Public Healthcare Model for Diabetes Prevention, Term Paper Example

There is an expanding demand for seamless service between hospitals, clinics and multidisciplinary teams concerned with the wellbeing of patients and their families. Now, the requirements of our population have changed to include health promotion/disease prevention and chronic disease management.  Such services need an unquestionable and effective case management model by which to provide care, however this can be tough to achieve. Previously the consequences of health care were assessed by measures of morbidity and mortality. Currently research suggests that outcomes may improve if primary care for the chronically ill incorporates enhanced systems for clinical information, evidence-based practice, health system integration, and patient self-management. Increasingly, individuals are dealing with the prevention and management of chronic conditions such as heart disease, hypertension, arthritis, and diabetes.

Healthcare providers working with diabetes patients have been long focused on proactive measures to institutional patient care. As preventive strategies have some effect on Diabetes patients in the earlier stages of the chronic disorder, a shift from medical intervention to supportive measures toward preventive/patient education is a priority within clinical treatment and attendant training of nursing and other healthcare staff. In the forefront of researched public health education on Diabetes is the National Diabetes Education Initiative^®  mission to provide professional recommendation for ‘a multicomponent educational program on type 2 diabetes designed for endocrinologists, diabetologists, cardiologists, primary care physicians, and other healthcare professionals involved in the care and management of patients with type 2 diabetes. NDEI programs address issues concerning insulin resistance and type 2 diabetes from the epidemiology and pathophysiology of the disease and its associated complications to the therapeutic options for treatment and prevention’ (NDEI 2010).

The successful implementation of change in clinical care depends on many factors including compounding evidence for the change and willingness of the patient to participate. This shift in the focus of health care argues for a change in health care service delivery. It has long been known that to achieve optimal patient outcomes, health care should be patient-centered. This is defined by Cohen & Cesta as providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensures that patient values guide all clinical decisions. Central to the patient-centered model is the planning of care between layers of the health care system, starting with connected, prepared, informed, and motivated patients, families, health care teams, and communities. This promotes care continuity, encourages quality through leadership and incentives, organizes and equips health care teams, support self management and problem prevention, develop and encourage the use of information systems, and creates a positive environment for the multidisciplinary team. Models developed for diabetes provide excellent examples of how changing care systems drive health care improvement.     

Clinical care professionals trained in the NDEI programs are introduced to a comprehensive curriculum in Diabetes Prevention with the following knowledge based outcomes:

• Implement ADA guidelines for the treatment of type 2 diabetes, with a specific focus on achieving target A1C and serum glucose levels
• Manage the spectrum of patients with insulin-resistant states, from impaired glucose tolerance to type 2 diabetes
• Understand the contribution of insulin resistance to the pathophysiology of type 2 diabetes
• Describe the link between macrovascular complications and insulin resistance
• Understand the rationale for early, aggressive intervention to prevent microvascular and macrovascular complications of type 2 diabetes
• Describe the mechanism of action, efficacy, and safety of available pharmacotherapeutic agents for the management of type 2 diabetes, and understand the role each agent plays in patient management

The NDEI professional training program in Diabetes Prevention has had significant impact in the way in which patient support is interpreted and managed. From an institutional perspective, application of such training initiatives enables nurses and clinical care staff to make the transition to comprehensive measures of chronic illness intervention that promise sustained benefits to both the patient, and to the capacity of care within the organization. Systemic attention to cardiometabolic risk (CMR) gives clinicians a more complete picture of patients’ health and potential risk for future disease and complications according to progression. Targeted attention is important in terms risk reduction to the patient, and mitigation of malpractice in prescriptive decision making.

Due to the persistence clusters of risk factors often present in a single case, the probability of related disorders such as cardiovascular disorders (CVD) indicate that type 2 diabetes are likely to promote such factors. The American Diabetes Association works to educate patients about cardiometabolic risk factors, and encourages patients to talk to their doctor, nurse practitioner, and physicians about their risk toward mitigation of nutritional and other activities that might advance type 2 diabetes and heart disease, so they can take action to lower their risk (American Diabetes Association 2010).

The recommended CMR focuses clinical attention on the value of systematic evaluation, education, lifestyle behavior changes, disease prevention, and treatment.

Cardiometabolic risk factors include:

Adequate and consistent assessment CMR ultimately introduces the idea of patients’ responsive measures to healthcare, and shared information on potential risks to their condition according to indexed findings for self apprehension of future disease and complications.

Since the 1980s, the public health model of preventive care has raised awareness about patient centered preventive models of education within the broader medical field. Community based healthcare intervention initiatives now include an integrated system of professional knowledge sharing, and by extension patient care. The efficacy of public health education programs has been especially effective in regard to chronic disorders like Diabetes that might be impacted significantly through patient and family education opportunities directed at self assessment and risk reduction measures. Group nutritional therapies and other ‘alternative’ community health initiatives are now finding increasing support in the traditional medical field, with inclusion of such options within spectrum patient care.

In the public health field, responsive case management and referrals outside of the primary patient care for a diabetes condition may include attendance at prevention education classes.  Due to the lack of ‘cure’  in the case of chronic conditions, the concept of ‘progress’  typically underscored as therapeutic outcome is delineated as inappropriate measure for patient outcomes. The institutional assessment methodologies employed by those agencies includes communications with medical professionals on patient records that have been retained for both individual client reference and anonymous group outcome data. Comprehensive care programs are, then, distinctly based on coordinated evaluation of a particular group’s integrated complex of individual medical histories. Distinguished from nursing practice in traditional medical settings not dedicated to research, the public health data generated from these tools offers patients, and their communities, reinforcement for risk reduction measures and goal oriented progress in their own healthcare

Community healthcare agencies now offer an array of professional services to extend the efforts of national diabetes education organizations like the ADA and NDEI. Organizations are responsive to the integrated or consortium of services approaches, and the existence of growth in partnership based, public policy funded, networked healthcare plans as bridges for traditional medical intervention evidences this fact. Awareness of resources such as knowledge sharing resources now seen in IT based professional portals further the exchange on Diabetes education and partnership opportunities for conferences and training with other collaborating agencies and local hospitals.

References

American Diabetes Association. Retrieved from: http://www.diabetes.org/

National Diabetes Education Initiative. Retrieved from: http://www.ndei.org/v2/website/content/aboutus.cfm