Health Care

3 response posts: 200-250 words each———-POST 1——–Changing Health Behavior
One of the first projects that I was involved with when I entered the healthcare industry was to build-out a health intervention targeting my clinic’s vulnerable diabetic population. The clinic in question was located in the inner-city, housed our internal medicine residency program, and saw around 10,000 patients annually. The majority of the patient population was African American, most of which relied on Medicaid or Medicare for insurance. The health system I worked for did have a formal diabetic education program, however, the program was significantly backlogged and serviced the entire metro area.

The diabetic population within the clinic was at significant risk of poor health outcomes due to the inability to access formal diabetic education as well as multiple social determinant factors such as transportation and diet. On average, 35% of the clinic’s population had an HbA1c value greater than 9.0 and elevated blood pressure placing those patients at an elevated risk of vascular complications such as myocardial infarction or a cerebrovascular accident (Zoungas et al., 2011).

Ryan (2009) states that promoting good health and chronic disease management requires patients to adopt and maintain healthy behaviors such as increasing physical activity, changing dietary habits, managing stress, and eliminating negative behaviors such as smoking and alcohol consumption. The foundation of all diabetic self-management education is focused on modifying these factors, yet despite this, outcomes continue to be poor for populations facing complex social determinant variables. A patient experiencing homelessness or a utility shutoff, for example, will lack an ability to keep their insulin refrigerated thereby reducing its efficacy. Simply put, there is no amount of behavior modification or self-management education that can overcome the barriers that occur with homelessness. Likewise, dietary modification is meaningless if the population lacks access to healthy foods to begin with. The social determinants are an unaccounted for variable in the development of health interventions and represent a significant barrier to successful behavior modification.

The clinic identified food scarcity and insecurity as a driver of poor health outcomes within the patient population, so I took a two-pronged approach to building out the health intervention. Phase one was to implement an onsite food pantry focused on delivering nutritionally appropriate food. Phase two was to provide chronic disease self-management education free of charge to the patient population. The education component consisted of six one-hour weekly sessions that explored the pathophysiology of diabetes and metabolic illness, and then provided participants with powerful set of tools they could use to prevent poor outcomes. Participants received a weekly bag of fresh produce coupled with a healthy recipe that they could sample during the class. The goal of this program was to mitigate as many barriers as possible and participants received resistance bands, a pedometer, a glucose meter and test strips, and resource connections to social services. The cohorts that completed the program saw an average A1c reduction of 1.2%, increased blood pressure control, and sustained weight loss versus those who did not complete the program. Much of the success of this intervention can be attributed to multiple factors including, a) understanding the patient population, b) understanding the social variables, and c) mitigation of barriers.

References
Ryan, P. (2009). Integrated theory of health behavior change. Clinical Nurse Specialist, 23(3), 161–170. https://doi.org/10.1097/nur.0b013e3181a42373Links to an external site.

Zoungas, S., Chalmers, J., Ninomiya, T., Li, Q., Cooper, M. E., Colagiuri, S., Fulcher, G., de Galan, B. E., Harrap, S., Hamet, P., Heller, S., MacMahon, S., Marre, M., Poulter, N., Travert, F., Patel, A., Neal, B., & Woodward, M. (2011). Association of hba1c levels with vascular complications and death in patients with type 2 diabetes: Evidence of glycaemic thresholds. Diabetologia, 55(3), 636–643. https://doi.org/10.1007/s00125-011-2404-1Links to an external site.———————-POST 2—————In the United States, chronic diseases currently affect six in 10 adults, account for the majority of the nation’s annual healthcare budget, and are the leading causes of death and disability (Centers for Disease Control and Prevention [CDC], 2022). While chronic diseases are the most common and costly medical conditions, they can be mostly prevented if we shift our focus to addressing the high-risk behaviors that lead to their development. As a Primary Care Provider, I spend most of my time trying to manage chronic diseases and fortunately have multiple opportunities to influence the behaviors of my patients.

Patient Education/Counseling

One of my biggest responsibilities as a provider is delivering education and counseling to my patients. Using the Transtheoretical Model of Behavior Change (TTM) to guide my advice would be more effective in helping to assess patient readiness for change and providing tailored interventions to facilitate movement through the stages until the desired outcome is reached (Nash et al., 2016). Also, instead of using warnings or threats to scare patients into change, positive strategies such as social incentives and progress monitoring would be better motivators (TEDx Talks, 2014).

