anticipatory care

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Anticipatory care

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Anticipatory care . When meditating over a disease, I never think of finding a remedy for it, but, instead, a means of preventing it. Louis Pasteur 1884. If we take responsibility for preventive work only of proven value we shall have our hands full. 1Diseased, diagnosed & controlled - PowerPoint PPT Presentation

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Page 1: Anticipatory care

Anticipatory care

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When meditating over a disease, I never think of finding a remedy for it, but, instead, a means of preventing it. Louis Pasteur 1884

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If we take responsibility for preventive work only of proven value we shall have our hands full.

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4

1 Diseased, diagnosed & controlled

2 Diagnosed, uncontrolled

3 Undiagnosed or wronglydiagnosed disease

4 Risk factors for disease

5 Free of risk factors

Diagnosed disease

Undiagnosed orwrongly diagnosed

disease

Iceberg phenomenon ?

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Does it work?

USA: Mortality from stroke has decreased by 50% since 1972– Early diagnosis and treatment of hypertension

Mortality from cervix cancer decreased by 80%– Pap smear

Neonatal screening: Decrease in mental retardation– Phenylketonuria screening– Congenital hypothyroidism

5National 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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Health promotion WHO "the process of enabling people to increase control over and improve their health

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Why in Family Practice ?

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Frequent contact between patient and doctor over many years

Responsibility for a defined population The contribution of PHC team The power of dr-pt relationship

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Role of Clinician in Prevention:- Changes in the pattern of diseases and

opportunities for prevention  Limitation of high technology medicine  Pressure on doctors to practice prevention

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Aims:

1-Improve the quality of life.2-Reduce the burden of premature

disability.3-Increase life expectancy.

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Health Promotion:

1-Primary Prevention:Health education.Prophylaxis.

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Action taken to prevent the occurrence of diseases

e.g. health education, immunization, sanitation sterilization of surgical instruments, eradication as with mosquitoes to prevent malaria.

* No disease or symptom but risk factor present

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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.

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Cont.

2-Secondary Prevention:Screening. Case finding.

3-Tertiary Prevention : systematic long term monitoring to prevent

or minimize the impact of complication.

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Secondary:-Early diagnosis and prompt treatment Disease present and diagnosable but no symptoms present Screening Planned (pap smears, mammography)

Opportunistic (check B.P. pt with sore throat)

Difference between planned and opportunistic

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Tertiary:- Management of established disease so as

to minimize disability Disease diagnosed and symptom presente.g. Management of D.M. to reduce

complication rehabilitation of stroke patient

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What are primary care physicians doing?

Preventive Medicine!

Primary Prevention Secondary PreventionTertiary

Prevention

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Secondary Prevention:

A. Screening: Are systematic attempts to detect undeclared

disease in a population of apparently healthy people.

Before mounting a screening initiative certain

criteria must first be satisfied (Wilson, 1973) .

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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.

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The Criteria:

1- The condition (the disease) sought should be:Important.Recognizable at an early stage.Readily treatable.

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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.

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Cont. PHE

4- Treatment should be:RecognizedEffective.

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.

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Cont. PHE

8-The population screened : Sufficiently high disease prevalence. Accessibility

9-Compliance with subsequent diagnostic tests &necessary therapy.

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Does it work?

USA: Mortality from stroke has decreased by 50% since 1972– 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

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Rationale:

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%

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Think of your daily life

A50-year old woman applies to your office. She has no history of disease but afraid of having breast cancer. – Should you perform a breast exam?– Should you teach her breast self exam?– Should you order a mammography?

How do you decide?

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Rationale

It’s an important disease for women– Worldwide 719000 new cases/year. (1/1000)– Ist female's cancer (Saudi cancer registry)

It can be recognized early without symptoms– Mammography

Curable– Surgery, Chemotherapy, Radiotherapy

The value of treatment is far more than its adverse effects

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Screening / PHE programs in Saudi Arabia

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

30

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Costs of Screening

Patients:anxietyfalse reassuranceeconomicDoctorsgovernment

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Obstacles to Prevention

Discuss the obstacles to prevention from:patientsdoctorsgovernment

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Overcoming Patient Obstacles

• Point out debits• Point out benefits• Anticipate and discuss difficulties• Suggest coping strategies• Simple advice and written information

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Conclusion:

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.

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Principles of patient education

Interest the recognition of the need patients are unlikely to listen to those things

which are not to their interest

Motivation

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Principles of patient education

Participation active learning Known to unknown knowledge is build up to enable patients to

develop an in-depth insight into their own health problems

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Principles of patient education

Comprehension Making patient understand what you say Educational background Mental capacity Re inforcement repetition of the information in the same or

during subsequent consultation

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Principles of patient education

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

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Principles of patient education

Encourage feed back

Involvement of others e.g. family members where appropriate

Establish wheather the objectives have been met and the patient is happy with the outcome

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Principles of patient education

Provide take away information patient instruction leaflets resource contacts

Arrange follow up Reinforcement of information preventive measures

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Principles of patient education

It is sometimes wrongly assumed that just by providing people with information, they will automatically be able to make healthy choices.

Examples ??

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Principles of patient education

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?

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Patient education model

Establish the patient’s knowledge of the problem

Describe the problem

Establish the patient’s attitudes to the problem

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Patient education model

Correct any incorrect health beliefs

Supplement the patient’s existing knowledge to a level appropriate to the needs of the patient and the doctor

Facilitation by the use of special charts, diagrams, models.

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Patient education model

Explore other preventive opportunities Reinforce the information Develop a management plan immediate long term patient participation in decision making

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Patient education model

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

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conclusion

Practicing the principles of patient education will facilitate the doctor relationship with patients and families and improve patient’s satisfaction, and outcome.

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