Week 15: GP/VS Flashcards
(41 cards)
What is treatment burden?
Workload that patients experience/need to do in order to manage their chronic condition
High levels of treatment burden can cause:
Poor adherence
Disengagment with healthcare services
Poorer quality of life
How does treatment burden arise?
Due to workload volume or care deficiencies
Illness work: Work that patients and families need to do to understand their chronic illness
Treatment work: Tasks that need to be done to manage health and follow treatments set by their healthcare providers
What is patient capacity
Degree to which pts can cope with their illness and lives
Needs to be considered with workload
What is polypharmacy?
5 or more medications to a pt at one time
Due to ageing population, multi-morbidity, preventative medication
What is the clinical presentation of John Darlington and how do you treat it?
Clinical presentation:
- Idiot (due to excessive crap in his head causing increased ICP and decreased CPP)
- Micropenis
- Mood disturbances
Treatment:
- Love and tender care, or
- Getting the stick out of his arse
Types of polypharmacy
Appropriate - pescribing for a pt with muitlple conditions where medications aligned with best evidence
Inappropriate - pescribing medications inappropriately, intended benefit not gained
What are the 2 main reasons for elderly to be at risk of polypharmacy?
Pharmacokinetics
Pharmacodynaimics
What types of patients are most at risk of ADRs from polypharmacy?
Increasing age
Increased fraility
Residents in care homes
High risk medications
Deprivation
How to identify which patients most at risk from polypharmacy?
STOPP/START (STOPP - screeining tool of older people’s medication, START - screening too to alert right treatment)
7 steps to appropriate polypharmacy:
- Identify what matters to pt
- Identify essential medications
- Is the pt taking uneccesary drugs?
- Are therapeutic objectives being acheived?
- Are they at risk of ADRs or suffering from them?
- Is the drug cost-effective?
- Is the pt willing/able to take the drug as intended
4 components of pt-centred care
Affording people dignity, compassion, respect
Offering co-ordinated care
Offering personalised care
Supporting people to enable them to live an independent, fulfilling life
Ways to support self-management
Open questions
Affirmation
Normalisation
Reflective listening
Agenda setting - explore priorieites and produce an agenda with pt
Goal setting and action planning - support pt to identify goals and how they can work towards it
Goal follow up - explore challenges, give positive affirmation of progress and effort
What is person-centred self management?
Supporting individual to build skills, behaviours to live with their long term condition. Listening to what matter to them, and work with their families to help them manage
Not about replacing services or expecting them do everything for themselves
What are the social determinants of health?
Socio-economic, cultural and environmental conditions
Education, living and working conditions, health care services
Social and comminity networks
Individual lifestyle factors
Age, sex, constitutional factors
What is candidacy?
What shape’s poeple knowledge of and acess to health services
E.g. financial status, residency, language barriers
Population vs. high risk approach
Treating people at highest ,evel of risk reduces indiviual risk but not marked reductions in population risk
Unoviersal prevention measures, shifts population risk to left, preventing disease in large proportion of people at low risk, reducing proportion of people above treatment threshold
Obesity
Tier 1: Information and guidance on healthy eating, exercise
Tier 2: Multi-component weight management services inc. lifestyle interventions
Tier 3: Muti-disciplinary treatments e.g. psycholoical, pharmacotherapy
Tier 4: Bariatric surgery
What should weight loss targets be based on?
Individual’s comorbidities and risk, rather than their weight alone
Barriers to access of Glasgow Weight Management Services
For patients: location/timing of classes, lack of awareness of service, delay in referral-assessment-classes
For dcotors:
don’t know where the nearest centre is, lack of knowledge what service involves, practice nurses better to discuss weight than GPs
When to refer someone for weight management services?
BMI >25 + diabetes
BMI 30 + Diabetes, CVD, mobility issues
BMI >40 (no comorbidity required)
How to make John Darlington lose weight?
Give all his empire biscuits to Jo
Acutally lift some proper weights
Erectile dysfucntion
Investigations
Psychosexual history
General - BP, BMI
Exam external genitalia
DRE
ED can be risk marker of CVD:
HbA1c
LFTs
Testosterone (hypogonadism)
PSA ( not routine). Consider if:
Age >50, abnormal DRE, risk factors for prostate Ca
Types:
Psychogenic (5%) - no physiological or neurovascular condition
Causes: stress, peformance anxiety, psycholgical problems
Organic (10%) - physical cause
Causes: CVD, Diabetes, hormonal (low testosterone, high prolactin) or drugs (Citalopram, Bblockers, Digoxin)
Treatment:
Sildenafil (phosphodiesterase type 5 (PDE5) inhibitors) - promotes smooth muscle relaxation, increaseing blood flow to penis
SE: back pain, migraine, nausea/vomiting
2nd line: alprostaldil (synthetic prostaglandin E1 analogue)
