Comment on these:
1. Improving Antibiotic Use
The first High-Burden Health Condition I explored is the improvement of antibiotic use. The two evidence-based interventions identified by the CDC for improving antibiotic use include requiring antibiotic stewardship programs at all hospital and nursing facilities, and incentivizing providers to follow the CDC Core Measures as it relates to antibiotic use (CDC, 2018). Those facilities are suggested to not only engage in education dispersement, but to also assist in providers utilizing the core measure practices. Providers can implement a few strategies such as commitment posters to antibiotic stewardship and tracking and reporting antibiotic use (CDC, 2018).
As nurses, we know that nosocomial infections can increase mortality and morbidity to a hospitalized patient and we are probably familiar with the understanding that nosocomial infections are often, if not always, not covered in reimbursement. Thinking about the stakeholders in this, I think about the hospitals and facilities as being the first collaborator. The need to have an established method of tracking and recognizing the need for antibiotic use as well as data on the effectiveness is essential to improving antibiotic use. The other stakeholder I think of, in addition to bedside nurses, is an infection control team. In a previous place of employment, I utilized the infection control team often if there were concerns about an antibiotic or its use. Additionally, the team closely monitors departments and patients to assess the need for antibiotic use and suggests switching antibiotics to more specific or sensitive ones as the patient results and cultures are returned. I often think about the Sepsis initiative and how, because of the Sepsis bundle, providers and nurses incorporated immediate antibiotic use in those patients. According to (Peltan et al., 2019), delays in antibiotic initial times point to an increase in long term, risk-adjusted sepsis mortality.
Preventing Unintended Pregnancy:
This is a topic I am very passionate about and want to spend a little more time discussing. The second High-Burden Health Conditions identified by the CDC I was interested in exploring is the prevention of unintended pregnancy. There are a few evidence-based intervention steps identified; reimbursing providers for the full range of contraceptive services, reimbursing for immediate postpartum insertion of long-acting reversible contraceptives, and removing administration and logistical barriers to those long-acting reversible contraceptives (CDC, 2018). Looking at the first initiative, I would suggest that this is intentionally marked as the first intervention step because without identifying the full range of care possible/provided to a patient, limitation and loopholes begin to arise. The CDC identified that approximately 50% of pregnancies are unintended and unintended pregnancies can increase the risk of potentially poor outcomes for mother and child (2018). The second intervention is the reimbursement for immediate postpartum LARC (long-tern reversible contraceptive) and is rooted in numbers that identify this may help reduce the economic burden for some women and families. The final step identified is to remove administrative and logistical barriers to LARC (CDC, 2018). This could be because the payer may need prior authorization from insurance or even having patients being lost to -follow-up care.
For all the interventions identified, Medicaid must pay for contraceptive and family planning services, and the patient can choose which method of family planning they would like to use without coercion (CDC, 2018). This coverage is essential to providing access to unintended pregnancy prevention regardless of socioeconomic standing. From the private or commercial side, non-grandfathered plans and insurers must cover at least one form of contraceptive for women (CDC, 2018). In helping to negative logistical and administrative barriers, it is recommended by the CDC that the process for women to receive and item or service must be easy (2018). Additionally, it is suggested that all dependent children must be eligible for these services as well.
Knowing that without public funding, the United States could see a 50% higher rate of unintended pregnancies and abortions; which is a separate discussion in itself (CDC, 2018). Looking specifically at the third intervention about reducing logistical barriers, I would first and most important stakeholder to identify is the patient herself. I believe in order to implement a supportive unintended pregnancy reduction strategy, it is most important to hear from the women who are experiencing barriers first hand. Discovering specific barriers is a way to identify the needs for a specific community or population; ie transportation, clinic or office hours, duration of appointments, difficulty contacting for services.The second stakeholder I would suggest collaborating with would be the clinicians. Assisting with creative ways to maximize access for patients would allow a symbiotic relationship between provider and patient, ultimately, access to care.
2. **Select two of the High-Burden Health Conditions targeted by the CDC in the 6/18 Initiative, and discuss the Evidence-Based Interventions for each. For one of the interventions, identify at least two stakeholders you would partner with to implement the strategy in your community.
Reference:
CDC.org. (October 4, 2018). CDC’s 6/18 Initiative. CDC**
The Center for Disease Control and Prevention (CDC) works with providers, patients, health insurance and employers to help prevent or improve illnesses. (CDC, 2021) Each year they choose new illness to focus on and the interventions that go along with trying to improve these outcomes for the people who have these illnesses. This to help improve awareness for these illness as well as outcomes for the people who afflicted by them. This is a step in preventative medications.
Preventing type 2 diabetes is much better for people who are at risk because it improves their lives, as well as saving them money, and improving their long-term outcomes. The preventive measures are better for the people who may be afflicted by this because it would be easier to prevent than to treat long term. However, for patients this is a longer-term goal because it is something that they are always having to work against. The intervention that the CDC recognizes for this ailment is to expand access to the National Diabetes Prevention Program. This gives people information, both people at risk as well as people who are healthcare workers who need more education on this ailment. (CDC, 2021)
Stakeholders are groups of people or organizations that works to help pay for some of the care of patients, especially ones with a specific ailment. One of the biggest stakeholders in preventing diabetes is insurance companies. They use a lot of money and resources to help in the treatment of type 2 diabetes. It takes a lot of money for the visits to providers, the medications and the other illnesses associated with diabetes. This means that if the patient needs to be treated for anything linked to autoimmune decrease of diabetes. This is a risk for the insurance company because they have to pay for all of these health expenses. This is why they have the biggest benefit in being a stakeholder and helping to provide interventions, especially education and access to the education, because it can decrease their cost.
Controlling high blood pressure is also an important for improving quality of life and improving outcomes for people. It can lead to other types of health conditions that could shorten their life or even decrease their quality of life. This can be depressing for the people who are do have this ailment because it can be sudden and without and preamble for changing their lives.
Some of the interventions that the CDC mentions to help improve or work towards decreasing blood pressure is lower the medication copayments, make readily available the refills for 90-day fills, improve care coordination between care teams, and standardize protocols for managing blood pressure. (2021) There are also many others, but these can help right away.
By managing and making readily available medications is the best way so that people can better handle and try to manage their condition. This helps people manage their blood pressure so that they are able have a better quality of life and prevent other health conditions.
One of the biggest stakeholders in this condition is pharmaceutical companies. They are the ones that make the medications that is helping manage the condition that is ailing people. They have the make the medications readily available, they have to also make medications that can help people who have resistance to medications. They are also the ones who have to make sure the medications are readily available to these patients for any subsequent conditions they may develop because of their high blood pressure.
Health conditions area very important to try and prevent if able and also important to manage because of their chances of evolving into something else that can cause the quality of life of a person to deteriorate. This is why education and medication management is so important to have people follow through with.
