1.05 Non-Medical Sciences

When is priority setting important in healthcare?

-when scarce resources as spread out

What are the factors that are considered when priority setting? (6)

1. Age - can't be considered on it's own

2. Type of illness - acute,life-threatening; severe,chronic debilitating;non-life-threatening,distressing;minor,self-limiting

3. Merit- usefulness to society

4. Demand- pressure groups

5. Effectiveness of treatment

6. Need - most important (both clinical and socioeconomic needs)

What does fairness mean in terms of distributive justice?

-Fairness does not mean everyone gets the same share/ does not mean equality, it means equity- those with equal need get equal care and those in the same circumstances with the similar conditions get the same treatment

Describe what QALYs are (3)

-Required by NICE.

-QALY= Quality Adjusted Life-Year. 1 QALY = 1 year in perfect health

-A health state is valued between 0 (worst health/death) and 1 (best health) combined with the length of time in that state.

E.g. a drug improves health state by 0.6 over a period of 10 years = (0.6x10) 6 QALYs.

What are the advantages of using QALYs? (4)

-Compares the values of different interventions across healthcare without placing monetary value on them

-Takes a holistic view of the patient.

-Facilitates transparency of resource allocation, opening up discussion.

-Exposes highly ineffective and expensive treatments.

What are the disadvantages of using QALYs? (3)

-Health states are very subjective

-Could disadvantage disabled people as there is less chance of improving their QoL and people with limited capacity

-The UK govt indicated that it is unwilling to fund interventions that cost more than £20,000 per QALY- could lead to inequity

What are the ethical rights to healthcare? (4)

-Welfare rights, healthcare should be available to all, not discriminating by ethnicity, religion, wealth etc

-deontology - duty to serve the public

-Consequentialism - giving all adequate healthcare benefits us all in the long run

-Virtue ethics - be good, treat people well

What are the legal rights to healthcare? (3)

-State responsibility-> NHS government run

-positive rights (other people must provide you with a good or a service)

-Human Rights Act

What are the challenges surrounding the right to health care? (3)

-determining what comes under healthcare

-resource allocation - who should we prioritise?

-Demand > Availability

What are hypothesis tests used for?

-to establish the likelihood that the observed association is genuine, or simply due to chance

What is the null hypothesis? Give an example

-there will not be a significant difference in outcome between the groups

-eg. if we are comparing the rate of smoking in the pop. the null hypothesis would be that smoking rates are the same in men and women in the population

What is the alternative hypothesis?

- holds if the null hypothesis is not true

What is the p-value?

-the probability of obtaining our results, or something more extreme, if the null hypothesis is true

Why can't the p-value be interpreted as the probability that the null hypothesis is true? (2)

-null hypothesis relates to the population of interest, rather than the sample

-null hypothesis is either true or false

What is the significance of the p-value? (3)

-the smaller the p-value, the more likely that the null hypothesis is disproven

-conventionally, we consider that if the p-value is less than 0.05, there is sufficient evidence to reject it -> reject null hypothesis and say that results are significant at 5% level

-if p-value is equal to or greater than 0.05, we conclude that there is insufficient evidence to reject the null-hypothesis so we don't reject it-> results are not significant at 5% level (does not mean null hypothesis is true-> just not enough evidence to reject it)

Describe the concept of the 'iceberg of disease' (3)

-Only a small proportion of people with symptoms actually make contact with health services

-The tip of the iceberg refers to people in hospital services - the very tip represents specialist hospitals

-Over a 2 week period 75% of the population will experience one or more symptoms of ill health

->1/3 of these people will do nothing

->1/3 will self medicate or seek alternative advice

->1/3 will consult their GP

Which factors are involved in leading to the top of the iceberg of disease? (3)

-the patient's perception of their own ill health (How serious is it? Have I had it before? How long has it been going on for?)

-availability of medical services

-the quality of previous consultations

What is the submerged portion of the clinical iceberg? (4)

-hidden mass of disease

-latent, inapparent, presymptomatic + undiagnosed cases

-epidemiologists are concerned

-screening is done

What is meant by estimation in statistics?

-process by which one makes inferences about a population based on information obtained from a sample

What is the "true value" (confidence interval)?

-mean value one would get if we had data for the whole population

What is the social model of disability?

The model says that people are disabled by barriers in society, not by their impairment or difference.

What are some examples of barriers in the social model of disability? (2)

-physical, buildings not having accessible toilets

-people's attitudes, assuming disabled people can't do certain things

How can the social model of disability be used to improve the lives of people with disabilities? (2)

-helps us recognise barriers that make life harder for disabled people

-removing these barriers creates equality and offers disabled people more independence, choice and control eg. removing steps for wheelchairs

Why is the social model of disability criticised sometimes?

-denies the link between physical impairment and social disability, reduces the urgency to find cures in disabled patients

-not all disability can be helped by removal of societal barriers

What is the medical model of disability?

-medical model of disability says people are disabled by their impairments or differences

What are some criticisms for the medical model of disability? (2)

-looks at what is 'wrong' with the person, not what the person needs

-creates low expectations and leads to people losing independence, choice and control in their lives

Read this scenario and describe a) the social model approach and b) the medical approach

You are a teenager with a learning difficulty who wants to live independently in your own home, but you don't know how to pay the rent.

a) The social model recognises that with the right support on how to pay your rent, you can live the life you choose

b) The medical model might assume that the barriers to independent living are insurmountable, and you might be expected to live in a care home

What is the difference between an impairment and a disability?

Impairment is the abnormality itself like a stroke whilst disability is the restriction caused such as the inability to walk

How can disability be viewed as a matter of social oppression? Give examples

- millions of disabled people in Britain are still not being treated as equal citizens and continue to be denied the everyday rights non-disabled people take for granted

-Examples: access to transport, appropriate health services and housing, benefit from education and employment (disability pay gap is persistent and widening)

Define quality of life

the standard of health, comfort and happiness experienced by an individual or a group

Which factors affect an individual's perception on quality of life? (3)

cultural values, goals and standards of the individual

What is Maslow's hierarchy of needs? Relate this to QoL (5+1)

1. Physiological needs

2. Safety and Security needs

3. Love and Belonging Needs

4. Self esteem

5. Self actualization

-the higher up you go, the more likely QoL will be increased

How can you measure quality of life? (2)

- evaluation of QoL whereby an individual picks the areas most important to them and rank them appropriately -> often done in an interview

-listening to a patient gives you an idea of quality of life -> may influence treatment plans

What is chronic illness?

-a long-term health condition that may not have a cure

What are some of the psychological impacts of being diagnosed with COPD?

-anxiety and depression are both more common in people living with COPD than they are in the general population

-shortness of breath can cause anxiety and even panic attacks. Experiencing worry about avoiding shortness of breath can make you less active -> staying active has positive effects on our mental health, which can help keep anxiety and depression at bay

Describe the ways in which someone with a chronic illness may cope with their illness (5)

Denial- denies having the illness

Normalising- classes symptoms as normal which neutralises threat but poor compliance

Avoidance- avoids situation which may exacerbate problem which may cause social exclusion

Resignation- person totally consumed by the illness often depend on others

Accommodation- Patients acknowledges and deals with the problem illness produces