BSN-FP4010 Assessment 3-1 Evidence Based Practice

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BSN-FP4010 Assessment 3-1 Evidence Based Practice

In the community that was observed through the Windshield Survey, the elderly, were identified as the most vulnerable section since they provided housing and sustenance to the younger, unemployed people and were dependent on the younger generation for care and support with healthcare issues.  Chronic diseases such as diabetes, cancer, COPD (chronic obstructive pulmonary disease), heart disease as well as cognitive disorders such as Alzheimer’s and dementia are common health issues among the elderly population.  This paper will delve deeper into the prevalence of diabetes among the elderly and discuss the health disparities that are evident within the minority elderly population.  The difference between the minority elderly population and the rest of the population in terms of quality of diabetes care by looking at the outcomes of a research study, its data collection and analysis methodology and the type of data set it utilized.  After evaluating the factors that affect the health promotion and disease prevention within the minority elderly population, recommendations will be provided for evidence based interventions for diabetes prevention in this community.

End-of-Life Decisions

Compare the Statistics

More than one fourth of the elderly (age 65 years and above) in the US suffer from diabetes, and the prevalence of diabetes in people aged 65 years and above is the highest among all age groups (Kirkman, Briscoe, et al., 2012).  However, there is disparity in the quality of diabetes care received by minority elderly population in the US.  The Medical Expenditure Panel Surveys pooled data from 2002-2007 indicates that elderly black patients and elderly Asian patients did not receive quality diabetes care when compared to white elderly patients.  There are significant differences in the quality of diabetes care reported by whites compared to blacks and Asians, based on quality rating scores as reported by patients.  White patients reported a quality score of 8.53 versus blacks who reported 8.01 and Asians who reported a score of 7.79 out of 10.  There is also a significant difference in the percentage of black elderly patients receiving foot exams compared to white elderly patients (38% versus 48%); and the percentage of white and black elderly patients (63% versus 54%) and white and Hispanic elderly patients (63% versus 52%) receiving an eye exam (Richard, et al., 2012).

Describing the Concepts, Data Analysis Methods, Tools, and Databases Used

It is evident from several studies using various types of quality measures, that the minority elderly population receives a much lower quality of diabetes care, across several different types of healthcare settings, compared to their white counterparts.  In order to study the disparities in quality of diabetes care among racial or ethnic minority elderly population, most studies have utilized data from a few sources such as Medicare claims data, the Health Plan Employer Data and Information Set (HEDIS) database, and the Veterans Health Administration (VHA) database.  However, these sources cannot be considered representative of the entire US population; hence, there was a need to use data from a survey that was more likely to have a sample that represents the US population’s diversity.  This study made use of data from the Medical Expenditure Panel Survey (MEPS) and selected a sample that consisted of patients 65 years and above with a confirmed diagnosis of diabetes, who had a regular source of healthcare and had visited their healthcare provider at least once in the past 12 months.  Disparities in quality of diabetes care as reported by elderly minority patients were assessed based on quality rating scores, HbA1c testing, eye and foot exams.  The data used in the study were based on the

Household Component (HC) of the MEPS data that was collected in six waves from 2002-

2007. This data is nationally representative and includes data points such as health service utilization, insurance cover, medical expenses, and payment sources.  The HC file includes demographic data, income, diseases, health status, access to healthcare, and satisfaction with care, among other things.  The primary independent variables were race/ethnicity in terms of people being Asian, Hispanic, non-Hispanic black and non-Hispanic white, with white people being the reference group.  Four outcomes were studied – patient-reported diabetes care quality rating, HbA1c test, eye exam or foot exam conducted within the previous 12 months.

Explain the Factors

Health promotion and diabetes prevention among the minority elderly population is affected by cultural, economic, and social factors.  The elderly from racial/ethnic minorities have deep-seated cultural beliefs that govern how they perceive their disease and their body and therefore what they consider a health problem and how they express these problems to their healthcare providers.  Cultural background may also determine how the minority elderly population exercises their rights to quality healthcare and what they may expect from healthcare providers in terms of information and treatment (U.S. Department of Health and Human Services, Office of Minority Health, 2001).  Thus, in order to reduce disparities in health and healthcare, it is important to sensitize healthcare providers to better understand and assimilate other cultures and to use appropriate language and culturally relevant tools to help promote disease awareness and preventive health measures among the minority elderly population.

