Improving Community Health
Instructions:Does your classmate’s proposal seem reasonable, based on the information provided? If you were a “voting member” of their community, would you vote for this measure to be enacted? Explain why or why not.
Provide feedback and ask questions about the funding sources and regulation/assessment of this project.
1st person post Ambrea Lee
St.
James Parish is a rural community composed of most low-income individuals
located within the state of Louisiana. The community is located in the middle
of “Cancer Alley”, a term given to an area between Baton Rouge and New Orleans
where chemical plants dominate the area. Here individuals are exposed to
polluted water, air quality, and food. The Louisiana Department of Health
acknowledges human exposure to environmental contaminants along with genetics,
poverty, and limited access to healthy foods as a driving factor for obesity
within the state (Louisiana Department of Health, n.d.). In St. James Parish
access to fresh produce is limited and the rest are fast food chains.
Diet
and exercise play an important role in combatting obesity. I am proposing a
farmer’s market program that will allow farmers locally and nearby to sell
produce on weekends. The idea is that the farmer’s market will operate like a
flea market every weekend, Saturday, and Sunday. It will be a no-cost entry fee
to farmers. This will allow residents to shop locally for fresh produce.
Approval
will be needed from the city council and mayor to agree on the proposal and for
the utilization of public grounds. I will enact support measures to aid with
funding by applying to the U.S. Department of Agriculture’s Farmers Market
Promotion Program. The U.S. Department of Agriculture’s (USDA) Farmers Market
Promotion Program (FMPP) is a federal initiative that provides grants to
farmers, farmer cooperatives, local governments, nonprofits, and other eligible
entities to support the development, promotion, and operation of farmers
markets and other direct-to-consumer marketing outlets.
However,
there may be pushback for this type of operation. Push-back may come from the
parish’s city council having to employ individuals and force longer hours on
city workers to keep the ground up to par. The city may also ask for funding to
aid in paying employment wages for the use of the public grounds.
2nd person post Tyler Hodge
Initial
Response:
To address
health disparities and socioeconomic factors within our community, I propose
the implementation of a Community Health Worker (CHW) program. CHWs are trusted
members of the community who act as liaisons between health and social services
and the community to facilitate access to services and improve the quality and
cultural competence of service delivery.
Need for the Measure:
Our community is
characterized by a diverse population with significant portions of low-income
households and minority groups. According to the U.S. Census Bureau, 25% of our
population lives below the poverty line, and there is a high prevalence of chronic
diseases such as diabetes and hypertension, particularly among African American
and Hispanic residents.
Enacting and Supporting the Measure:
To implement the
CHW program, we will recruit and train local residents from various cultural
and socioeconomic backgrounds to become CHWs. Collaborate with local health
organizations and clinics to integrate CHWs into the care teams. Secure funding
through state grants and partnerships with non-profits focused on health
equity. The training will encompass basic health education, chronic disease
management, and skills to navigate social services. CHWs will conduct home
visits, provide health education, support patients in managing chronic
conditions, and link them to necessary services (Rosenthal et al., 2021).
Expected Push-back:
Some community
members may be skeptical about the effectiveness of non-clinical workers in
improving health outcomes. To mitigate these concerns, we will conduct
information sessions to educate stakeholders on the evidence supporting CHWs
and highlight successful models from similar communities (Brownstein et al.,
2020).
Approval and Support:
To enact this
measure, we will need approval from the city council and support from the
mayor’s office. This involves presenting a detailed proposal that includes
evidence of the program’s effectiveness, projected outcomes, and a clear budget
plan. Securing state funding and grants will be essential for initial setup and
sustainability. We will also engage community leaders and organizations to
endorse the program and provide additional support.
Unit 2 Discussion 1 –
Patient Panel Regulation
3rd person post Whitney Hill
Hello All,
Patient panel size refers to the number of patients that a
physician cares for during a specified period, usually 12 or 18 months. The
standard patient panel size has often been determined to be 2500 patients.
However, according to the Journal of the American Board of Family Medicine,
this number is not feasible for a primary care physician to provide adequate
patient interaction for all patients. At a panel size of 2500, a physician
would have to work 21.7 hours per day to provide proper care to each patient.
Calculating the ideal patient panel size is important to ascertain the number
of patients seeking consultations and treatments, as well as the provider’s
workload. It is important that providers on the same level share similar
workloads, especially if they are earning similar salaries (Harrington, 2022).
