Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

  • Do you agree with your peers’ assessment?
  • Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
  • Share your thoughts on how you support their opinion and explain why.
  • Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources.

Amanda’s D Response-

As a primary care provider working in an underprivileged free clinic you realize there are some challenges and barriers in your patient population. You are seeing a number of children with significant health conditions and inadequate follow-up. What can you do as a community provider to promote social justice and reduce health disparities in this population?

In my opinion, the first step to reducing health disparities is to enable providers with the tools and knowledge to recognize them. The American Academy of Pediatrics (AAP) policy regarding Health Equity stresses patient appointments as opportunities to identify and address social, educational, economic, and environmental needs of families and patients (Cheng, Emmanuel, Levy, & Jenkins, 2015). Delivering healthcare that is sensitive to patient needs, literacy, and health beliefs is believed to improve patient safety and the quality of care (Stevens, Pickering, Seid, & Thai, 2009). Health disparities are a safety and healthcare quality issue which must be managed on a population and policy level. That being said, providers play a vital role in promoting health equity. Health disparities are embedded in environmental and social circumstances beyond the health care system. The Robert Wood Johnson Foundation Commission to Build a Healthier America strongly recommends that “new health vital signs” be assessed at provider visits (Cheng, Emmanuel, Levy, & Jenkins, 2015). These “new health vital signs” reference the origin of health disparities such as, housing, food security, health literacy, education, and family employment (Cheng, Emmanuel, Levy, & Jenkins, 2015). An example of this would be a patient with asthma living in a residence with mold. This patient would benefit from the help of housing organizations, social workers, and legal aide. Assessing these new vital signs would assist the provider in identifying the potential source of the health disparity (Stevens, Pickering, Seid, & Thai, 2009). “WECAN10” is a 10 question screening tool used to assess family employment, housing, education, and food security (Cheng, Emmanuel, Levy, & Jenkins, 2015). One study concluded that the implementation of this screening tool added only < 2 minutes to the patient appointment. Research suggests that childhood health disparities are associated with adult chronic illnesses.

References

Cheng, T., Emmanuel, M., Levy, D., & Jenkins, R. (2015). Child Health Disparities: What Can a Clinician Do? American Academy of Pediatrics, 136(5), 961-968.

Stevens, G., Pickering, T., Seid, M., & Thai, K. (2009). Disparities in the national prevalence of a quality medical home for children with asthma. Academic Pediatrics, 9(4), 234-41. Retrieved from

Cathy G’s Response-

As a primary care provider working in an underprivileged free clinic you realize there are some challenges and barriers in your patient population. You are seeing a number of children with significant health conditions and inadequate follow-up.

What can you do as a community provider to promote social justice and reduce health disparities in this population?

Inadequate follow up in the inner city patient pediatric population is not uncommon. Many parents switch cell phone numbers on a regular basis and move frequently. The health care provider may call the patient for follow up and the number has been disconnected for many reasons including non-payment. There are federal programs that provide cell phones free of charge to the underserved low-income populations. Many times the community medical home is the only contact the patient will have to gain information on what services can be accessed. Pamphlets with information on available services should be made available to the parents of children with health disparities.

Even thought the case scenario is a free clinic, medical care such as prescriptions and specialist care must be paid. Lack of insurance is the number one issue that limits access to care for underserved populations. Research shows that most low income parents are aware of Medicaid and other government insurance programs but too much red tape and confusing regulations keep the public insurance out of reach for many families. Once the parent obtains public insurance, finding a health care provider, dentist, or other specialists who will accept it is also a challenge. Access to care is limited because of the low number of providers that will take the insurance so many cannot afford to travel long distances to access care. More health care providers are needed that accept low-income insurance programs. In addition the provider must take into consideration when prescribing whether or not the medication is covered by the insurance. Many parents will not say anything and will just not pick up the medication leaving the child vulnerable health wise. With the diverse population the underprivileged free clinics serve, there may be a lack of understanding of the treatment regimen for the child due to language and educational barriers (Centers for Disease Control and Prevention, 2014).

The primary care provider must address all of these issues and secondary contact information must be obtained so the parent can be reached for follow up on the child’s condition. In addition, the provider must make information available for all resources for the child and parent to aide in the continuum of care especially when dealing with chronic conditions such as asthma and diabetes.

References

Centers for disease control and prevention. (2014). MMWR supplements: past volume 2014. Morbidity and mortality weekly report (MMWR). 63(4)1-27. Retrieved from https://www.cdc.gov/mmwr/preview/ind2014_su.html

 

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