Healthcare System and Patient-Centered Care

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Questions and Answers

What are the levels of the health care system?

Secondary care (correct)

Quaternary care

Primary care (correct)

Tertiary care (correct)

Teleconsultations can provide timely care that is easily accessible.

True

What is the main philosophy behind Patient-centered care (PCC)?

Shared consultation and focusing on the patient as a whole

Teleconsultations refer to interactions between a clinician and a patient for providing diagnostic or therapeutic advice using ______.

virtual communication Signup and view all the answers

Match the following steps of the patient-centered model with their descriptions:

Exploring both disease and illness = Understanding the person's physical and emotional concerns Understanding the whole person = Exploring the patient's history and personality development Finding common ground = Mutually defining problems and treatment goals Prevention and health promotion = Monitoring areas in the patient's life that need improvement for long-term health Signup and view all the answers

What are the vital signs that reflect the body's physiological state?

temperature, pulse rate, respiratory rate, blood pressure Signup and view all the answers

Which temperature remains constant most of the time?

Core temperature Signup and view all the answers

Fever above 41°C is referred to as hyperpyrexia.

True Signup and view all the answers

A fever with a temperature above normal is known as ____________.

Pyrexia Signup and view all the answers

Match the following categories of blood pressure in adults with their corresponding values:

Normal BP = SBP: less than 120mmHg, DBP: less than 80 mmHg Elevated BP = SBP: 120-129mmHg, DBP: less than 80 mmHg Hypertension Stage 1 = SBP: 130-139mmHg, DBP: 80-89 mmHg Hypertension Stage 2 = SBP: ≥ 140mmHg, DBP: ≥ 90 mmHg Signup and view all the answers

What is the key of cardiovascular risk and often referred to as a silent killer?

Hypertension Signup and view all the answers

What is the best goal for weight loss as a lifestyle measure in treating hypertension?

ideal body weight Signup and view all the answers

How much reduction in body weight should be aimed for in most adults who are overweight?

1kg Signup and view all the answers

What is the optimal goal for daily dietary sodium intake?

≤1500mg/d Signup and view all the answers

What is the recommended daily intake range for dietary potassium?

3500-5000mg/d Signup and view all the answers

What is the recommended duration of aerobic physical activity per week for treating hypertension?

90-150 min/week Signup and view all the answers

Study Notes

Early Patient Encounter (EPE)

Practice of medicine is an art based on science
Good physicians treat the disease, but great physicians treat the patient who has the disease

Levels of Health Care System

Primary care: provided by physicians trained for and skilled in first contact; provides continuing care for persons with any health concern
Secondary care: medical care that is provided by specialists upon referral by a primary care physician; requires more specialized knowledge and skill than primary care physician
Tertiary care: specialized consultative health care; referral from a primary or secondary health professional; has facilities for advanced medical investigation and treatment (e.g., tertiary referral hospital)

Clinical Encounter

Can occur in clinics, hospitals, emergency departments, or patient's own house during home visits
Can also occur virtually through teleconsultations
Teleconsultations: interactions between a clinician and a patient for providing diagnostic or therapeutic advice
Examples of services that can be done through teleconsultation:
- Providing results of investigations
- Request for sick notes
- Emergency appointment requests
- Health promotion (e.g., promoting smoking cessation services)
- Effective healthcare (e.g., follow-up of depressed or diabetic patients)

Benefits of Teleconsultation

Convenience for patients (e.g., no time off work)
Convenience for doctors (e.g., shorter consultation)
May reduce practice costs (e.g., more doctor time available for other patients)
Can overcome the issue of a lack of consultation rooms
Can improve medical access for the disabled

Disadvantages of Teleconsultation

Absence of non-verbal cues and missed hidden agendas or fears
No examination findings
Issues of confidentiality
Deafness or language can be a big barrier to communication
Reduced opportunity for health promotion (e.g., blood pressure measurement)
No opportunity for basic investigations (e.g., pregnancy test or urine dip test)

Teleconsultations in Pandemics

Safe and effective way to guide the patient's diagnosis and treatment, minimizing the risk of disease transmission
Enable many clinical services to continue to operate regularly
Help with management of patients

Patient-Centered Care (PCC)

Philosophy of care that encourages shared consultation and decisions about management of problems with the patient
Focuses on the patient as a whole (in contrast to a focus on body part or disease)
Involves:
- Transforming the relationship between providers and patients from traditional model to a patient-provider partnership
- Treating patient as partners, involving them in planning their healthcare
- Helping the patient become medical decision-makers

The Science of Patient-Centered Care

Replaces the 'disease-oriented' model with patient's experience of illness, psychosocial aspect, and decision-making with patient and family
Compares medical (traditional model) and patient-centered model:
- Patient role: passive vs. active
- Focus: disease-centered vs. quality of life-centered
- Recipient of treatment vs. partner in treatment plan
- Compliance vs. following plan
- Dominant decision vs. collaborative decision

Steps of Patient Centered Model

Exploring both disease and illness

Disease: abnormality structure, function of body organ/systems including physical and mental disorder
Illness: how patient feels about being ill, what impact the illness has on patient's function

Understanding the whole person

Person's history, personality development

Finding common ground

Mutual definition of problems
Mutual definition of goals of management/treatment

Prevention and health promotion

Health enhancement: doctor and patient monitor areas in patient's life that need improvement for long-term physical and emotional health
Risk reduction and early detection: doctor monitors, recognizes problems, and screens for unrecognized disease

Patient-doctor relationship

Every visit develops care and effective long-term relationship

Being realistic

Time: manage time for maximum benefit of patient
Realistic about availability of resources

Research on Patient-Centered Method

Greater levels of patient satisfaction
Greater levels of doctor satisfaction
Better patient adherence
Higher quality of self-reporting
Fewer malpractice claims
Greater physician detection
Has a positive impact on healthcare utilization costs

