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Flashcards in HaDSoc Deck (59):
1

Qualities of good healthcare?

SETEE
safe, effective, timely, efficient, equitable

2

Why do pt safety problems occur? how to fix

human error or behaviour. Fix with checklists, avoid reliance on vigilance and memory, simplify and standardise processes and procedures

3

what policies encourage quality in the NHS

payment for high standard, clinical governance

4

what are the NHS 5 domains of national outcomes

PHEET
Prevent premature death, Help pt recovery, Ensure QoL for LTCs, Ensure pt has good exps, Treat in safe environment

5

What is purpose of the nhs national outcomes framewokr

make nhs accountable and increase quality

6

what mechanisms can be used to improve quality of nhs care

standard setting, clinical commissioning, financial incentives e.g. QoF, disclosure, regulation, clinical audit, professional regulation

7

what is cquin?

safety and pt exp = ££

8

benefits of a systematic review?

decrease time to guidelines, provides up to date conclusion for docs, identify gaps in research

9

pros and cons of quantitative research?

pros - greater no of subjects, comparable between studies, reliable and analysable
cons - doestn reflect how ppl really feel, limited results, forces ppl into categories

10

types of qualitative research

focus groups, interviews, ethnography and observe

11

what are focus groups good and bad for

good for participation but not good for sensitive topics and individual views

12

pros and cons of qualitative research

pros - explains relationships betwwen variables, info not revealed in quantitative
cons - not generalisable, labour intensive

13

what is evidence based practice?

integrating clinical expertise with best available evidence

14

critcism of evidence based practice? practical and philosophical

practical - RCT not always ethical, expensive, requires pharma companies to be honest
philosophical - rule followers, population guide may not apply to individual, professional autonomy

15

difficulties in getting evidence into practice

funding, doctors not aware of evidence or dont want to use it

16

diversity in health according to black report?

income diversity, artefact, behavioural cultural, social selection

17

define inequality and inequity

inequality - not equal
inequity - unfair and avoidable inequality

18

where do lay beliefs come from

social, cultural and personal knowledge

19

what is illness behaviour

activity done in ill health to define illness and seek solution

20

how are lay referrals useful

explains why and when pts present and the services they use

21

what are determinants of illness behaviour

culture, threshold for tolerance, visibility of symptoms, lay referral, disruption of life

22

purpose of health promotion

enable people to improve control over their own health

23

critiques of public health

sociological - surveillance critiques, consumption critiques (lifestyle choices are tied to identity)

24

what aproaches can be taken to promote health

MBEES
medical and preventative, Behavioural, Education, Empowerment, Social change

25

what is primry, secondary, and tertiary prevention. give egs where relevant

primary - imunisation, decrease risk factors, decrease risk of health related behaviour
secondary - screening, treat BP
tertiary - minimise effects of disease

26

dilemmas of health promotion?

ethics of interfering, victim blaming, prevention paradox, reinforces negative stereotypes

27

why evaluate health promotion programmes

accountability, ethical obligation (ensure no harm), evidence based interventions

28

how do you evaluate health promotion programmes? process, impact? Problems with evaluating outcomes?

process - quantitative
impact - assess immediate effects
outcomes - subject to delay, expensive, hard to measure confounders

29

what is illness narratives

accounts of experiences of LTCs

30

what is involved in chronic ilness work? explain

biographical work (loss of self and grief for former life), illness work, identity work, emotional work, everday life work

31

what are the dilemmas of identity work

scrutinise others reactions, dependence on others, relationships harder to maintain, loss of social life

32

define stigma

negatively defined thing that confers deviant status

33

what is narrative reconstruction

identity reconstructed in ways that explain their illnes

34

define impairment, disability, and handicap

impairment - abnormal function + structure of body
disability - loss of ability to participate
handicap - broader social and psych impacts of impairments e.g. cant get a job

35

tools for measured HRQoL

morbidities, mortaility, patient based outcome

36

what are patient based outcomes useful for?

clinical audits, measure service quality, assess benefits of treatment

37

what are the components of HRQoL

physical and cognitive function, symptoms, satisfaction

38

give eg of generic HRQoL

SF-36, EQ-5D

39

pros and cons of generic HRQoL

pros - broad range, assess health of whole population
cons - 2 general, less acceptable to pts

40

what is a specific HRQoL good for? pros and cons

good for disease, site specific, dimension specific e.g. pain
pros - sensitive to change, relevant
cons - must have disease, limited comparison

41

what are the 3 ways of detecting a disease

opportunistic, screening, spontaneous

42

what factors are needed to have a screening programme

disease - must be detectable, treatable, important
test - precise and valid, acceptable, cheap
treatment - early treatment must be useful and exist

43

define sensitivity, specificity, ppv, npv

sensitivity - if ur +ve, chances test says +
specificity - if ur -ve, chances test says -ve
ppv - if test is +ve, chances u r +
npv - if test is -ve, chances u r -ve

44

what can false +ves and -ves lead to?

false + - anxiety, stress
false -ve - false assurance, delay diagnosis

45

cons of screening?

surveillance critique, victim blaming, lag time bias, length time bias, selection bias, false + and -ves

46

what is the health and social care act 2012

creates ccgs and gives GPs power to make commissioning decisions

47

what is explicit rationing? pros and cons

defined rules and systematic allocartion
pros - fair, transparent, open to debate
cons - pt distress, doesnt account for individual need, complex

48

implicit rationing pros and cons?

pros - sensitive to complexity of pt
cons - abuse, social deservingness, inequality

49

How does the NHS ration healthcare?

5Ds
Deterrent (prescriptions), delay, deflection (referred to different institution), dilution (service offered but quality declines as cuts made), denial

50

what are healthcare resource groups?

payment by results. treatments put into a group that is similar and uses similar resources

51

define technical and allocative efficiency

technical - most efficient way to meet a need
allocative - choosing between many needs

52

what is cost minimilisation, utility, effectiveness, benefit analysis?

minimilisation - choose cheapest of 2 treatments with similar outcomes
effectiveness - cost per health unit outcome e.g. cost to reduce 10 mmHg of BP
benefit - incomes and outcomes in £s
utility - focussed on quality of health outcome produced e.g. QALY

53

what is incremental cost effectiveness ratio?

cost per QALY

54

criticisms of QALY?

problems with calculation, resource not distributed according to need, may not embrace all dimensions of benefit

55

problems with complaints in nhs

no feedback, lack of confidence in a resolution, complex system

56

how are patients viewed investigated directly and indirectly

indirectly - ombudsman, pt complaints
directly - qualitative and quantitative

57

what can cause pt dissatisfaction

poor interpersonal skills, concerns not addressed

58

what are 4 approaches to pt doc relationship? criticise where necessary

functionalism - powerful vs vulnerable. Crit - some pts cant get better, assumes passive role of pt and beneficence of medicine
conflict - Crit - pts can exert control via non adherence, inaccurate
interpretism - emphasises meaning given to social situation
patient-centred partnership

59

what are the 2 types of regulation of doctors and criticisms?

self regulation - self serving, whistleblowing discouraged, fialure of regulation
managerial - less clinical autonomy