Equitable health access

Topic 8 DQ 1

Discuss the role of translational research in advancing equitable health access to health care and preventative services and policies based on population health. Provide an example of a local health care policy that has been recently enacted and or is awaiting legislative passage that has been influenced by research.

Sample student response one

Translation research is an evolving field that aims to bridge the gap between basic research and its application in practical health care delivery. The main essence of conducting research is to come up with interventions that improve the quality of patient care. Similarly, the purpose of translational research is to improve equity in health care by coming up with measures that improve access and affordability, more so, in disadvantaged communities (Barreto et al., 2020).

Donors usually pump in millions of dollars to finance research that facilitates the understanding of behavioral, social, and biological factors that cause illness, affect recovery and enhance positive health outcomes for individuals and populations (Guastaferro & Collins, 2019). Doing so provides a platform through which effective interventions that are applicable across different population groups can be established.

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Translation research aims to also bridge the existing gaps that make health care to be expensive, for example, through the establishment of effective preventive approaches to dealing with chronic diseases. This ensures that a majority of the population attain positive outcomes, that would otherwise be a burden, especially to socioeconomically disadvantaged groups.

One of the current health care policies that has been signed into law in the state of Illinois is a law by the current Governor JB Pritzker, which seeks to expand access to mental health care. The legislation requires insurance coverage for mental health issues beginning January 2023. This is a policy that is long overdue and one that is backed by research, including a paper by Creedon and Cook (2016), which notes a significant disparity in access to care by persons with mental health issues.

Reference

Barreto, J. O. M., Silva, E. N. D., Gurgel-Gonçalves, R., Rosa, S. D. S. R. F., Felipe, M. S. S., & Santos, L. M. P. (2020). Translational research in public health: challenges of an evolving field. Saúde em Debate, 43, 04-09.

Creedon, T. B., & Cook, B. L. (2016). Access to mental health care increased but not for substance use, while disparities remain. Health Affairs, 35(6), 1017-1021. https://doi.org/10.1377/hlthaff.2016.0098

Guastaferro, K., & Collins, L. M. (2019). Achieving the goals of translational science in public health intervention research: the Multiphase Optimization Strategy (MOST). American Journal of Public Health, 109(S2), S128-S129.

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Sample student response two

Translational Research has a lot to offer in the healthcare industry’s bridging equitable access to healthcare and preventative services. EBP’s are transformative elements in reforming the healthcare delivery system. These EBP’s are innovations that provide opportunities for providers to find ways to improve care despite the presence of challenges and barriers to equity. Translational research enables these EBPs to make impactful changes and outcomes from an individual scale to multiple populations.

A ” Vision Zero ” is a local health policy and program in partnership with the CA DMV is the “Vision Zero.” This program aims to lessen the incidence of traffic collisions and the fatalities that comes with it. In a study made by Singh, C. et al. (2019), Between 2011 and 2017, statistics have shown that 4699 people died of traffic collisions in Los Angeles County alone and became the leading cause of childhood death between the ages of 5 through 14.

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Traffic-related fatalities have increased by 38% in LA county. In 2016, LA County had more pedestrian-related fatalities than any US county. This program emphasizes the role of clinicians in decreasing and eventually ending traffic fatalities by doing the following:

1. Build patient awareness of traffic safety by sharing information on safe transportation behaviors, especially with parents and children.
2. Connect victims of traffic crashes and their family members with support services, if interested
3. Share your stories with neighbors, friends, and the community.
4. Advocate for institutional and policy changes. 

Vision Zero Los Angeles County: A Plan for Safer Roadways guides the County’s efforts on reducing traffic deaths and severe injuries on unincorporated County roadways through 2025. It creates a vision for the future and sets goals and actions to enhance traffic safety in collaboration with agencies and community partners. This project is a collaborative effort backed up by research and data science to help create safer roadway and driving practices and provide a safe environment for the community and can be used in other cities and counties in the nation.

References:

Los Angeles County (n.d). Vision Zero. LA County. Retrieved from: https://pw.lacounty.gov/visionzero/

Singh, C., Porter, K., Armbruster, J. (2019). Vision Zero: Preventing Traffic Deaths -The Critical Role of Clinicians. Retrieved from: http://rx.ph.lacounty.gov/RxVisionZero0719

Tucker, C. M., Kang, S., & Williams, J. L. (2019). Translational research to reduce health disparities and promote health equity. Translational Issues in Psychological Science, 5(4), 297-301. http://dx.doi.org/10.1037/tps0000215

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Topic 8 DQ 2

As an advanced registered nurse, discuss your future role in advocating for equitable health access to population health services and policies. Do you anticipate any challenges or barriers to “population advocacy”? How would you meet these challenges?

