Community Orientation

Dr Omar Makki - GP ST3

What is Community orientation?

It is one of the 12 competencies we are assessed for in EVERY workplace based assessment

(CbD, COT, CSR)

What is it about?

This competency is about the management of the health and social care of the practice population and

local community

Needs Further Development

• Identifies important characteristics of the local community that might impact upon patient care, particularly the epidemiological, social, economic and ethnic features

• Identifies important elements of local health care provision in hospital and in the community and how these can be appropriately accessed by doctors and patients

• Identifies how the limitations of local healthcare resources might impact upon patient care

Competent

• Applies an understanding of these features to improve the management of the practice's patient population

• Uses this understanding to inform referral practices and to encourage patients to access available resources

• Optimises the use of limited resources, e.g. through cost-effective prescribing

Excellent

• Uses an understanding of these features to contribute to the development of local healthcare delivery e.g. service design.

• Uses an understanding of the resources and the financial and regulatory frameworks within which primary care operates, to improve local healthcare

• Balances the needs of individual patients with the health needs of the local community, within the available resources

Who is a vulnerable Adult?

Who is a vulnerable Adult?

A vulnerable adult is someone aged 18 or over: 

– Who is, or may be, in need of community services due to age, illness or a mental or physical disability.

– Who is, or may be, unable to take care of himself/herself, or unable to protect himself/herself against significant harm or exploitation.

(Definition from the Department of Health 2002)

Which adults are vulnerable?

Abuse can affect any vulnerable adult, but particularly someone who is, or may be, unable to protect themselves against significant harm or exploitation, for example:

– Older people– People with mental health problems– Disabled people– People with learning difficulties– People with acquired brain damage– People who misuse substances

Falls assessments

The NICE clinical guideline on falls covers older people who live in the community, either at home, in a retirement complex, or in a residential or nursing home.

In this guideline, an older person is defined as someone who is aged 65 or older.

Who needs a falls assessment

Older people who present for medical attention because of a fall, or report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance should be offered a multifactorial falls risk assessment.

This assessment should be part of an individualised, multifactorial intervention.

Multifactorial falls risk assessment

• identification of falls history• assessment of gait, balance and mobility, and muscle

weakness• assessment of osteoporosis risk• assessment of the older person’s perceived functional

ability and fear relating to falling• assessment of visual impairment • assessment of cognitive impairment and neurological

examination• assessment of urinary incontinence• assessment of home hazards• cardiovascular examination and medication review

Multifactorial interventions

All older people with recurrent falls or assessed as being at increased risk of falling should be considered for an individualised multifactorial intervention. It involves:

•Strength and balance training•Home hazard assessment and intervention•Vision assessment and referral•Medication review with modification/withdrawal.

OCCUPATIONAL THERAPY ASSESSMENT

The purpose of Occupational Therapy is to enable patients to perform those daily occupations they find useful or meaningful in their environment.

INITIAL ASSESSMENT

Through a semi-structured interview with the patient, all

areas of function are assessed:

• Self care: dressing, grooming, hygiene, sleeping, eating, homemaking, transportation, money management, etc.

• Productivity: schooling, employment, volunteer work, etc.

• Leisure: areas of interest and participation, etc.

• Components of the patient's mental, physical and psychosocial performance are also assessed at this time.

FURTHER ASSESSMENT

• Functional assessment: to identify the performance components contributing to the patient's dysfunction through activity analysis, eg., making a meal, taking a bus, etc.

• Home assessment: to determine how the patient's home environment contributes to his/her function and/or dysfunction.

• Standardized assessment: to gain qualitative and quantitative data regarding the patient's current level of function, e.g., Canadian Occupational Performance Measure (COPM), Cognitive Competency Test (CCT).

Who are Community Matrons?

Community Matrons

Community matrons are highly experienced, senior nurses who work closely with patients (mainly those with a serious long term condition or complex range of conditions) in a community setting to directly provide, plan and organise their care.

The role of Community Matrons

• As well as providing nursing care, community matrons act as ‘case manager’ – a single point of contact for care, support or advice, typically for a caseload of around 50 very high intensity users.

• Community matrons are usually deemed to be working as advanced nurse practitioners

What is Podiatry?

What is Chiropody?

Podiatry

Podiatry or podiatric medicine is a branch of

medicine devoted to the study of, diagnosis, and treatment of disorders of

the foot, ankle, and leg.

In many English-speaking countries, the older title of "chiropodist" may be used by

some clinicians

What is a Chiropractor?

What is an Osteopath?

Chiropractic

Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuro-musculo-skeletal system and the effects of these disorders on general health

Osteopathy

Osteopathy is a system of diagnosis and treatment for a wide range of medical conditions.

It works with the structure and function of the body, and is based on the principle that the well-being of an individual depends on the skeleton, muscles, ligaments and connective tissues functioning smoothly together.