Prevention and Patient-Centered Care Notes

Levels of Prevention

• Primary Prevention:

  • Stopping disease before it starts; removing causes of disease.
  • Examples: healthy eating, regular exercise, immunizations.
  • Mnemonic: P (Primary and Preventing)

• Secondary Prevention:

  • Catching diseases early through screening.
  • Examples: pap smears, mammograms.
  • Early treatment to prevent progression.
  • Mnemonic: S (Secondary and Screening)

• Tertiary Prevention:

  • Treatment of existing disease to limit damage and promote recovery.
  • Examples: medication for diabetes complications, rehabilitation programs.
  • Focus on recovery and preventing further issues.
  • Mnemonic: T (Tertiary and Treatment)

Social History and Social Determinants of Health

• Social History Elements: Education level, employment status, sexual history, substance use, housing situation, recent stressors/life changes.
• Social Determinants of Health: Non-medical factors influencing health risks and outcomes.
  • CDC definition: Conditions in which people are born, grow, live, work, worship, and age.
  • Understanding these factors helps tailor individualized care plans.

Healthy People 2030

• A national initiative setting objectives to improve overall health and well-being every ten years.
• Priorities include addressing social determinants of health to reduce health disparities and inequalities.

Health Disparities

• Unequal and preventable differences in access to healthcare services and health outcomes among socially disadvantaged populations.
• Example: Certain populations being less likely to receive routine medical care.
• Addressing these disparities is working towards health equality.

Health Literacy

• The ability to understand and use health information to make informed decisions.
• Key elements:
  • Reading and comprehension skills.
  • Understanding and using numerical information.
  • Effective communication with healthcare clinicians.
• Crucial for interpreting medical/medication instructions, following treatment plans, and navigating the healthcare system.
• Poor health literacy can lead to difficulty managing conditions, medication errors, and worse patient outcomes.
• Role of NPs: Enhancing health literacy through clear communication, avoiding jargon, using accessible educational resources, and confirming patient understanding.

Cultural Competence

• Clinician's ability to provide high-quality, respectful care to patients from diverse cultural backgrounds.
• Involves open, respectful dialogue, asking about preferences/beliefs/values, and avoiding assumptions.
• Ensuring patients feel seen and respected, receiving care aligned with their cultural context.
• Tailoring communication, which may involve language translation services.
• Practicing cultural humility: Recognizing that learning about other cultures is a continuous process.
• Being aware of one's own values/beliefs and how they impact care.
• Recognizing that patients' understanding of disease and health, shaped by their cultural context, is valid.

Inclusivity

• Creating a welcoming atmosphere where every patient feels acknowledged and valued.
• Fostering an environment of support where patients feel safe to share vital health information.
• Maintaining privacy and discussing health concerns with sensitivity.
• Reflecting the language individuals use to describe themselves (avoiding assumptions about identities/relationships).
• Respectfully asking about pronouns and preferred terms when unsure.
• Applying inclusivity to healthcare access policies and clinical practices to accommodate patient needs and remove barriers to care.

Motivational Interviewing

• Patient-centered communication to explore feelings about a behavior and increase intrinsic motivation for positive change.
• Four Key Processes:
  • Engaging: Establishing a trusting relationship.
  • Focusing: Collaboratively setting the agenda and specific changes.
  • Evoking: Drawing out patient's reasons for change (benefits).
  • Planning: Developing a concrete plan of action that the patient agrees with.
• OARS Technique:
  • Open Questions: Encouraging patients to share experiences/feelings.
  • Affirmations: Recognizing patient's strengths/efforts.
  • Reflective Listening: Showing understanding and empathy.
  • Summarizing: Consolidating information and preparing to move forward.

Shared Decision Making

• Patient and clinician working together to make informed decisions about care.
• Collaborative, open conversation where the patient shares goals/preferences.
• Clinician helps patients understand their condition and shares treatment options with risks/benefits.
• Jointly developing a game plan.
• Empowers patients, improves satisfaction and outcomes.
• Can be applied to big decisions (surgery) and smaller scenarios (screening).
• USPSTF recommends shared decision making for prostate cancer screening.

Communication in Sensitive Situations

• Creating a safe, supportive environment for patients experiencing intimate partner violence.
• Approaching the topic directly but without placing blame.
• Knowing mandatory reporting laws and local resources for intimate partner violence and abuse cases.