Patient and Public Involvement (PPI)

17 Apr

Previously I had always overlooked PPI in favour of other more exciting things in healthcare, like the social determinants of disease and the importance of defining quality and measuring quality. Nevertheless, I can now see why patient public involvement is increasing in popularity and prominence in the world of public health and beyond.

There are the obvious things that you’d expect PPI to improve like patient empowerment and satisfaction, accountability of healthcare providers and appropriate treatment and care. In addition, PPI has been shown to improve quality of care which in turn can lead to increased compliance and better health outcomes. Nevertheless, with the above attributes, PPI remains a tool to improve the patient’s outlook on life with apparently very little benefit for the health professional or indeed, the health system itself.

Currently however, extensive patient public involvement is becoming a widely realised necessity to the health systems of the future. Okay that sounds grand but hear me out: we are seeing a massive epidemiological transition in the burden of disease globally, with increasing prominence in long term diseases such as diabetes, cardiovascular disease and mental health problems. Alongside this, ever-tightening budget restraints and a history of unsustainable spending is forcing many health systems along with the NHS to reconsider its action plan. We all know primary health care is the crux of a cost effective healthcare system but with PPI, it can be improved and enhanced even further.

Increasing PPI offers the opportunity to shift the focus from a reactive healthcare system dependent on specialised care in hospitals to a proactive healthcare system represented by extensive localised networks of community services. In doing so, PPI can help shape a much needed reform to fit the needs of the population. PPI can allow systems to be adapted to a population’s cultural or otherwise non-medical needs.

The Health Foundation’s scoping paper written by Angela Coulter (2009) gives many local examples in the UK that show the impact of various PPI projects. Of what I read (exam time dictates selective reading), it was really useful seeing how PPI was improving not only the patient experience but was also increasing efficiency of the health system.

The growth of ideas such as the Third Way and co-production is perhaps a reflection of the populist appeal they hold. PPI is a great way in which we can humanise the often bureaucratic and heartless health system, transforming its image for the public. Additionally, PPI holds great potential in accelerating the drive for efficiency within the healthcare sector without the need for introducing market principles or competition directly. PPI is a necessary companion to primary health care and it holds promise of salvaging the UK’s healthcare sector from its predicted trajectory.

Guess what time it is….

17 Apr

Exam time! Woke up today with what I can only describe as a massively overdue sense of panic and doom. Hopefully I’ll be able to pick up the slack before the exam which is in two weeks, and let’s try not to think about the not-so-mini-project which I have yet to start. EEEK.


The NHS and patient safety

5 Feb

Sir Liam Donaldson told us last week in a lecture on patient safety that 1 in 300 patients admitted to a NHS hospital die a preventable death every year. For such a rich and developed country, 1 in 300 is unnecessarily high and reflects pretty poorly on the current NHS. Although this great British institution is a great achievement, it also screams of inefficiency and unsustainable practice that threaten to shorten its days as we know it. The warning bells for the NHS have been ringing for quite some time, and a systems wide change is desperately needed. Will the reforms (due in April) improve the NHS? I don’t think it should be discounted, despite the vast opposition to it, but the stress of implementing such a fundamental change to a complex health system short on funds is unlikely to show immediate results. Nevertheless, I’m inclined to remain hopeful (should that be naive?): opposing change is no use when it’s already happening around you.

First steps into Health Economics

23 Jan

Having entered the foreign world of health economics, I’ve picked up on a few key terms that are really fundamental within the field. Here I try to define them in my own words… Yikes.

Utility: the benefits a good/service might bring to an individual; e.g. health services improve health or maintain health, which is valued formally as utility. It is described in mathematical terms as a fuction of each medical service received i.e. U = U(X,Y,Z etc) NB we assume individuals are rational; ie their behaviour is consistent with their aims. For example, someone in last week’s lecture asked whether the utility function applied to a drug user’s “utility” gained from using coccaine, the “goods”. Here, it is clear that the utility function doesn’t apply because addiction is not a rational behaviour. This doesn’t mean the consumption of addictive goods can’t be modelled though, a model has been shown to accurately show that “addicted people maximise utility consistently over time”. (Morris et al, 2012)

Marginal utility: this describes how much utility increases by per increase in consumption of the medical good/service. In mathematical terms, it is described as the slope of the curve; if you think about it (well I had to think about it) the slope of a curve indicates the change in the y-axis (utility) per change in the x-axis (medical good/service), which makes perfect sense! ­čÖé