Health Promotion and Disease Prevention in Vulnerable and Diverse Populations

Economic factors limit the minority elderly population’s access to healthcare resources.  African Americans, Hispanics, American Indians, and Alaskan natives often live in poverty, largely because they have limited education and face inequalities in job opportunities.  The poor economic status, coupled with lack of health insurance cover often makes it difficult for the minority elderly population to gain access to healthcare services (Hugh, Arnold, Buschman, 2012).

Social factors that may affect minority elderly population’s access to healthcare resources that may help in disease prevention or health promotion include geographical location and difficulty in accessing healthcare services due to distance and lack of support.

Health Care Initiatives Used

With the vision of, “a nation free of disparities in health and healthcare,” the Department of Health and Human Services (HHS) has formulated the HSS Disparities Action Plan which has helped devise policies and programs to enhance health equity, improve access to healthcare, expand insurance coverage, and fortify the healthcare workforce and infrastructure.  The HHS, in 2013 put in place the Culturally and Linguistically Appropriate Services (CLAS) in order to provide appropriate care for the minorities (Ubri & Artiga, 2016).  Racial and Ethnic Approaches to Community Health (REACH) are community-focused initiatives that have been launched to reduce health and healthcare disparities by universities, local health departments and non-profits using grants from Centers for Disease Control and Prevention (Ubri & Artiga, 2016).  Furthermore, the Affordable Care Act has extended Medicaid coverage to low-income families (up to 138% of FDL), resulting in the reduction in the percentage of poor Hispanic, black and Asian families remaining uninsured (Ubri & Artiga, 2016).

The Agency on Aging (AOA) has provided grants for evidence based disease and disability prevention programs (EBDDPP) across 27 states and some of these provide educational resources and programs that benefit racial/ethnic minority seniors (Boutaugh, et al., 2014).  For instance, the National Caucus and Center on the Black Aged, conducts a health and wellness program for African Americans that cover cancer, hypertension, heart disease, physical activity, nutrition, and access to care.  These programs disseminate newsletters, brochures, and videos for public awareness and provide technical assistance and training to conduct health promotion campaigns.

Health Promotion and Disease Prevention in Vulnerable and Diverse Populations Windshield Survey

Recommend an Evidence Based Health Care Initiative

Given below are community and primary healthcare setting interventions that can enhance health promotion and diabetes prevention among the minority elderly population of the community that was studied in the Windshield Survey (Strategies…, n.d.):

• Improve access to healthcare and diabetes resources: Work with community partners like pharmacies, groceries, healthcare organizations, and fitness groups to develop a discounted-fee mechanism for availing health services.
• Enhance patient education through language-appropriate resources: Develop and disseminate educational materials about diabetes prevention and treatment in the community’s first language, using visuals and simple terms.
• Interventions within the community: Culturally-sensitive materials and methodologies should be used to address groups of people at schools, workplaces, churches or temples.  Emphasis can be placed on family participation, particularly in promoting things like physical activity.
• Training healthcare providers and community workers: Cultural competency training should be provided to community workers and healthcare providers so that they can use appropriate language and words to convey information to, and can elicit appropriate responses from patients.
• Promote and run screening programs: Early detection of diabetes can go a long way in improving quality of life and preventing further complications.  Thus, it is imperative to run ‘free’ screening camps at medical centers within the community.  The promotion of such screening programs should be facilitated by using community-based role models via messages that could be sent out over the radio or posted at local markets or community recreational facilities.

Health Promotion and Disease Prevention in Vulnerable and Diverse Populations Conclusion

In conclusion, diabetes is a major health problem among the minority elderly population since their diet and lifestyle choices often predispose them to the disease.  The lower quality of diabetes care could further magnify the problem and result in high morbidity and mortality among the minority elderly population.  From a nationally representative data set, we determined the level of disparity in the diabetes care received by the minorities compared to the white elderly.  Understanding the cultural, economic, and social factors that affect health promotion and diabetes prevention among minority elderly population helped us arrive at an evidence based healthcare program that can be conducted in the community and in primary healthcare settings to help improve access to healthcare and promote healthy behaviors among the vulnerable population within this community.