Tutorial 1 - Impact of long term conditions

Question 1

What is meant by ‘the burden of treatment’?

Answer 1

The enormous demands that are placed on patients and caregivers by healthcare systems

Question 2

What is meant by ‘biographical disruption’?

Answer 2

The loss of confidence in social interaction and self identity produced by the loss of confidence in the body that generally follows diagnosis/development of a long term condition

Question 3

What is meant by ‘the sick role’?

Answer 3

The privileges and obligations which accompany illness

Question 4

Chronic conditions mainly afflict which two groups of people?

Answer 4

The elderly

The deprived

Question 5

Chronic conditions mainly afflict which two groups of people?

Answer 5

1. The elderly

2. The deprived

Question 6

What is incidence?

Answer 6

The number of new cases of a particular disease occurring within a population over a specified period of time

Question 7

What is prevalence?

Answer 7

The total number of people afflicted with a particular disease at a fixed point or specified period of time

Question 8

What are the two general categories of factors which cause long term conditions?

Answer 8

1. Environmental factors

2. Genetic factors

Question 9

What is vulnerability?

Answer 9

An individual’s ability to resist disease, repair damage and restore physiological homeostasis

Question 10

Give four broad examples of the burden of treatment for patients

Answer 10

1. Drastic alterations in the behaviour of oneself or others to adhere to lifestyle modifications
2. Home monitoring of signs and symptoms of their condition (can also require the collection and recording of clinical data)
3. Requirement for adherence to a complicated regimen of pharmaceutical management (sometimes multiple overlapping regimens are required in cases of patients with multiple comorbidities)
4. Necessity to engage with and navigate complicated administrative systems as well as different health and social care services which are uncoordinated and often confusing

Question 11

What is meant by ‘the expert patient’?

Answer 11

Patients with long term conditions will often have a much greater knowledge and understanding of their condition than any healthcare practitioner could ever have. Recent shifts in attitude have begun to involve patients more as key decision makers in their treatment process to take advantage of this depth of knowledge. This also applies to the parents of children with long term conditions.

Question 12

What are the three main definitions of disability?

Answer 12

1. Dictionary
2. Legal
3. WHO

Question 13

What are the three main subcategories of disability according to the WHO definition?

Answer 13

Body and structure impairment
Activity limitation
Participation restrictions

Question 14

What is meant by body and structure impairment under the WHO definition of disability?

Answer 14

Abnormalities of structure, organ or system function

Question 15

What is meant by participation restrictions under the WHO definition of disability?

Answer 15

The difficulties experienced by the patient at a social and environmental level due to their impairments and disabilities

Question 16

What is meant by activity limitation under the WHO definition of disability?

Answer 16

The change in functional performance and activities by the individual as a result of impairments and disabilities

Question 17

What are the two main models of viewing disability?

Answer 17

1. The medical model

2. The social model

Question 18

What constitutes the medical model of disability?

Answer 18

Personal cause i.e. accident while drunk
Underlying pathological cause i.e. morbid obesity
Individual level intervention i.e. individual advice offered by health professionals
Individual change/adjustment i.e. alterations in behaviour

Question 19

What constitutes the social model of disability?

Answer 19

Societal cause i.e. low wages
Environmental cause i.e. damp housing
Social/political action needed i.e. facilities for the disabled
Social attitude change needed i.e. use of politically correct language

Question 20

Name two pieces of legislation which have been created regarding protecting the rights of disabled individuals

Answer 20

The disability discrimination act 1995 and 2005

The equality act 2010

Question 21

What are some of the causes of disability worldwide?

Answer 21

Obesity 
Alcohol use
Drug use
Mental illness
Communicable disease
Non-communicable disease
Congenital disease
Iatrogenic 
Injury 
Malnutrition

Question 22

What are Wilson’s criteria for screening tests?

Answer 22

Knowledge of disease
Knowledge of test
Treatment for disease
Cost considerations

Question 23

What are the sub-criteria of knowledge of disease under Wilson’s criteria?

Answer 23

Disease must be important health concern
Course/progression of the disease must be understood
There must be a recognisable latent/early symptomatic presentation

Question 24

What are the sub-criteria of knowledge of test under Wilson’s criteria?

Answer 24

Suitable test or examination available
Test acceptable to population
Case finding should be continuous

Question 25

What are the sub-criteria of treatment of disease under Wilson’s criteria?

Answer 25

Accepted treatment available for those with the disease
Facilities for screening and treatment must be available
Agreed policy concerning who to treat as patients

Question 26

What is meant by ‘cost considerations’ under Wilson’s criteria for screening?

Answer 26

The cost of diagnosing and treating patients with the disease must be balanced out in relation to total healthcare expenditure. In essence, the test and treatment should not be too expensive