Briefly explain how a patient panel is
constructed (for example, in a free-standing primary care clinic). Who is
involved in the process? Are internal policies involved?
The process for a patient panel typically begins with patient
recruitment, which includes marketing efforts, referrals from other healthcare
providers, community outreach, and patient self-referrals. Patients are then
enrolled in the clinic’s system, which includes collecting demographic
information, medical history, insurance details, and contact information. Once
patients have been enrolled, they are assigned to a primary care provider (PCP)
within the clinic based on factors such as patient preferences, provider
availability, continuity of care, and patient complexity. Some clinics use
algorithms or software to assist in provider assignments. Internal policies and
guidelines are pivotal in the formation of patient panels. These policies can
delineate criteria for provider-patient assignment, patient caseload management
for providers, scheduling procedures, patient qualification for specific
programs or services, and criteria governing patient discharges or transfers
within the clinic.
Should patient panel size and diversity be
regulated by the government? Explain your position.
I do not think that patient panel size and diversity should be
regulated by the government. 1.) because healthcare needs and demographics vary
across regions, populations, and healthcare settings. A one-size-fits-all
approach to patient panel size and diversity may not account for these
variations and may limit healthcare organization’s ability to adapt to local
needs and preferences. I believe that it should be left to providers and/or
organizations to determine appropriate patient panel sizes and diversity based
on their clinical judgment, resources, and capacity. They are better equipped
to assess factors such as patient complexity, provider workload, continuity of
care, and patient preferences to optimize patient care delivery. 2.) if a
physician or organization’s patient panel is regulated by the government it
could affect the quality of care that is received by the patients at that
clinic. If the patient panel is too large this could negatively affect outcomes
causing the clinic or physician to have to rush to see patients throughout the
day. Appropriate
panel size deserves greater attention at the policy and practice levels if
primary care is to function at its best for physicians and patients (Raffoul
& Moore, 2016).
4th person post Susan Smith
Patient panels in a free-standing primary care
clinic are typically constructed based on the clinic’s internal policies and
guidelines, with input from various stakeholders within the organization. The
process of constructing a patient panel in such a clinic involves several key
individuals and considerations. Primary Care Providers (PCPs) play a central
role in determining their panel size based on factors such as their clinical
skills, experience, and capacity to provide comprehensive care. Practice Managers/Administrators
assess factors like the clinic’s operational capabilities, staffing levels, and
resource availability to ensure appropriate panel sizes. Internal policies
often outline guidelines for panel size, patient assignment criteria, and
processes for panel management. Additionally, patient characteristics such as
demographics, health status, and socioeconomic conditions are considered to
ensure equitable access and appropriate resource allocation. Quality
Improvement Committees may review panel compositions, identify disparities, and
provide recommendations for adjustments to improve care quality and access
(Sinsky et al, 2020).
Regarding
the regulation of patient panel size and diversity, while the government plays
a crucial role in setting standards and guidelines for healthcare delivery,
regulating patient panel size and diversity at a granular level may not be
practical or desirable for several reasons. The optimal panel size and
composition can vary significantly based on factors like practice location,
patient demographics, and available resources (Altschuler et al., 2012).
Allowing healthcare providers and organizations to determine panel sizes
and compositions based on their expertise and local circumstances promotes
autonomy and flexibility in care delivery. Strict regulations on panel size and
diversity could potentially lead to unintended consequences, such as limiting
patient choice, restricting access, or compromising the quality of care.
Instead of direct regulation, it may be more effective for the government to
establish broad guidelines and best practices for patient panel management,
while allowing individual healthcare organizations to adapt and implement these
guidelines based on their unique circumstances and local needs (Roos et al.,
2018).
Arrhythmia
Instructions:
Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least three of these prompts:
Do you agree with your peers’ treatment plan approach?
Take an opposing view to a peer and present a logical argument supporting an alternate approach.
Share your thoughts on how you support their treatment plan and explain why.
Present new references that support your opinions.
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
Please review the rubric to ensure that your response meets the criteria.
Arrhythmia
5th person post Lindsay Landers
What additional symptoms should you ask the
patient if she has experienced?
Some
additional questions that I would ask the patient are:
Have
you experienced any chest pain? Can you describe the pain? Does anything make
the pain better or worse? Do you have any nausea or vomiting? Do you experience
any shortness of breath? Are you having any heart palpitations?
