Post on 22-Dec-2015
Person-centred care &
Sources of Health and
Demographic
Information
Patrick Elder
What is person-centred care?
Four definitions given in our lecture:
• Person-centred care is ‘treating patients as they want to be treated’ (Person-Centred Practice, 2008)
• ‘… providing care that is responsive to individual, personal preferences, needs and values and assuring that patient values guide all clinical decisions (Evidence into Practice, NHS Scotland)
• ‘ … putting patients and their families at the heart of all decisions’ (The Health Foundation)
• ‘No decision about me, without me’ (Liberating the NHS: Equity and Excellence, 2010)
I’d at least learn the top two!
What are the 6 key components of
person-centred care?• Seeing (and getting to know) the patient as a person rather than the
person as a patient – person’s own experiences are valued
• Putting the person’s needs and preferences, as they define them, first and above those as identified by clinicians - person’s definition of the situation that is important
• Shared decision making: patients and doctors as partners in decision-making and management of conditions
• Recognising the person’s strengths in self-care and management of their condition
• All interactions and care underpinned by values of compassion, dignity and respect
• Patient and public involvement in the design and delivery of services.Terrible mnemonic: SPS RAP / Sean Paul RAPS
Why is person-centred care considered
important? (3)
• Evidence of positive outcomes for patients
• Social and political drivers
• Concurs with ethical principles underpinning duties of a doctor
Name four social and political
drivers behind person-centred care • Wider society: less hierarchical
relationships, less deference, more critical and questioning public → patients want to be involved
• Patient dissatisfaction with the NHS: evidence from surveys
• Spiralling economic cost of NHS: better outcomes for patients may control costs (currently no UK evidence of reduction in costs)
• Recent reports on appalling care standards at Mid Staffordshire NHS Trust (Francis report in 2013) and Serious care review of Winterbourne View Hospital (2012)
What effect have these social and
political drivers had on health focus?• Together these have increased health policy focus*
on:
• Delivering safe, dignified and compassionate care
• Putting the person at the centre of their own care
• Patient and public involvement in service planning
*See Health and Social Care Act(2012), Liberating the NHS :Equity and Excellence (2010), NHS Constitution
Not sure if you need to learn this, but it’s worth being aware of it
What are the 5 ethical principles and
values that underpin person-centred
care?• Respect
• Autonomy
• Dignity
• Care
• Consequences
How to remember them:
CRACD (or RADCC if you’re unimaginative)
What are the 3 conditions of autonomy?
Three common conditions of autonomy
• Capacity (age 16 and over assume capacity)
• Freedom (requires freedom from interference and opportunities for choices)
• Authenticity ( consistent with personal identity and values)
There are definitions for all of the principles in the lecture, but I wouldn’t worry about knowing them too well.
What are the 5 elements of
dignity?Elements of dignity:
• Respect
• Privacy
• Self-esteem
• Freedom from unnecessary pain
• Autonomy
What underpins the principle of care in a
healthcare context? 3 things
Beneficence (doing good…but from whose perspective?)
Best interests
- Best interests test in Mental Capacity Act 2005
An ethic of care (relationships and responsibility)
What are the four consequences that underpin
the ethics of person-centred care?
Better patient outcomes
Fewer complaints
Less litigation
Increased trust in the medical profession
Sources of demographic
and health information
Which tool do we use to assess the
quality of health information?
The CARTA framework:
Completeness
Accuracy
Representativeness / relevance
Timeliness
[Accessibility]
What is a population census?
A census is:
“the simultaneous recording of demographic data by the government at a particular time pertaining to all the persons who live in a particular territory” (United Nations)
Census describes both households and people
UK Census history: who carries it out, and
how often? When did it start?
Office for National Statistics (ONS) in England and Wales
Every 10 years since 1841
Legal requirement to complete it
How accurate is the Census?
Explain your answer
Complete source of population info - 98%
Why not 100%?