Clinical Approach

Includes:
- History taking
- Examination (general and specific)
- Investigation
- Diagnosis
- Comprehensive management
- Follow-up
Important for decision-making and providing care to patients

History Taking

Important skill that is essential for decision-making
Useful for making diagnosis before performing physical examination
General approach:
- Introduce yourself
- Great patient in a friendly relaxed way
- Confidentiality and respect patient privacy
- Questioning: simple, clear, open, and leading questions
Complete history taking:
1. Personal history: full name, age, sex, address, marital status, occupation
2. Chief complaint: main reason for visiting a physician
3. Present history: elaborate on chief complaint in detail
4. Past history: asking patient if they have any medical problems
5. Family history: previous similar illnesses in the family
6. Psycho-social history: smoking, drinking, occupation, education background

Vital Signs

Reflect body physiological state and provide information to evaluate homeostatic balance
Include: temperature, pulse rate, respiratory rate, and blood pressure
Purpose:
- Obtain data about patient condition
- For diagnostic, therapeutic purpose

Taking Vital Signs Accurately

Precautions:
- Examination room should be quiet and warm
- Take a minute before starting examination
- Look at the patient in their entirety
- Make observations before starting examination

Temperature

Body temperature: balance between heat production and heat loss
Stable if heat generated = heat lost
Normal: 37°C or 98.6°F
Two kinds of body temperatures:
- Core temperature (temp of internal organ; remains constant most of the time)
- Surface temperature (temp of skin, sub-cutaneous tissue, fat cell; rises or falls in response to environment)

History of Acute Sore Throat

Acute pharyngitis is one of the most common conditions encountered in outpatient clinical practice
Most cases of acute pharyngitis are caused by respiratory viruses and are self-limited (lasts for about a week)

Investigation of Acute Sore Throat

Diagnosis is usually clinical
Evidence of infection can be gained by measuring changing antibody response (ASO titre)

Center Criteria

1 point for each feature:
- Tonsillar exudate
- Tender anterior cervical lymph nodes
- History of fever >38°C
- Absence of cough

Fever PAIN Score

1 point for each feature:
- Fever in the previous 24 hours
- Pus on tonsils
- Attends rapidly (e.g., within 1 month)

Referral for Tonsillectomy

Recurrent acute tonsillitis that leads to missing a lot of school/work (e.g., >7 attacks/year for 2 years)
Airway obstruction: very large tonsils causing sleep apnea
Chronic tonsillitis >3 months + halitosis
Unilateral tonsillar enlargement or recurrent quinsy### Acute Otitis Media (AOM)
Majority of AOM cases resolve spontaneously
No need for long-term prophylactic antibiotics in primary care
Watchful waiting and observing children for clinical improvement is the appropriate strategy for non-severe AOM
Antibiotics should be provided to children if the infection worsens or fails to improve within 24-48 hours

Referral of AOM

Children with AOM associated with severe systemic infection
Children with acute complications like meningitis or intracranial abscess
Recurrent AOM (three or more ear infections in the last six months)
Impaired hearing following AOM
Failure of infection to resolve even after taking previous antibiotics
Persistent perforation
Neonates, children younger than 3 months of age, or those with a high temperature of 38°C or more

Hypertension

Persistent elevation of blood pressure: ≥ 140 systolic and/or ≥ 90 diastolic
Categories of BP in adults:
- Normal BP: < 120 mmHg systolic and < 80 mmHg diastolic
- Elevated BP: 120-129 mmHg systolic and < 80 mmHg diastolic
- Hypertension: stage 1 (130-139 mmHg systolic or 80-89 mmHg diastolic), stage 2 (≥ 140 mmHg systolic or ≥ 90 mmHg diastolic)
- Resistant hypertension: BP above goal despite adherence to a combination of at least 3 optimally dosed antihypertensive medications
- Hypertensive urgency: acute rise in BP without evidence of acute end-organ dysfunction
- Hypertensive emergency: acute rise in BP with acute end-organ dysfunction
- White coat hypertension: BP higher when measured in the medical office than when measured at home

Diagnosing Hypertension

Clinical presentation:
- Asymptomatic
- End-organ damage
- Secondary cause
Patient evaluation aims:
- Assess lifestyle and identify other cardiovascular risk
- Reveal identifiable causes of high BP
- Assess target organ damage and CVD
Clinical examination:
- General examination (BP measurements, weight, and height)
- Cardiac examination (LVH)
- Abdominal examination (renal mass, aortic aneurysm)
- Chest examination
- Neurological examination
Investigations:
- Basic testing (fasting blood glucose, complete blood count, lipid profile, electrocardiogram, etc.)
- Optional testing (echocardiogram, uric acid, urinary albumin to creatinine ratio, etc.)

Treating Hypertension

Lifestyle measures:
- Weight loss (aim for ideal body weight, expect about 1 mmHg reduction in BP for every 1 kg reduction in body weight)
- Healthy diet (DASH pattern, diet rich in fruits, vegetables, and grains)
- Reduced intake of sodium (optimal goal ≤ 1500 mg/d, aim at least 1000 mg/d reduction for most adults)
- Enhanced intake of potassium (aim for 3500-5000 mg/d, by consuming a diet rich in potassium)
- Physical activity (at least 90-150 minutes/week of aerobic exercise)
- Moderation in alcohol intake (reduce alcohol to ≤ 2 drinks daily for men, ≤ 1 drink daily for women)
Pharmacological management:
- Recommendations for choice of initial monotherapy versus initial combination drug therapy

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Description

This quiz covers the levels of the healthcare system, the concept of teleconsultations, and the philosophy behind patient-centered care. It also explores the vital signs that reflect the body's physiological state.