Using
Table 36.1, calculate the patient’s CHADS2 score and determine whether
anticoagulation is recommended based on the score.
CHF=
0, HTN = +1, Age > 75 = 0, DM = 0, Stroke/TIA symptoms = 0, vascular disease
= 0, Female = 1
+2
CHADS2 scoring.
With
these results, the patient should be placed on an anticoagulant due to the
increased risk of potential ischemia (Ibdah et al., 2023). The patient should
receive a full history and physical before being placed on these medications.
What
is the significance of this condition happening off and on for the last 48
hours?
She
is more likely to have a stroke because of her known history of hypertension as
well as now possibly having atrial fibrillation. Over 50% of ischemic and 70%
of hemorrhagic strokes are linked to hypertension and its effects;
nevertheless, even with adequate blood pressure (BP) management, 10% of
recurrent cerebrovascular events are still possible, and there is currently no
known way to prevent vascular cognitive damage (Webb et al., 2022).
You,
the nurse practitioner, decide the patient needs treatment beyond the walk-in
clinic’s resources. What action do you take to ensure that the patient is
treated promptly?
Her
heart rate of 180 is the primary issue, in my opinion; it suggests that she may
be experiencing atrial fibrillation (AF) with rapid ventricular rate (RVR). I
would immediately call for an ambulance and take her to the closest emergency
room if she showed up at the clinic. Her assessment of tachypnea, diaphoresis,
weariness, weakness, weak peripheral pulses, chilly, pale skin, and reduced
capillary refill indicates that she is symptomatic. Emergency physicians should
determine the clinical stability of their patient and then treat the reversible
causes.
Because
the patient is an undocumented immigrant, what considerations will be needed
while care is provided?
Community
health centers provide low-cost healthcare to undocumented immigrants. We
should help to provide as many resources to these patients at low coasts so
that the patient can continue to receive their care. Another way to help the
patients is to use interpreters frequently and to set up the patients’
follow-up appointments before they leave the office. As discussed above, the
patient should have a full history and physical appointment to fully assess the
patient and to get an understanding of her background.
6th person post
Susan Smith
1.
What additional symptoms should you ask the patient if she has
experienced?
In
addition to dizziness and fainting, the patient will be asked about any chest
pain, shortness of breath, palpitations, cognitive changes, or changes in
urinary frequency or color that she might be experiencing. These symptoms could
provide further insight into the underlying cause of her presentation and help
guide appropriate management (American Heart Association, 2022).
2.
Using Table 36.1, calculate the patient’s CHADS2 score and
determine whether anticoagulation is recommended based on the score.
·
Congestive heart failure (unknown): 0 points
·
Hypertension (present): 1 point
·
Age (64 years old): 1 point
·
Diabetes (not mentioned): 0 point
·
Stroke/TIA (not mentioned): 0 point
Total CHADS2 score: 2
According
to current guidelines, a CHADS2 score of 1 or higher suggests a potential
benefit from anticoagulation for stroke prevention in atrial fibrillation
patients [Lip et al., 2018]. However, the decision for anticoagulation should
be individualized based on the patient’s specific risk factors and bleeding
risk.
3.
What is the significance of this condition happening off and on
for the last 48 hours?
The
fact that the patient’s symptoms have been occurring off and on for the last 48
hours raises concerns about the potential for underlying complications, such as
hemodynamic instability, thromboembolic events, or electrolyte imbalances. This
patient might be experiencing paroxysmal atrial fibrillation and transient
ischemic attack (TIA) (Lip et al., 2018).
4.
You, the nurse practitioner, decide the patient needs treatment
beyond the walk-in clinic’s resources. What action do you take to ensure that
the patient is treated promptly?
As
the nurse practitioner, I would arrange for the patient to be transferred to a
nearby hospital for further evaluation and management. This may involve
coordinating with emergency medical services to ensure safe transportation and
timely access to appropriate medical care, including cardiology consultation
and possible admission for stabilization and treatment (American Heart
Association, 2022).
5.
Because the patient is an undocumented immigrant, what
considerations will be needed while care is provided?
While
providing care to the undocumented immigrant patient, it’s essential to
prioritize her health needs without regard to her immigration status. This
includes ensuring the confidentiality of her personal information, offering
culturally sensitive care, and addressing any concerns she may have about
accessing healthcare due to her immigration status. It’s also important to know
local policies and resources available to support undocumented individuals
accessing healthcare services (American College of Physicians, 2020)
