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90 Cards in this Set

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Why are consumers frequently dissatisfied with traditional western medical care? (2)
1)skepticism
b)patients increasingly informed
Is the purchaser of a prescription....(2)
1)consumer
2)patient
Role of Health Care Provider (3)
1)treat sick
2)care offered primarily during acute periods of illness
3)not generally associated with wellness or prevention
HC providers not generally being associated with wellness or prevention is reinforced via...(2)
1)health insurance philosophy
2)active-passive role of patient
Changing ppl to include "wellness behavior" is SLOW just look at rates of....(4)
1)smoking
2)alcohol consumption
3)exercise
4)weight control
Health care in US is a "SICKNESS" model meaning...
early signs of chronic diseases are ignored until condition is critical
When does CAD begin?
as early as 7yo
Health providers come into contact w/ patient only during sick periods b/c...(4)
1)individual priorities (time)
2)limited resources ($)
3)screening not a priority for patients
4)reimbursement structure (insurance)
Structure of health care system (2) and what this means
1)reduction of acute conditions
2)shift to continuous treatment of chronic diseases

Consumers reqd to assume more active role in health care
How do you make an informed consumer decision as a patient? (2)
1)rely on advise of health professionals
2)use marketing model (access info to make purchase decision)
Consumers are becoming active in health care process by gathering info via...(3)
1)internet
2)DTC drug advertising
3)hospital stats
Patient centered model of care shifts focus from...(2)
body system/disease to person as a whole

biomedical to biopsychosocial
In the Patient centered model of care consumer have greater satisfaction when...and ex
treated as a person instead of a medical problem

don't ID patient during rounds by disease, ID by name
_____ is the most patient centered care
hospice
3 Patient-Provider models of care
1)active-passive model
2)Guidance-cooperative model
3)Mutual-Participation model
Active Passive Model def. (3)
1)active MD tells what to do
2)patient does it without really understanding why
3)like parent/infant
Guidance Cooperative Model def. (2)
1)like teacher/student
2)MD still in control but tries to make patient understand what is going on
Mutual-Participation Model def. (2)
1)MD and patient are equally powerful
2)happens a lot w/ chronic diseases
Biopsychosocial model def. (4)
Incorporates health and illness as a product of:
1)physical
2)social
3)emotional
4)psychological context
Biopsychosocial model defines health as...
complex set of variables more extensive than a set of clinical indicators
Health Behavior Models fxn (2)
1)help explain health behavior
2)assist in aiding patients to change their health behavior
4 different Health Behavior Models
1)Social Cognitive Theory
2)Theory of Reasoned Axn
3)Health Belief Model
4)Transtheoretical model of change
Social cognitive theory model def. (2)
1)first social-behavior model trying to explain health behaviors
2)our expectations influence our behavior
Social cognitive theory expectations that influence behavior (2)
1)outcome expectations
2)efficacy expectations
Outcome expectations
belief that certain behavior results in particular outcome
Efficacy expectations
own expectations that can accomplish behavior (we either think we can or can't do something)
KEY to social cognitive theory (2)
1)individuals perceptions of the expectations
2)efficacy expectations must match outcome expectations or it won't happen
Social cognitive theory locus of control?
1)what inspires one to do something or not
External locus (social cognitive theory)?
think it is outside of your control to change your health behaviors
When did Health Belief Model occur (HBM)?
started in 1950's w/ free immunizations
HBM key
likelihood that individual will take action or change behavior
Use of HBM?
to understand the success or failure of health behavior change via susceptibility and severity
Susceptibility (HBM)
PERCEPTION of individual risk
Severity (HBM)
PERCEPTION of seriousness of disease if untreated
Additional factors in HBM (2) (and ex of each)
1)PERCIEVED benefits (will change/eliminate condition)
2)PERCIEVED barriers (compliance/SE's)
Decision to change health behavior in HBM depends on...(2)
1)indivial perception of risk and severity
2)likelihood of action after weighing perceived benefits/barriers
Modifying factors of HBM (8)
1)age
2)education
3)race/family
4)personality
5)social status
6)reference groups
7)peer pressure
8)prior experiences
Influences in health behavior in HBM (2)
1)cues to axn like commericals and seeing what's happening to others
2)self-efficacy/confidence in ability to act
To quit smoking (steps in relation to HBM) (5)
1)believes that he is susceptible to (-) effects
2)recognizes severity of risk
3)recognizes potential benefits
4)Wonder if barries will be too great
5)wonders if will get support of family members
HBM doesn't...
help to change ppl; just to understand them
Transtheoretical model of change
a)fxn
b)developed by...and why?
c)theory behind it
d)people must...
a)meant to help change ppl; not just to understand them
b)Prochaska; other models didn't explain why behavior change worked in some and failed in others
c)behavior change not just set of perceptions & factors
d)go thru set of states before behavior change occurs
TTM Core Constructs (5)
1)Five Stages of Change
2)10 Processes of change
3)Decisional balance (pros vs. cons)
4)self-efficacy
5)temptation to relapse
TTM 5 Stages of Change to healthy behavior
1)precontemplation
2)contemplation
3)preparation
4)action
5)maintenance
TTM Precontemplation Stage (4)
1)No thought of change
2)unmotivated
3)demoralized
4)wont act for next 6 months
TTM Contemplation Stage (4)
1)Beginning/intending to change within next 6 months
2)know benefits of change but be aware of costs
3)easy to get stuck in this stage due to behavioral procrastination
4)NO plan for action (nor are they ready for plan of action)
TTM Preparation Stage (5)
1)Take axn in immediate future
2)ready to change
3)have plan of action
4)taken big step/axn in past year
5)Do action-oritented programs (like weight watchers)
TTM Action Stage (2 and 1 ex)
1)made OVERT modifications to lifestyle within last 6 months
2)greatest risk @ this stage is relapse
3)must stop smoking cant like switch to low tar cigs
TTM Maintenance Stage (3)
1)Change process not as frequent in action stage
2)6months-5years
3)focus on relapse prevention
According to TTM interventions by health professionals should be...and 2 ex why
STAGE SPECIFIC