As you can see from the Utility curve, as the quantity of medical care consumed increases, utility doesn’t increase exponentially. The lecturer used chocolate as an example: A chocoholic will be very happy after 1 bar of chocolate, pretty happy after 2, not so great after 3… There is clearly a limit on the utility of medical care, irrespective of how many operations/casts/drugs you receive. This decrease in marginal utility allows two laws to be established:

The Law of diminishing marginal productivity: each additional unit of medical good/service is associated with smaller and smaller improvements in health

The Law of diminishing marginal utility: Increasing health is associated with smaller and smaller increases in utility

That’s it for now as I like to take things slooooow… Just kidding, coursework is starting to get on top of me again…

References: Morris S, Devlin N, Parkin D & Spencer A (2012) Economic Analysis in Healthcare (2nd ed)

Dissertation stress…

20 Jan

As term 2 flies by, it is clear that nabbing a dissertation topic has become priority. I’m not looking forward to making the decision, partly because I’m worried I’ll strike unlucky with the project or supervisor, and because I am super indecisive. We are given 4 months for the project over summer, and having had a bad experience with unmotivated supervisors during my undergrad, I’m keen to invest time into making the right decision. We’ve been given an extensive list of project titles to consider, and although I have managed to whittle this down to less than 10 titles, I am still far from having made a decision. My research interests are shamefully broad and unspecific, although at this stage in my career I’m definitely sure that policy analysis would be over my head. I am also pretty confident that systematic reviews will not keep me interested for four months – having started a module purely on systematic reviews I can confirm that they do not excite me greatly, although admittedly they are more interesting than I thought. Otherwise, after a term and a bit’s worth, I know that I’d like to research something in the field of primary care; in the context of health systems it is undoubtedly the most widely utilised by the majority of the population. We all know the oft-repeated public health statement of “prevention not treatment” but the importance of primary health care goes beyond prevention. The shift in focus from specialist treatment to primary health care in recent years has been alongside a move away from the paternalistic approach to medicine. I think this is not pure coincidence; by emphasising primary services, health professionals have had greater opportunity to empower patients and increase their participation in treatments and care. Additionally, doctors are increasingly working on a more level playing field with patients with the rise in the burden of chronic diseases which often require the patient’s input as well as medical intervention. Primary health care presents great value for money which in today’s climate of economic turbulence can only be a good thing.

That’s enough poorly articulated arguments about primary care, now back to the actual project selection: I’m planning on meeting each supervisor armed with what is probably considered an inappropriate number of questions to grill them with. These are on their expectations of the project and of me, the nature of the data source and whether I could use it remotely, the scheduled time scale of things, etc. I’m hoping the answers to these questions as well as meeting the supervisors in person to judge the extent of personality concordance will help me decide! If anyone has any further advice on how to choose a dissertation, it would be greatly appreciated. ­čÖé

New module: Health Economics

16 Jan

Today we started the health economics module organised by the business school. It was a pretty brief introduction that took the first steps into the deep deep waters of health economics… I had been looking forward to this module and simultaneously dreading it as I have no knowledge of any economics whatsoever. The lunch afterwards provided a great opportunity to start getting to know the students from the International Health Management course, who we will be sharing lectures and coursework with. First impressions of both the course and the new students were good, most seem to be clueless about economics too which is reassuring! Will keep you posted on how it goes!

Theory of Planned Behaviour

7 Jan

The theory of planned behaviour (TPB) is possibly the most popular health behavioural model out there apparently. An individual’s intention to carry out a health behaviour is shaped by 3 things: attitude, social norms, and perceived behavioural control. Depending on these three factors, once enough intention is built up this is translated into actual behaviour.

Theory of Planned behaviour

Theory of Planned behaviour

ADV: It has been used extensively throughout social psychology as well as public health. It includes the all important consideration of social pressures et al on an individual’s behaviour. It gives an accurate prediction of behaviour in comparison to the other models

DISADV: it is a motivation model like the HBM and the PMT, meaning that intention is the key focus. In actual fact, there is such a thing called the Intention behaviour gap which signifies the difficulties in getting individuals to convert their intentions (I want to quit smoking) to the action (I will quit smoking, NOW!).