Year 2 Updated

Question 1

What is ‘person-centred care’?

Answer 1

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

Question 2

What are the five principles of patient centred healthcare?

Answer 2

Respect
Choice and Empowerment
Patient involvement in health policy
Access and support
Information

Question 3

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

Answer 3

50%

Question 4

What is ‘vulnerability’?

Answer 4

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

Question 5

What is the ‘burden of treatment’?

Answer 5

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.

Question 6

What is ‘biographical disruption’?

Answer 6

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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

Body and structure impairment
Activity limitation
Participation restrictions

Question 9

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

Answer 9

Medical

• 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

Social

• 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.

Question 10

What factors may affect a person’s response to their disability?

Answer 10

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

Question 11

What is ‘The Sick Role’?

Answer 11

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

Rights

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

Obligations:

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

Question 12

At what different levels does disability cause disruption?

Answer 12

Personal
Economic
Social

Question 13

What are some causes of disability?

Answer 13

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

Question 14

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

Answer 14

Prevalence and severity rise with age

One third of those with a disability are employed

Question 15

What is the Wilson/Jungner criteria for screening?

Answer 15

Disease

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

Test

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

Treatment

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

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

Question 16

What is the difference between disease and illness?

Answer 16

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

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

Disease is underlying pathology, illness is what the patient experiences

Question 17

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

Answer 17

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

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

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

Question 18

How do contact rates vary between age/gender?

Answer 18

Increases with age (Except high rates in <4)

Women generally more likely to see healthcare professional

Question 19

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

Answer 19

Description
Explanation
Disease control

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

Question 20

What are different sources of epidemiological data?

Answer 20

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

Question 21

How is the relative risk of a population carried out?

Answer 21

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

Question 22

What is ‘health literacy’?

Answer 22

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.

Question 23

What are the aims of the SIGN guidelines?

Answer 23

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

Question 24

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

Answer 24

Descriptive studies
Cross-sectional studies
Case control studies
Cohort studies

Question 25

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

Answer 25

Randomised control trial

Question 26

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

Answer 26

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

Question 27

What biases may exist in the performing of studies?

Answer 27

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

Question 28

What is a 'confounding factor'?

Answer 28

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

Question 29

What are the criteria for causality?

Answer 29

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.

Question 30

What is an audit?

Answer 30

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

Question 31

How have demographics changed over time, how does this vary with how developed the countries are?

Answer 31

In developed, aging population since 1950s - Expected more elderly population than young in 2050 (33% 60+) - life expectancy increasing Less developed - faster changing, but further behind (expected 20% 60+ in 2050) - less time to adapt to changes, also happening in low socio-economic groups unlike the developed world Least developed - further behind but similar changes, will be 2100s before population more elderly

Question 32

What are the two main reasons for population growth?

Answer 32

The baby boomers born after the Second World War will be entering their early 80s by 2031 and overall mortality rates are expected to continue to improve Older people are increasingly healthy, and there is an increasing emphasis on preserving health and fitness into old age

Question 33

What are some non-healthcare reasons for an increase in elderly population?

Answer 33

Baby boomers born after WWII will be entering 80s by 2031 Increasing emphasis on healthy lifestyle means people are healthier for longer Birth rates decreasing Net migration in????

Question 34

What are the healthcare, social, political, and economic implications of ageing populations?

Answer 34

Healthcare - increased geriatricians, more facilities Social - dependence on families, more demand for caring (home/nursing), more need for community activities, housing demands (adaptations) Economic - retirement age increasing, may decrease jobs for young, proportionately less people paying into pension - state pension may be inadequate = poverty Political - elderly population can influence elections, workforce planning must take ageing population into account

Question 35

How has the relative birth/death rate changed over time?

Answer 35

Birth rate 50% higher in 50s-70s | Now almost equal (birth slightly lower)

Question 36

How is life expectancy between the two sexes changing?

Answer 36

Male life expectancy below that of females, but increasing faster

Question 37

What is the most common cause of death in men, and in women?

Answer 37

Heart disease in men Dementia/Alzheimer's in women Each is the second highest cause in the other group Other highest are COPD, lung cancer, stroke

Question 38

What is the healthy life expectancy of men/women? How does it vary with socioeconomic class?

Answer 38

Early 60s for both (63.4 vs 64.1) Life expectancy has increased more than healthy life expectancy (years in poor healthy slightly increased) Vs average, about 10 years less healthy life expectancy in most deprived areas (vs ~5 overall life expectancy) Vs most affluent, difference almost 20 and ~7)

Question 39

How has spending on social care changed over time?

Answer 39

Increasing (even adjusted for inflation)- slight drop after financial crash

Question 40

What is the definition of multi-morbidity?

Answer 40

The co-existence of two or more long-term conditions in an individual This is the standard scenario in primary care patients

Question 41

What are the options of care for those leaving hospital in need of care?

Answer 41

Living in own home with support from family Living in own home with support from social services Sheltered housing Residential home Nursing home care

Question 42

What is an anticipatory care plan?