Cant tell diabetic how to use a glucose monitor if in precontemplation stage

Compliance monitors also useless for ppl in PC and C stages
Goals of intervention of a PC or C patient (4)
1)assist in motivation
2)promote awareness
3)focus on pros of changing
4)more of a coach and less of an instructor
DTC advertising has resulted in....
patients coming to MDs wanting a specific Rx medication
Choosing a cholesterol drug boils down to 3 questions
1)will it get cholesterol low enough
2)will patient tolerate it
3)can patient afford it
What % of patients with high cholesterol will lose weight, change diet and exercise to control it?
MINORITY
Most common side effect from cholesterol meds...
muscle aches that stop when medication is halted
How do you progress thru the TTM stages of change? (3)
1)covert and overt activities
2)guides for intervention programs
3)independent variables needed to move from one stage to next
10 independent variables in the TTM processes of change
1)consciousness-raising
2)dramatic relief
3)environmental reevaluation
3)self-reevaluation
4)self-liberation
5)social liberation
6)counterconditioning
7)stimulus control
8)contingency management
9)helping relationships
Which TTM processes of change encompass PC to C
consciousness raising
Which TTM processes of change encompass P to A (2)
social liberation
dramatic relief
Which TTM processes of change encompass C to P
self-reevaluation
Which TTM processes of change encompass A to M (4)
environmental reeval
counterconditioning
stimulus control
contingency management
Which TTM processes of change encompass P to M
self-liberation
Which TTM processes of change encompass ALL of them
helping relationships
Dramatic reliefs entails...(2)
1)emotional experience
2)role playing
Self-reeval entails...
assessments of self-image w/ and w/o condition
Environmental reeval entails...
effect on one's social environment
Self-liberation entails...
belief and commitment to act
Social liberation entails...
increase in social opportunities
Counterconditioning entails...
learning healthy behaviors to substitute unhealthy
Stimulus control entails...
remove cues for unhealthy behavior
Contingency management entails...
consequences for taking steps in certain directions
Helping relationships entails...
support of family/friends
What is the decisional balance of change? (and when does this happen)
weighing pros and cons of changing

@ each stage of processes of change
To progress thru processes of change what has to happen w/ decisional balance?
Pros must increase and cons must decrease
Relationship b/w stage and decisional balance for an UNhealthy behavior
Pro's incrase initially then decrease
Relationship b/w stage and decisional balance for a healthy behavior
pro's increase then stay that way
Self-efficacy? and 3 ex
Situation specific confidence ppl get when able to cope w/ high-risk situations w/o relapse

1)go to party w/o drink/smoke
2)avoid binge eating @ buffet
3)continuing meds when adverse event occurs
Temptation is caused by? and 3ex
intensity of urges to go back to specific habit in the middle of a difficult situation

1)emotional distress
2)cravings
3)positive social situations
Relationship b/w stage and both self-efficacy and temptations
Temptation has to go down for self-efficacy to go up
In which model does a person weigh perception of risk in addition to their percieved severity if they get the condition?
health-belief model
In the TTM consciousness raising is considered a part of:
process of change
Schlering-Plough & Merck are planning a combo pill of...
singular
claritin
____ is the name of the clinics being setup in CVS's
MinuteClinic
____ services are used to unsnarl medical bills (4)
1)SmartMedicalConsumer
2)MedBillManager
3)RevolutionHealth
4)Quicken Medical Expense Manager
President Bush's plan for increasing the # of ppl w/ health insurance
Give tax breaks to ppl who buy their own health insurance; making it more affordable for them
What % of children diagnosed as bipolar are thought to have been misdiagnosed?
50%
In the netherlands their healthcare is becoming more like america's in that...
a)individuals must...
b)insurers must...
c)empolyers must...
a)buy insurance or pay penalty
b)offer coverage to all comers
c)DO NOT have to offer any coverage
In the massachusetts plan
a)individuals must..
b)insurers must..
c)employers must...
a)buy insurance or pay penalty
b)may limit coverage for pre-existing conditions
c)must offer coverage or pay penalty
In the proposed california plan
a)individuals must...
b)insurers must..
c)employers must..
a)buy insurance or pay penalty
b)offer coverage to all comers
c)offer coverage or pay penalty
Medco Health solutions just bought ____ so that it could...
PolyMedica

offer diabetic medical supplies
Medicare is now offering to pay for what in order to prevent certain diseases?
more screening tests and immunization in order to save money by preventing certain diseases