Low enumeration groups e.g. students, babies, travelling families etc. - hard to get data from them
Accuracy: England &Wales: 52 million ± 0.2% (2001) - so highly accurate
How much does the Census cost?
2011 Census: £480 million
How is the census information submitted?
2011: Online completion (or post back)
What are the 5 categories of data
that we can obtain from the census?
Demographic data - age / sex
Cultural Characteristics - ethnicity / religion
Material deprivation - employment / home ownership / overcrowding / car access / lone parents / lone pensioners
Health – General, long-term illness, unpaid care
Workplace & Journey to work
How is UK Census data useful for healthcare workers? 3
Population size & structure: young, old, ethnic minorities service needs
Base population (denominator) rates
Measures of material deprivation:
identify & target inequalities
Strength & Weakness – UK CensusStrengths Weaknesses
Completeness 98% complete Low enumeration of some groups
Accuracy Check of forms, coverage survey: population +0.2%
Self reported – religion ‘Jedi’ !!
Representative/relevance
Data available for different levels (200 people to country)
Low enumeration of some groups
Timeliness 10 years. Takes time for release.
Access www.ons.gov.uk/Local councils
Individual returns confidential 100yr
Describe the process of Birth Registration
Office for National Statistics (ONS) – Birth Statistics
Birth Registration – by parent(s) within 42 days
Birth Notification
– by birth attendant (usually midwife) within 36 hrs - to Health Authority (child health record, health visitor)
Local Registrar for Births, Marriages & Deaths
Describe the process of Death Registration
– certifies the fact of death
Death Certificate issued by Doctor - age, place of death
- information on cause of death
– by informant (usually relative) within 5 days Death Registration - Local Registrar for Births, Marriages & Deaths
Office for National Statistics (ONS) – Mortality Statistics
DefinitionsWhat is the Crude Birth Rate?
Crude Birth Rate = live births / 1,000 popl.
What is the General Fertility Rate?
General Fertility Rate = live births / 1,000 women aged 15-44 yrs (child bearing lifespan)
What is the Total Fertility Rate?
Total Fertility Rate = “average number of live children that a group of woman would have if they experienced the age-specific fertility rates of the calendar year in question throughout their child-bearing lifespan”
Birth and death data
Strengths (2)
Complete coverage in UK (births as well)
Important information on health of the population
Weaknesses (4)
•Accuracy? e.g. underlying cause of death subject to diagnostic uncertainty, coding issues and variable quality.
•Not reliable as picture of morbidity
•Ethnicity not collected
•Derivation of socio-economic status - posthumous inflation of status
How do we use population estimates and projections?Why ?
Used for planning services / resource allocation
In the past: to understand what has been happening to the population
The present: to make sense of present activity
In the future: to predict what is going to change
When would you make a population
estimate, and how would you do it?
Estimate of population size & structure between census – no point doing it in a census year because it’ll give you the data
Applies what is known on births/deaths/migration to present
Census baseline + births – deaths + migration
What are the strengths and
weaknesses of population
estimates?Strengths (2)
• more up to date than the census
• more accurate than projections
Weaknesses (3)
• less reliable with time from census
• poor information on migration
• says nothing about the future
What is the purpose of population projections? What
assumptions are they based on? (3)
Forecast future population size and structure
Based on assumptions about: mortality
fertility
migration
What are the strengths and
weaknesses of population projections?
Strengths (1)
Can be used for longer term planning
Weaknesses (2)
• Less accurate the further ahead they look
• Unforeseen changes of past trends can invalidate projections
What are the 3 main sources of
morbidity data in the UK?Cancer registration system
Cancer diagnosis triggers registration
Notifications of infectious diseases
NHS activity data
Hospital Episode Statistics (HES)
QOF data
What are the main sources of information about
determinants of health? 2
Range of information available e.g.
socioeconomic, deprivation (census)
lifestyle factors e.g. smoking, diet (surveys)