Sample student response one

lies to Laura Arbuckle

Advanced registered nurses (ARN) play a leading role in influencing the quality of care they give to patients and by extension the population. The ARN role has evolved to provide high-quality care, especially in primary care settings, leading interventions that address the root causes of common health problems pertinent to different population groups (Kim et al., 2021). The training, skills, knowledge, and experience ARNs have acquired over time, place them in an advantaged position to identify and come up with effective strategies to deal with the prevailing population health challenges.

Socially disadvantaged groups are more likely to experience poor outcomes, have limited access to care, and are at risk of dying prematurely (Williams et al., 2018). One of the ways of addressing the challenges that such communities face is by analyzing the social determinants of health (SDoH). Therefore, one of the roles I have as a future ARN is to analyze and understand the SDoH that are pertinent in communities that face health care disparities, and use the same information to advocate for appropriate policies that address the health care needs of such population groups.

My role as a future ARN is to consolidate the necessary stakeholder support for concerted initiatives that aim to address existing disparities in health. In as much as policies help in addressing existing disparities, the key to success in the implementation phase lies with the stakeholders, which underscores the need for ARNs to identify and engage with strategic stakeholders to succeed in their advocacy efforts (Williams et al., 2018).

There are likely to be several challenges to population advocacy. One of the challenges is reluctance by other nurses and healthcare professionals to participate in advocacy initiatives. Advocating for better population health, including through policymaking is usually a joint venture rather than an individual initiative (Myers, 2020). Therefore, lack of interest by other nurses to participate in such initiatives can be a major barrier to achieving equitable population health. To deal with such a challenge, it is important to create awareness as to why they need to show interest and participate in such initiatives.

Another barrier is dealing with the political infrastructure responsible for creating policies that impact population health. The realm of politics has different dynamics including balancing of individual and societal interests. Dealing in such an environment can be challenging without understanding effective communication and stakeholder management techniques. That is where the education we have acquired thus far in policymaking comes in, including how to reach out to legislators and getting their input in advocating for better population health outcomes.  

References

Kim, S., Lee, T. W., Kim, G. S., Cho, E., Jang, Y., Choi, M., Baek, S., Lindsay, D., Chan, S., Lee, R., Guo, A., Wong, F., Yu, D., Chair, S. Y., Shimpuku, Y., Mashino, S., Lim, G., Bonito, S., Rumsey, M., Neill, A., … Hazarika, I. (2021). Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed-methods study. Human Resources for Health, 19(1), 19. https://doi.org/10.1186/s12960-021-00555-6

Myers C. R. (2020). Promoting Population Health: Nurse Advocacy, Policy Making, and Use of Media. The Nursing clinics of North America, 55(1), 11–20. https://doi.org/10.1016/j.cnur.2019.11.001

Williams, S. D., Phillips, J. M., & Koyama, K. (2018). Nurse Advocacy: Adopting a health in all policies approach. Online Journal of Issues in Nursing, 23(3). https://doi.org/10.3912/OJIN.Vol23No03Man01

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Sample student response two

Today’s Advanced Practice Registered Nurse’s (APRNs) role in advocating for equitable population health services and polices has three main goals. First being in providing better care to the population/community which leads into the second goal of outcomes of better health of the patients, population, and or community (Hain & Fleck, 2014). Thirdly, lower healthcare cost so that all patient populations with have equal care advantages in order to lower the health disparities.

APRNs according to the Institute of Medicine (IOM) 2011 should be advocates by caring for the populations within complex healthcare systems as well as be allowed to practice to the fullest extent of their education and training, but we all know that there are limits that the APRNs are currently trying to change for that reason alone. Some of the major barriers and challenges APRNs are facing are of course the state licensure regulations with practice limitations from state to state variations.

Another is physician acknowledgment and augments, professional associations and organizations such as the American Medical association do not believe that the APRNs are capable of providing quality safe care due to the fact of length and rigorous training physicians have to go through versus the APRNs.

One other big barrier is the payer policies, commercial health plan payment policies often do not recognize the APRNs as primary care providers their for resist to credentialing or directly paying them for their services provided and delivered to the patients, this is why the Centers of Medicare & Medicaid Services (CMS) state for billing purposes physicians must establish initial care and the nurse practitioner (NP) will perform the follow up care with physician on site.

Reference

 Hain, D., Fleck, L., (2014) “Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign” OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript 2. https://doi:10.3912/OJIN.Vol19No02Man02