e. cancer)
What is the difficulty in treating chronic diseases?
This may be aimed at the disease, or the effect of the disease.
In order to treat a disease, it is important to realise the chronic nature and come to terms with this which can be difficult.
Both patient and doctor must admit failure in diagnosis or cure.
Why can treatment become a burden (4 factors)?
Changing behaviour or policing the behaviour of others to adhere to lifestyle modifications
Monitoring and managing their symptoms at home.
Complex treatment regimens and multiple drugs (polypharmacy)
To secure eligibility for services, Pts face complex administrative systems, and accessing, navigating, and coping with uncoordinated health and social care systems
What is biographical distribution?
- A long term condition leads to a loss of confidence in the body.
- There is then a loss of confidence in social interaction or self-identity.
How does the biographical distribution influence the meaning of illness for the individual (3 factors)?
Illnesses may involve `re-negotiating’ existing relationships at work and at home.
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.
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.
How stigma of a condition from those who do not have it affect the Pt?
Can be invisible/visible/both
The decision about whether to disclose the condition and suffer further stigma, or attempt to conceal the condition or aspects of the condition and pass for normal.
What are the impacts of long term conditions on the individual?
Can be negative or positive; denial, self pity and apathy
What are the impacts of long term conditions on the family?
Can be financial, emotional or physical.
Other family members can become ill as a result.
What are the impacts of long term conditions on the community/society?
Isolation of a individual
Why has more emphasis now been put of Pt to become key decision-makers in the treatment process?
It has been describe from healthcare workers that the Pt understands their disease better than they do.
Their knowledge about their condition could greatly benefit the quality of patient’s care and ultimately their quality of life.
What is the dictionary definition of disability?
Lacking in one or more physical powers such as the ability to walk or coordinate ones movements
What is the legal definition of disability?
Disability Discrimination Act - 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.
What is the WHO definition of disability?
ICIDH – International classification of Impairments, Disability and Handicap. Updated with ICF. Removes the terms disability and handicap.
What are the three factors of the International classification of Impairments, Disability and Handicap and give examples for each?
Body and Structure Impairment:
Abnormalities of structure, organ or system function (organ level)
Changed functional performance and activity by the individual (personal level)
Pt is at a disadvantage due to impairments and disabilities (interaction at a social and environmental level)
Give four point to the medical model of disability
- Personal cause (i.e. accident when drunk)
- Underlying pathology (i.e. obesity)
- Individual level intervention (i.e. health professional advise individually)
- Individual change/adjustment (i.e. change in behaviour)
Give four points to the social model of disability
- Societal cause e.g. low wages
- Conditions relating to housing
- Social/Political action needed e.g. facilities for disabled
- Societal attitude change e.g. use of politically correct language.
What are the two cofounding factors in the model of disability?
Social and medical
What two legislations have been passed that give rights to those with disabilities?
Disability Discrimination Acts 1995 and 2005
Equality Act 2010
What are your responsibilities as a doctor with treating someone with a longterm illness?
• Attitude • Listen to patients and learn • Take into account age and culture • Ensure empathy • Don't spectate: - Assess - Coordinate MDT - Intervene with rehab
Describe the complexity of disabillities
- Social and medical management
- MDT often required
- In training rarely exposed to disability
- Treat patient not just body
- “Benefits cheats”
What is the personal reaction of disability?
- Nature of disability
- Coping strategies
- Reaction of those around
- Support network
- Time to adapt
- Individual role
- Additional resources e.g. benefits, self-help groups
What is the sick role?
Possible “benefits” of illness – social, familial, psychological, financial, medications, responsibilities.
What are the three factors of the sick role?
Patient rights, obligations and the health;thcare professional role
Describe the are the three factors of the sick role?
• Exemption from societal norms
• Not responsible for condition
• Should try to get well
• Should seek professional help and cooperate
Healthcare professional role:
• Objective and not judge morally
• Must act to for patient interest first as opposed to greed
• Obey professional code of practice
• Maintain necessary knowledge and skill
• Right to examine patient intimately and prescribe medication
What are three way in which a disability can disrupt the family?
Name nine different causes of disabilities worldwide
- Communicable Disease
- Non-Communicable Disease
- Drugs-iatrogenic effect and/or illicit use
- Mental Illness
Describe the change in prevalence of disability in the UK
In the UK the prevalence and severity of disability rise with age.
One third of those with a disability are in employment.
What is Wilson’s Criteria?
Criteria set by Wilson and Jugner to determine if a condition could be screened for
What are the four criteria of Wilsons Criteria?
- Knowledge of disease
- Knowledge of test
- Treatment for disease
- Cost consideration