Saturday, 31 March 2007

Health Promotion

Issues to consider in Part A:

“Hey – maybe we can quit together”

Role of Doctors in helping patient quit smoking:

Treatment depends on patient’s status. 3 different catergories:
- Patients willing to quit
- patients unwilling to quit and
- patients who have recently quit.

patient has to want to quit before you can encourage him/her!! Patient’s own decision.

- assistance and support of a doctor in helping a patient quit smoking has been proven to be more successful (most patient’s stuck in pre-contemplation/contemplation phase - don’t know how to go about the next step and carry out action plan – role of GP)
- a little encouragement goes a long way!
- Keep track of where patient is in Prochaska Di Clemete cycle and facilitate the steps (of course don’t facilitate relapse la!)
- Motivational approaches include detrimental effects of smoking and benefits of quiting, not jut health wise but financial wise, encourage patient’s to think about love life, family, social life
- Reinforcement for success (have a buddy, quit together, motivate each other, praise each other on successes no matter how small)

Strategies for behavioral change:
1. pick appropriate behaviour – quit smoking

2. pick appropriate methods
- (SAME)
- set time frame
- Stimulus control (eg stay away from places where people smoke a lot such as clubs and pubs)
- doctors should help patient decide methods (therapeutic? Pharmacological – quit smoking medications?) cold turkey/gradual cessation? Methods depend on tobacco status of patient

3. do not expect too much
about 70% of smokers trying to quit will fail using any particular method

4. give method a chance to work
- observe behavious : Think over Antecedents and address these issues – ie has the patient tried to quit before? What went wrong? What is preventing him quitting now? Ask him to keep a record of his quit campaign so you can see what works and what doesn’t, so you can change these if patient fails on the first attempt.

5. people are not failure, but the methods maybe
- If methods fail, reiterate to patient that it is the method that is a failure, not him.
- lapses are likely to occur with any behaviour change program. Does not mean failure!

“They’ve never been to this clinic before” (suggests that they’ve been GP hopping)

Benefits of continuity of care

The concept of a long-term relationship between a patient and a doctor is a hallmark of primary care and has long been thought to improve health outcomes. Recent research has confirmed that better continuity of care is associated with a higher level of trust between doctor and patient, and contributes to better quality health care. Conversely, discontinuity of care plays a role in many medical adverse events.

Benefit of having a regular family doctor for patients who are chronically ill:
- Doctor is able to accumulate a thorough and continuos knowledge of the progression of the patient’s condition
- Doctor is more in control of the healthcare network surrounding the sick patient, ie specialist referrals, hospital admissions, etc.
- Doctor comes to know the patient, his family, and their psycho-social needs, and thus can better understand and manage the patient’s response to various aspects of the management of his disease
- Can develop a strong, good relationship with patient, thus aiding his compliance to treatment
- Provides continuation to patient in a tumultuous time


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