Escolar Documentos
Profissional Documentos
Cultura Documentos
Peter Whincup,
St George’s, University of London
Learning objectives
• Be able to outline the public health approach to
to health needs assessment, including the
components of an epidemiological needs
assessment
N D
Unmet
Demand
Met
need S
Services
Unused meeting
Services demand
Defining needs for health –
a hierarchy
• “Basic needs for health (survival)”
– Food, water, shelter
– Felt need
Challenges
-difficult to measure benefit for chronic illness
-`needs’ may change dramatically with new
technological advances
-often difficult to define exactly who will
benefit from an intervention, and who will not
Definition Of
Health Needs Assessment
• Health needs assessment (HNA) is
• Comparative approach
• Corporate approach
Epidemiological Health
Needs Assessment
– Which interventions helpful?
(clinical trials, other studies, Cochrane database)
Elective THR
• Reduced pain, immobility, disability
• Greatly increased independence
• At age 60 years, THR gives ~ 7
additional high quality life years
• At age 80 years, THR gives ~2
additional high quality life years
• Highly effective and cost effective
especially at younger ages
Effectiveness of THR
– Radiological changes
In 5% of over 55 yr-olds
In a population of 100,000
•55,000 people over 35 years
•~8000 with Chronic Hip Pain (HP)
•~825 with Severe HP
•~122 New Severe HP/Year
Combine data on treatment effectiveness and size of
problem
• Number of existing cases of end-stage arthritis (Unmet Need)
• Number of new cases per year (New Need)
USA white 76
USA black 35
Finland 58
Denmark 82
Sweden 115
Norway 115
UK 80 (guideline is 105)
N D
Unmet
Demand
Met
need S
Services
Unused meeting
Services demand
Increasing needs and demands
◦ ageing population
◦ medical progress
◦ new technologies
◦ rising expectations (see next)
Waiting Lists
Emergency Presentation
Professional Dilemmas
Political Pressure
Shortage of resources leading to people being denied or having
delayed access to a beneficial service due to resource restraints
Irrational rationing
• Rationing:-
– conflicts with conventional medical ethics
• Doctor patient relationship – doing best for
that individual patient
– is unpopular with the public
Professional guidance on
rationing
• Doctors have a responsibility to treat their
individual patients to the best of their ability and
a duty to society to make the most equitable use
of resources overall. The fact that not all available
medicines are affordable should be openly
discussed within the context of the doctor-
patient relationship. (Royal College of Physicians,
2000).
• ….rationing decisions are complex, often requiring
the sacrifice of one strongly held value in order to
uphold another. (BMA, 2001)
Increasing • More Resources for Services (Money/Staff)
• Other Approaches to Care
Need
to redefine levels of need requiring treatment
Rational allocation of
limited resources
Need to consider for all important conditions:-
• Size of the ‘problem’ (burden of disease)
• Responsiveness to treatment; ‘size’ of benefit
(health gain)
• Accessibility, equity in treatment
• Reflect wishes of public/professionals
• Reductions in health inequalities
• Not doing harm
• Agreement with national priorities
Decisions in health care supply
• 1.How much national resource (taxation)