Diabetes in rural communities paper

Diabetes in rural communities paper
Introduction

Diabetes is a chronic illness that occurs when there is inadequate insulin produced by the pancreases or when the insulin produced by the body is not effectively utilized. Insulin plays a role in the regulation of blood sugar. The most common effect of uncontrolled diabetes is hyperglycemia is a detrimental to the health of an individual as it may cause serious damage to the body systems mostly the blood vessels and nerves (Sinnott et al., 2017). Globally diabetes has become the leading cause of death with disease burden rising in every country which is greatly fuelled by obesity, diet, physical activity, and unhealthy lifestyle prevalence. In 2013, there was an estimated prevalence of 382 million people with diabetes which is expected to increase by the year 2035 (Sinnott, et al., 2017, pg. 97). According to the aetiological classification of diabetes, there is type 1 and type 2 diabetes, with type 2 being the most common and accounts for the majority of diabetes. Type II diabetes has become a major public health problem that affects the health and economic status of both the society and the affected individuals. The key determinants of type 2 diabetes are mainly influenced by our environment and social lifestyle. Therefore, to help in the prevention of diabetes, there is the need for intervention at distinct levels, inclusion of public policy to counseling which all aim at encouraging and enabling healthier lifestyle behavior changes hence reducing the occurrence of elevated blood glucose levels (Sinnott, et al., 2017). The focus of this research paper is to take an in-depth look at diabetes, and policies influencing clinical practice. The burden of cost for healthcare way over exceeds $245 billion yearly and with proper education and implementation of programs in rural areas, the healthcare cost can be decreased (Centers for Disease Control and Prevention, 2017, pg. 3).

Diabetes is estimated to have affected more than 30 million Americans and of the total population of citizens with more than 1 million diagnosed with diabetes type 1 being children (Centers for Disease Control and Prevention, 2017, pg. 4).  More than 23.1 million people are diagnosed, while there are millions who are undiagnosed each year, which accounts for approximately 23.8% of the total population of individuals with diabetes. Rural areas experience a 17% higher diabetes rate than urban areas (Centers for Disease Control and Prevention, 2017, pg. 5). Telemedicine is one strategy that has been implemented in rural areas to help with diabetes management, prevention, and education. There are many comorbidity that are diagnosed alongside diabetes such as incontinence, the risk for fractures, the risk for cancer and poor prognosis likely to increase with the rise of the country’s population, significant policies ought to be instituted to curb the ailment at the prevention level.

Policy

With the increasing concerns rising from diabetes management and available disparities, policies are crucial to help curb them. Within the healthcare system there are so many causes of health disparities with the largest number associated with discrimination by healthcare providers, poor access to healthcare services, social determinants, and lack of health insurance coverage Social determinants in healthcare can be described as any political, economic, environmental and social conditions where people live and play a major role in causing health disparity (Haire-Joshu, 2015).The social behaviors such as smoking, unhealthy eating and lack of exercise lead to detrimental effect to diabetic patients and efforts should be made to change the social determinants. These health disparities also contribute to poor quality diabetic care and expected health outcomes among the disadvantaged individuals (Haire-Joshu, 2015). The policy is therefore to help Eliminate Disparities in Diabetes Prevention, Access, and Care.

The focus of the policy will be on the National Institute of Health to enhance research on the possible causes and affects it poses to the minority group. It will help in the expansion, Intensification and supporting all the activities pertaining to type II diabetes for the minority communities. Healthcare professionals will have mentoring programs where grants will be awarded to aid in obesity research, weight counseling and general nutrition (Haire-Joshu, 2015). The Centers for Disease Control and Prevention focus is conducting and supporting research related to activities that concern diabetes in the minority populations. It will also help in the provision of diabetes treatment and prevention strategies that are more effective, educating the public especially those who are highly affected (Haire-Joshu, 2015). National Diabetes Prevention will be included to help in access of more effective community interventions.

Another benefit of this act is that through the Health Resources and Services Administration the healthcare workforce working in the areas more impacted by diabetes by strengthening them. The Health Resources and Services Administration are very important as it is involved in confronting any unequal treatment that may exist due to Racial and Ethnic Disparities in Health Care. Availability of required medical equipment in treatment and prevention of diabetes acts like a plus to motivate them to work towards the goal of reducing the prevalence of diabetes. The National Diabetes Education Program will be actively involved in forming campaigns that aid in education of certain group of people to provide required information putting into consideration factors such as culture (Haire-Joshu, 2015). This is to help the community members to completely get assimilated to the required lifestyle and nutritional changes to enhance their health. Long term improvement will involve formulation of strategic plan to tackle disparities by giving report to the congress on any existing federal activities in reference to diabetes.

Legislators supporting the policy

The policy was introduced in the House by Diana DeGette and later referred to the subcommittee of health (Moulton et al., 2013). The legislator’s advocated for policy adoption in all counties to help in reducing the increasing number of increasing diabetic patients which is likely to become a threat to the economy. They believed that diabetes has become a problem that should be handled before it gets out of hand.

Role of APRNs

Advanced Practicing Research Nurses (APRNs) are nurses who well prepared to be able to meet the increasing health needs by providing excellent leadership skills in the community health centers, and are involved in future policy directing and advocating. APRNs can adopt the policy through adopting the use of evidence-based care which is in alignment with the patients’ needs and can help improve health outcomes. It also includes translation of research evidence to practice context to help the community (Mayan et al., 2016). They also help in Eliminating Disparities in Diabetes Prevention, Access, and Care by providing direct patient care without discrimination, utilization of information technology skills to help patient’s access information and providing clinical leadership which leads to improved patient health outcome (Mayan et al., 2016). APRNs help in creation of new  avenues for community leadership which will in turn help the patient also take part in their care for example lifestyle changes. The APRN will also help the community members understand the policy legislation and its objectives. Basing on the role of the APRNs, they are able to integrate the guidelines given in the policy to help guide their interventions.

