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What is 'person-centred care'?

Person-centered care 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.

Only the person can define what it means to them


What are the five principles of patient centred healthcare?

Choice and Empowerment
Patient involvement in health policy
Access and support


What percentage of GP appointments are due to long-term conditions?



What is 'vulnerability'?

An individuals capacity to resist disease, repair damage and restore physiological homeostasis can be deemed vulnerability.


What is the 'burden of treatment'?

Demands by healthcare on patient and caregiver:

- 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) contribute to the burden of treatment.
- Complex administrative systems, and accessing, navigating, and coping with uncoordinated health and social care systems add to this.


What is 'biographical disruption'?

A long-term health condition can cause loss of confidence in social interaction or self-identity - which can be termed biographical disruption


How does the health of people vary within different areas of Scotland?

Higher proportion of people with Good/Very Good health in North/North East/Edinburgh

Higher proportion of bad/very bad health in Glasgow City, North Lanarkshire, Inverclyde, East Ayrshire


What does the WHO define the different levels of disability as?

Body and structure impairment
Activity limitation
Participation restrictions


What are the different factors in the Medical and Social Models of disability?

- individual/personal cause e.g. accident while drunk
- Underlying pathology e.g. morbid obesity
- Individual level intervention e.g. health professionals advise individually
- Individual change/adjustment e.g. change in behaviour

- 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 factors may affect a person's response to their disability?

Nature of the disability
Information base of the individual, ie education, intelligence and access to information
Personality of the individual
Coping strategies of the individual
Role of the individual – loss of role, change of role
Mood and emotional reaction of the individual
Reaction of others around them
Support network of the individual
Additional resources available to the individual e.g. good local self-help group, socio-economic resources
Time to adapt i.e. how long they have had the disability


What is 'The Sick Role'?

The sick role is a concept that concerns the social aspects of becoming ill and the privileges and obligations that come with it

- exempt from normal social roles
- person is not responsible for their condition

- should try to get well
- should seek technically competent help and cooperate with the medical professional


At what different levels does disability cause disruption?



What are some causes of disability?

Communicable Disease
Non-Communicable Disease
Drugs-iatrogenic effect and/or illicit use
Mental Illness


How does the prevalence of disability vary with age and what percentage of disabled people work?

Prevalence and severity rise with age
One third of those with a disability are employed


What is the Wilson/Jungner criteria for screening?

- must be important
- must have recognisable latent or early symptomatic stage
- the natural course of the disease should be understood

- should be acceptable to population
- should be continuous for the population

- should be an accepted treatment
- facilities for diagnosis/treatment available
- agreed policy over who to treat

- cost of case finding should be balanced in relation to possible expenditures on medical care as a whole


What is the difference between disease and illness?

Disease – symptoms, signs – diagnosis. Bio-medical perspective

Illness – ideas, concerns, expectations – experience. Patients perspective

Disease is underlying pathology, illness is what the patient experiences


What factors may affect a person's decision to seek medical advice?

Peer, family, internet, TV, media
Practice leaflets, posters, website

Medical factors
- new symptoms, visible symptoms, increasing severity/duration

- beliefs, expectations, social class, economic, psychological, environmental, cultural/ethnic/age/gender


How do contact rates vary between age/gender?

Increases with age (Except high rates in <4)
Women generally more likely to see healthcare professional


What are the three main aims of epidemiology? Why is it done?

Disease control

Can help identify aetiological clues, scope for prevention, and the identification of high risk or priority groups in society


What are different sources of epidemiological data?

Mortality data
Hospital activity statistics
Reproductive health statistics
Cancer statistics
Accident statistics
General practice morbidity
Health and household surveys
Social security statistics
Drug misuse databases
Expenditure data from NHS


How is the relative risk of a population carried out?

Incidence of disease in exposed group divided by incidence in unexposed groupE.g. incidence of lung cancer in smokers divided by incidence of lung cancer in non-smokers


What is 'health literacy'?

People having the knowledge, skills, understanding and confidence to use health information, to be active partners in their care, and to navigate health and social care systems.


What are the aims of the SIGN guidelines?

Help health and social care professionals and patients understand medical evidence and use it to make decisions about healthcare

Reduce unwarranted variations in practice and make sure patients get the best care available, no matter where they live

Improve healthcare across Scotland by focusing on patient-important outcomes


What are the different types of studies that may be used in the making of guidelines?

Descriptive studies
Cross-sectional studies
Case control studies
Cohort studies


What is the best type of trial for assessing any new treatment in medicine?

Randomised control trial


What factors should be considered in interpreting the results of trials?

Standardised mortality ratio vs general population
Quality of data
Case definition
Coding and Classification


What biases may exist in the performing of studies?

Selection bias - study sample not representative of population
Information bias - e.g. researcher aware of whether person is case or control
Follow-up bias - certain subjects followed up more rigorously than others
Systematic error - problems with equipment, use of equipment, interviews/questionnaires


What is a 'confounding factor'?

A confounding factor is one which is associated independently with both the disease and with the exposure under investigation and so distorts the relationship between the exposure and disease.

E.g. age, sex, social class


What are the criteria for causality?

Strength of association - as measured by relative risk or odds ratio

Consistency - Repeated observation of an association in different populations under different circumstances.

Specificity - A single exposure leading to a single disease.

Temporality - The exposure comes before the disease. (This is the only absolute criteria)

Biological gradient - dose-response relationship. As the exposure increases so does the risk of disease.

Biological plausibility - The association agrees with what is known about the biology of the disease.

Coherence - The association does not conflict with what is known about the biology of the disease

Analogy - Another exposure-disease relationship exists which can act as a model for the one under investigation. For example, it is known that certain drugs can cross the placenta and cause birth defects - it might be possible for viruses to do the same.

Experiment - A suitably controlled experiment to prove the association as causal - very uncommon in human populations.


What is an audit?

Done to assess, evaluate and improve care of patients in a systematic way.
Audit measures current practice against a defined (desired) standard