2Anticipatory Care & principles of patient health education Prof. Sulaiman Al-ShammariDepartment of Family & Community Medicine , College of Medicine King Saud University , Riyadh, Saudi Arabia2
3At the end of this session students would be able to: Anticipatory CareLearning ObjectivesAt the end of this session students would be able to:Define anticipatory careRecognize its importance.Recall levels of prevention with appropriate examples.Define screening.Recognize its principles.Recall criteria of screening.
4PHC and anticipatory care. Level of preventive intervention. ContentIntroduction.Definition.PHC and anticipatory care.Level of preventive intervention.Screening:- Definition- Principles- EthicsConclusion.
5“There I am standing by the shore of a swiftly flowing-river and I hear a cry of a drowning man. So I jump into the river, put my arms around him, pull him to shore and apply artificial respiration. Just when he begins to breathe, there is another cry for help. So I jump into the river, reach him, pull him to shore, apply artificial respiration, and then, just as he begins to breathe, another cry for help. So back in the river again, reaching, pulling, applying, breathing and then another yell. Again and again, without end, goes the sequence. You know, I am so busy jumping in, pulling them to shore, applying artificial respiration, that I have no time to see who the hell is upstream pushing them all in”.Zola, I.K. “Helping – does it matter? The problems and prospects of mutual aid groups”.
6Benefit of Treating The Metabolic Syndrome: Finnish Diabetes Prevention Study 25%20%After 4 years, risk of diabetes reduced by 58%15%10%The cumulative incidence of diabetes was lower in the intervention group than in the control group. At four years, the cumulative incidence was 11% (95% CI, 6%-15% ) in the intervention group and 23% ( 95% CI, 17-29%) in the control group.According to the Cox regression analysis of all-persons-years accumulated, the cumulative incidence of diabetes was 58% lower in the intervention group than in the control group.Tuomilehto J, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:5%0%InterventionControlWith Diabetes (%)Tuomilehto J, et al. N Engl J Med. 2001;344:
7Serum cholesterol level Levels of Risk Associated with Smoking, Hypertension and HypercholesterolaemiaHypertension(SBP 195 mmHg)x3x4.5x9x16x1.6x4Multiple risk factors for CVD are usually present in an individual; rarely do they occur in isolation. When risk factors co-exist the effect is often exponential; their combined effect is greater than the sum of their individual effects.1Multiple risk factors are also associated with the metabolic syndrome which is characterized by dyslipidaemia, hypertension, insulin resistance, visceral distribution of body fat, and a prothrombotic state.2References1. Poulter N. In Cardiovascular Disease: Risk Factors and Intervention. Eds: Poulter N, Sever P, Thom S. Radcliffe Medical Press, Oxford, 1993.2. Deedwania PC. Am J Med 1998;105(1A);1S-3S.x6SmokingSerum cholesterol level(8.5 mmol/L, 330 mg/dL)Poulter N et al., 1993
8The Rule of Halves in Hypertension ½ Known treatedand controlled½ of thoseTreatedNot controlled½ not known½ of those knownNot treated
10About six cents of every health dollar in the U. S About six cents of every health dollar in the U.S. is spent on medical and health research.Source: America Speaks: Poll Data, Vol. 5, Research!America, 2003.
11Less than one cent of every health care dollar in the U. S Less than one cent of every health care dollar in the U.S. is spent on prevention research.Source: America Speaks: Poll Data, Vol. 5, Research!America, 2003.
12What is anticipatory care? It include all measures which promote good health and prevent or delay the onset of diseases or their complications.This care aims to:Improve the quality of lifeReduce the premature disabilityIncreased life expectancySo it denotes “the essential union of prevention with care and curve”(RCGP-1981).
13The optimum setting for anticipatory care: Primary Health Care.Frequent contacts.Defined population.Primary-care team.Dr.-Pt. relationship.Holistic approach.
15ACCOMMULATION OF HAZARDS Risk behaviorUnbalanced dietInactivityObesitySmoking
16Conclusion:Anticipatory care is the integration of prevention and cure.PHC service is the optimal place to apply this care and observe.Every opportunity to be utilize to deliver this care.Case finding V/S formal screening.
17Successful Health Promotion Regular ExerciseBalanced DietIdeal Body WeightNo Smoking
19patient education purposes Conveying knowledge and understandingCreating a different attitude or perspectiveBuilding skillsChanging behavior
20Factors to consider Patient’s and family’s beliefs and values Their literacy, educational level and languageEmotional barriers and motivationsPhysical and cognitive limitationsThe financial implications of care choices
21To ensure pt ed is effective component of pt care Incorporate it into mission and strategic prioritiesCreate environment that encourage pt ed effortsEnsure infrastructure to oversee, provide and support pt edIncorporate it policies, procedures and protocolEnsure performance improvement address pt edProvide necessary resources (staff, training and materials)
22Improving patient education Assess educational and clinical needsInclude in patient education classesSkills lab for patient and familyIndividualize printed materials (?culturally sensitive)Educational telephone programSelf-monitoring diaries for self assessment and learningWell prescription (behavior, exercise, diet, stress ,reading ect)Workshops for staffMultidisciplinary pt ed committees + pt +family (needs, design, evaluate )
23Challenges to effective education Sensory and physical impairmentsIlliteracyLanguageAgeSocial, cultural, spiritual
24The value of patient education can be summarised as follows: Improved understanding of condition, diagnosis, disease, disabilityImproved understanding of methods and means to manage multiple aspects of medical condition.Improved self advocacy in deciding to act both independently from medical providers and in interdependence with them.Increased Compliance .Patient Outcomes –respond well to plan – fewer complications.Informed Consent.Utilization – More effective use of medical services .Satisfaction and referrals .Risk Management - Lower risk of malpractice when patients have realistic expectations.