Answer 42

Advance and anticipatory care planning, as a philosophy, promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care

Question 43

What are different aspects that should be considered in an anticipatory care plan?

Answer 43

Legal aspects - power of attorney (welfare/financial), guardianship Medical - home care package, DNR, palliative care, aids/appliances Personal - wishes regarding treatment, next of kin, consent to share information, preferred place of death, cultural/religious beliefs, family support

Question 44

What are some roles of the practice nurse?

Answer 44

* obtaining blood samples * ECGs * minor and complex wound management including leg ulcers * travel health advice and vaccinations * child immunisations and advice * family planning & women’s health including cervical smears * men’s health screening• sexual health services• smoking cessation.

Question 45

What is the role of a health visitor?

Answer 45

Lead and deliver child and family health services (pregnancy through to 5years) - offering parenting support and advice on family health and minor illnesses - new birth visits which include advice on feeding, weaning and dental health - physical and developmental checks - providing families with specific support on subjects such as post natal depression. Provide ongoing additional services for vulnerable children and families - referring families to specialists, such as speech and language therapists - arranging access to support groups, - organising practical support - for example working with a nursery nurse on the importance of play. Contribute to multidisciplinary services in safeguarding and protecting children - are trained in recognising the risk factors, triggers of concern, and signs of abuse and neglect in children - often, they are the first to recognise whether the risk of harm to a child has increased to a point where actions needs to be taken

Question 46

What is the role of a MacMillan nurse?

Answer 46

Macmillan nurses specialise in cancer and palliative care • Specialised pain and symptom control • Emotional support both for the patient and their family or carer • Care in a variety of settings – in hospital (both inpatient and outpatient), at home or from a local clinic • Information about cancer treatments and side effects • Advice to other members of the caring team, for example district nurses and Marie Curie nurses • Co‐ordinated care between hospital and the patient's home • Advice on other forms of support, including financial help. Macmillan nurses do not carry out routine nursing tasks, such as personal hygiene, changing dressings and giving medicines, and do not focus on non-cancer patients. 

Question 47

What are the different members of the primary/community care team?

Answer 47

``` GP partners Salaried GPs GP registrars Practice nurse Practice manager Receptionist Community nurse Midwives Health visitor Nurse practitioner District nurse ``` Care manager - social workers - identify individual's goals and locate support services ``` AHP: Physiotherapy Occupational Therapy Dietetics Podiatry Pharmacy - advise medical/nursing staff on selection and use of medications Counselling ```

Question 48

What is the role of a dietician?

Answer 48

Interpretation and communication of nutrition science to enable people to make informed and practical choices about food and lifestyle in health and disease. • working with people with special dietary needs • informing the general public about nutrition • offering unbiased advice • evaluating and improving treatments • educating patients/clients, other healthcare professionals and community groups.

Question 49

What is the role of a physiotherapist?

Answer 49

Core skills include manual therapy, therapeutic exercise and the application of electro‐physical modalities. They also have an appreciation of psychological,cultural and social factors influencing their clients

Question 50

What is the role of an occupational therapist?

Answer 50

``` Assessment and treatment of physical and psychiatric conditions using specific activity toprevent disability and promote independent function in all aspects of daily life • physical rehabilitation • mental health services • learning disability • primary care • paediatrics • environmental adaptation • care management • equipment for daily living ```

Question 51

What legislation was put in place to integrate health and social care?

Answer 51

THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014 - placed a requirement on NHS boards and local authorities to integrate health and socialcare budgets - requires NHS boards and local authorities to jointly submit an integration scheme for each area, setting out the detail of which functions will be delegated to the integration authority

Question 52

What are the two systems NHS boards are allowed to use to integrate health and social care?

Answer 52

The integrated joint board model (body corporate model) or The lead agency model Integrated - Integration Joint Board set up - NHS Board and Local Authority delegate responsibility for planning and resourcing service provision for delegated adult health and social care services to the IJB. The Board/Authority delegate a budget

Question 53

What secondary care services may the primary care team make use of?

Answer 53

Diagnostic imaging Consultations Operating services

Question 54

What do changes affecting the primary care health team affect?

Answer 54

Which professional groups are part of the PHCT Which professional groups work alongside PHCT The working relationship between these different professional groups

Question 55

What are the recommendations for good team work, as outlined by 'The Forum on Teamworking in Primary Healthcare'

Answer 55

Include patient/representative is a member of the team Establish agreed purpose Agree objectives and monitor progress towards them Agree teamworking conditions, and conflict resolution process Ensure each team member understands and appreciates the roles of others Pay important attention to importance of communication between members Ensure practice population understands and accepts how the team works within the community Select leader of team for their skills rather than status/hierarchy Promote teamwork across health/social care Evaluate teamworking initiatives on basis of sound evidence Ensure sharing of patient information complies with regulations Take active steps to facilitate inter-professional collaboration/understanding via conferences, education, training Be aware of other measures involving national organisations educational measures, research and general guidance which impact on teamworking

Question 56

What are the stages of an audit?

Answer 56

``` Selection Planning Execution Reporting Follow-Up. ```