 

How policy influences clinical practice

The policy focuses on eliminating health disparities that exist within the healthcare system through educating the healthcare personnel of the health disparities and how to address and eliminate them. Promoting diabetes self-care is very crucial through provision of high quality education which is shown through improved patient self-management. Introduction of telemedicine has increased the number of affected people who have access to healthcare services regardless of their location or financial capability to move from one place to another. In regard to telecommunication different interactive strategies have come up which helps the patients and the health care providers communicate easily. For instance the use of web-based portals or text messages can help patients ask questions and get feedback immediately about their health. Clinicians are also able to follow up are of their patients easily and give appointments when necessary.

Coordinated care for patients with diabetes

The policy promotes the use of interdisciplinary team such as the community health workers to help in management of patients with diabetes and other people who are at risk by educating them. As per Diabetes Prevention: Interventions Engaging Community Health Workers | Healthy People 2020. (n.d.), recommendations are made by the community of preventative services to ensure the community has options and resources available for diabetes programs. The resultant upside of such an initiative is advancement in the improvement of control of outcomes related to the weight of individuals who can be diagnosed with diabetes type II. The community health workers do serve as a significant linkage between the community and the healthcare system. Advancing preventive measures to ensure the reduction in those at risk for diabetes type 2 include general counseling, creation of support groups, and lifestyle changes inclusive of dietary adjustments, and increase of physical activities (American Diabetes Association., 2017). The program planning is inclusive of mobilizing, assessing, planning, implementing, and tracking of patients within the community.

Inclusion of community health workers in managing diabetes does ensure comprehensive management of diabetes type 2 as they do play critical roles. They are tasked with structured education of community members, health systems advocacy, and ongoing patient support systems. Adequate preparation of community health workers to ensure key synchrony of these roles for productivity is essential: the result, satisfactory desired clinical outcomes (Egbujie et al., 2018). Community health workers are vital too as they ensure medication adherence among patients, follow-up care for such individuals is a driving force in guaranteeing adequate prevention of complications among patients. Consistent interventions to ensure adherence does ensure the proper diabetes control among the predisposed individuals who are at risk for developing further complications. With community health workers constant access to the community members, they do provide sufficient information to healthcare workers in terms of the incidence and prevalence of diabetes within a given population. As a result, healthcare providers can provide holistic care to patients (Franklin et al., 2015). Education is a key component help manage and treat when diagnosed with a lifetime illness such as diabetes and with proper education and resources available to the patient, maintaining a healthy life with diabetes is possible.

The policy also supports the use of patient-centered approach which involves direct engagement of the patient in the care. Different team of healthcare professionals can be used to engage the patients where each of them evaluates the patient and discuss possible treatment regimen. Engaging with a patients means that the physician has to listen to the patient’s problems and together take a collaborative approach to find a solution to the problem without biasing any side. Most often patients believe that only ant diabetics can be used to control their blood sugars but it also take extra measures such as avoiding sedentary lifestyle, smoking, unhealthy eating and doing regular exercises. The policy for instance involves different programs that will help the patient in management of diabetes.

Conclusion

As discussed diabetic has become a world-wide problem and to reduce diabetes related mortality and morbidity, access to efficient health care services is a necessity for people with diabetes. To be able to deliver required healthcare services and rational planning it is imperative to have an up-to-date population disease burden estimates. Successful diabetes prevention will need to incorporate individual concerted efforts, healthcare workers and healthcare facilities to enhance risk factors awareness and the necessary behavioral changes. All the healthcare providers are primed with the responsibility of eliminating any existing healthcare barrier and a new era of improved healthcare services advocated for all. Therefore a healthcare system that is transformed is a requirement to meet this goal. Implementation of this policy also requires collaboration between healthcare departments to promote coordinated care that is patient focused.

References

American Diabetes Association. (2017). 4. Lifestyle management. Diabetes Care40(Supplement 1), S33-S43.

Centers for Disease Control and Prevention. (2017). National diabetes statistics report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services.

Diabetes Prevention: Interventions Engaging Community Health Workers | Healthy People 2020. (n.d.). Retrieved from https://www.healthypeople.gov/2020/tools-resources/evidence-based-resource/diabetes-prevention-interventions-engaging-community

Egbujie, B. A., Delobelle, P. A., Levitt, N., Puoane, T., Sanders, D., & van Wyk, B. (2018). Role of community health workers in type 2 diabetes mellitus self-management: A scoping review. PloS one13(6), e0198424.

Franklin, C. M., Bernhardt, J. M., Lopez, R. P., Long-Middleton, E. R., & Davis, S. (2015). Interprofessional teamwork and collaboration between community health workers and healthcare teams: An integrative review. Health services research and managerial epidemiology2, 2333392815573312.

Haire-Joshu, D. L. (2015). Next steps: eliminating disparities in diabetes and obesity. Preventing chronic disease12.

Mayan, M., Lo, S., Oleschuk, M., Paucholo, A., & Laing, D. (2016). Leadership in community-based participatory research: individual to collective. Engaged Scholar Journal: Community-Engaged Research, Teaching, and Learning2(2), 11-24.

Moulton, A. D., Albright, A. L., Gregg, E. W., & Goodman, R. A. (2013). Law, public health, and the diabetes epidemic. American journal of preventive medicine45(4), 486-493.

Sinnott, S. J., McHugh, S., Whelton, H., Layte, R., Barron, S., & Kearney, P. M. (2017). Estimating the prevalence and incidence of type 2 diabetes using population level pharmacy claims data: a cross-sectional study. BMJ Open Diabetes Research and Care5(1), e000288.

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