Transcript Anticipatory care.ppt

Anticipatory care
Dr. Basema AL.Khudhair
Family Medicine consultant & trainer)MOH)
Clinical Assistant Professor (KSU)
email ( [email protected])
If we take responsibility for preventive work only of
proven value we shall have our hands full.
Iceberg phenomenon ?
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Diseased, diagnosed & controlled
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Diagnosed, uncontrolled
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Undiagnosed or wrongly
diagnosed disease
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Risk factors for disease
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Free of risk factors
Diagnosed
disease
Undiagnosed or
wrongly diagnosed
disease
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Does it work?
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USA: Mortality from stroke has decreased by
50% since 1972
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Mortality from cervix cancer decreased by 80%
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Early diagnosis and treatment of hypertension
Pap smear
Neonatal screening: Decrease in mental
retardation
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Phenylketonuria screening
Congenital hypothyroidism
National Center for Health Statistics.
http://www.cdc.gov/nchs/r&d/ndi/ndi.htm
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Health Promotion
Includes all measures which promote good
health and prevent or delay the onset of
disease or their complications.
 The essential union of prevention with care
and cure (RCGP,1981).
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Why in Family Practice ?
Aims:
1-Improve the quality of life.
2-Reduce the burden of premature
disability.
3-Increase life expectancy.
Health Promotion :
1-Primary Prevention:
 Health education.
 Prophylaxis.
Primary Prevention:
A. Health education:
Aims to enlighten people by providing them with
information factors which are known to cause disease.
B. Prophylaxis:
An active intervention in an attempt to protect the
individual from developing a particular disease e.g.:
vaccination.
Cont.
2-Secondary Prevention:
 Screening.
 Case finding.
3-Tertiary Prevention :
systematic long term monitoring to prevent
or minimize the impact of complication.
What are primary care physicians
doing?
Health Care
Health
promotion
Risk
prevention
Primary Prevention
Risk
reduction
Early
diagnosis
Secondary Prevention
Preventive Medicine!
Complication
reduction
Tertiary
Prevention
Secondary Prevention:
A. Screening:
Are systematic attempts to detect undeclared
disease in a population of apparently healthy
people.
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Before mounting a screening initiative certain
criteria must first be satisfied (Wilson, 1973) .
PHE
Evaluation of apparently healthy individuals in
certain time periods, using a number of standard
procedures such as counseling, physical
examination, and laboratory investigations is
called Periodic Health Examination.
Preventive Medicine and
Periodic Health Examinations in Primary Care
Introduction to Primary Care: a course of the Center of Post Graduate Studies In FM
The Criteria:
1- The condition (the disease) sought should be:
 Important.
 Recognizable at an early stage.
 Readily treatable.
Cont. PHE
2- The screening test used should be:
 Practical and safe.
 Acceptable to patients and non invasive.
 Highly sensitive and highly specific and easy to
interpret.
3- Facilities for diagnosis and management should be
readily available.
Cont. PHE
4- Treatment should be:
 Recognized
 Effective.
5- The cost of screening test should be balanced and
screening should be a continuous process.
6- To agree on a policy on whom to treat.
Cont. PHE
8-The population screened :
 Sufficiently high disease prevalence.
 Accessibility
9-Compliance with subsequent diagnostic tests
&necessary therapy.
Does it work?
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USA: Mortality from stroke has decreased by 50% since 1972
–
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Early diagnosis and treatment of hypertension
Mortality from cervix cancer decreased by 80%
Neonatal screening
–
Decrease in mental retardation
 Phenylketonuria screening
 Congenital hypothyroidism
National Center for Health Statistics. http://www.cdc.gov/nchs/r&d/ndi/ndi.htm
Rationale:
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Many young people die every year due to RTA
> 90,000 die < 65year :
<32,000 due to cancers.
<25,000 due to IHD .
Cessation of smoking
<33% reduction in all cancers.
<25% reduction In IHD.
Treating & controlling hypertension reduce CVAs by 50%
Think of your daily life
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A50-year old woman applies to your office. She has no
history of disease but afraid of having breast cancer.
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Should you perform a breast exam?
Should you teach her breast self exam?
Should you order a mammography?
How do you decide?
Rationale
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It’s an important disease for women
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It can be recognized early without symptoms
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Mammography
Curable
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Worldwide 719000 new cases/year. (1/1000)
Ist female's cancer (Saudi cancer registry)
Surgery, Chemotherapy, Radiotherapy
The value of treatment is far more than its adverse
effects
Screening / PHE programs in Saudi Arabia
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Annual periodic health examination for all
diabetic and hypertensive patients registered at
PHC
Cervical screening
Breast cancer screening in some areas
Pre-marital screening (genetic dis., infectious dis.)
Well baby clinic
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Conclusion:
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Management decision must be related to one or
more of the following objectives:
Prevention of an illness.
Prevention of disability in curable illness.
Prevention of further disability in chronic disease.
Prevention of relapse.
Prevention of death.
Principles of patient education
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Interest
the recognition of the need
patients are unlikely to listen to those things
which are not to their interest
Motivation
Principles of patient education
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Participation
active learning
Known to unknown
knowledge is build up to enable patients to
develop an in-depth insight into their own
health problems
Principles of patient education
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Comprehension
Making patient understand what you say
Educational background
Mental capacity
Re inforcement
repetition of the information in the same or
during subsequent consultation
Principles of patient education
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Encourage the patient to participate in decision
making and in accepting some degree of
responsibility for his/her own management
Record body weight
glucocheck
Monitoring temperature
B.P
Principles of patient education
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Encourage feed back
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Involvement of others e.g. family members where
appropriate
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Establish wheather the objectives have been met
and the patient is happy with the outcome
Principles of patient education
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Provide take away information
patient instruction leaflets
resource contacts
Arrange follow up
Reinforcement of information
preventive measures
Principles of patient education
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It is sometimes wrongly assumed that just by
providing people with information, they will
automatically be able to make healthy choices.
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Examples
??
Principles of patient education
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Fahad 55 years old blind recently diagnosed type
2 diabetes mellitus, come to the primary care
clinic for follow up visit.
How you will help fahad to understand and cope
with diabetes?
Patient education model
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Establish the patient’s knowledge of the problem
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Describe the problem
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Establish the patient’s attitudes to the problem
Patient education model
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Correct any incorrect health beliefs
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Supplement the patient’s existing knowledge to a
level appropriate to the needs of the patient and
the doctor
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Facilitation by the use of special charts, diagrams,
models.
Patient education model
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Explore other preventive opportunities
Reinforce the information
Develop a management plan
immediate
long term
patient participation in decision making
Patient education model
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Learning by doing
the right step towards positive action
Good human relationship
patients must accept you as a friend
Leader
patients learn best from the educator whom they
respect and regard
conclusion
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Practicing the principles of patient education will
facilitate the doctor relationship with patients and
families and improve patient’s satisfaction, and
outcome.