Technology

Health information technology (HIT) is an amazing tool that I feel could be better employed at my clinic. Standardized forms and questionnaires that can be prepopulated; access to fitness or food trackers; interactive reminders of appointments, screenings, and medication refills; and providing access to accurate and tailored health information are all ways of developing patient engagement and lead to improved health outcomes and patient satisfaction, reduced healthcare costs, and enhanced clinician experience (Nash et al., 2016; Krist et al., 2017).

Community

Incorporating the social determinants of health into care is essential and something my clinic could improve upon. Having a social worker as part of our team to help strengthen clinic and community support systems would positively affect the environments that lead to risky behaviors and improve health outcomes and patient satisfaction (Nash et al., 2016). A better understanding of determinants would also allow for the delivery of targeted health information and services based on the specific needs of the population (Nash et al., 2016)

References

Centers for Disease Control and Prevention. (2022, May 6). Chronic diseases in America. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htmLinks to an external site.

Krist, A. H., Tong, S. T., Aycock, R. A., & Longo, D. R. (2017). Engaging patients in decision-making and behavior change to promote prevention. Studies In Health Technology and Informatics, 240, 284–302.

Nash, D. B., Fabius, R. J., Skoufalos, A., Clarke, J. L., & Horowitz, M. R. (2016). Population health: Creating a culture of wellness (2nd ed.). Jones and Bartlett.

TEDx Talks. (2014, October 28). How to motivate yourself to change your behavior | Tali Sharot | TEDxCambridge [Video]. YouTube.
https://youtu.be/xp0O2vi8DX4—————–POST 3————-In my previous profession as an orthodontic assistant, I expected several behavioral changes from my patients. I constantly had to coach them about the most efficient and effective ways to complete their treatment. For example, starting orthodontic treatment is a change. As far as routine and habits go, what used to be acceptable must be evaluated and changed depending on the patient and the type of orthodontic treatment received. Invisalign treatment requires for 22-hours of aligner wear time which is crucial to the success of treatment. Not wearing the aligners will result in extended treatment time. Fixed appliances, and braces, often require a significant change in diet and food choices to avoid breaking brackets and extending the amount of time spent in treatment.

The main concern in any orthodontic office is the patient’s success in treatment and overall maintenance of oral health during treatment. It is stressed at the consultation and many times are shown to patients via photos what the results of treatment will look like without the proper oral health routine. This is normally not a huge behavior change for individuals who possess good oral health habits prior to treatment. However, patients with poor oral health habits that enter orthodontic treatment experience the hardest adjustments.

“Environmental actions may include altering the physical, social, economic, or political environment around the individual to promote behavior change” (Nash et al., 2021, p. 277). An example of environmental change that occurs when a patient begins Invisalign is reducing or eliminating the desire to snack throughout the day which requires the frequent removal of aligners. Depending on the age, and lifestyle of the patient, this must be supported by the community in which the patient is surrounded. For example, if the patient is young and not in charge of their own grocery shopping, their parents are then providing either a conducive or non-conducive environment to successfully finish Invisalign treatment.

References

David B. Nash, Alexis Skoufalos, Raymond J. Fabius, & Willie H. Oglesby. (2021). Population Health: Creating a Culture of Wellness: Vol. Third edition. Jones & Bartlett Learning.

Wein, H. (2019, April 22). Shape your family’s habits. National Institutes of Health. https://newsinhealth.nih.gov/special-issues/parenting/shape-your-familys-habits

ANSWER

M3 Discussion Responses

Post 1

Health behaviors are determined by a multitude of factors including biological, psychological, social, and economic influences. Health behaviors are considered to be health-promoting or health-risking depending on the individual and context in which the behavior occurs (Wein, 2019). I agree with the post that promoting good health and chronic disease management demands patients to adopt and maintain healthy behaviors such as changing dietary habits, increasing physical activity, managing stress and eliminating negative behaviors such as alcohol consumption and smoking. However, it’s important to understand that no amount of behavior modification or self-management education can overcome the barriers of social determinant factors. Dietary modification is meaningless if the population lacks access to healthy foods.

Most health interventions fail to consider the social determinant factors which have a significant effect on behavior modification (David et al., 2021) Implementing onsite food pantry would help focus on delivery of nutritionally appropriate food while the chronic disease self-management education would help in managing the patient population. The two pronged approach to build an effective health intervention indicated that health intervention can be attributed to factors of understanding the patient population, understanding the social variables and mitigation of barriers.

Post 2

The Trans-theoretical Model of Behavior Change is a model of intentional change that posits that individual’s progress through a series of stages in order to adopt new behaviors. The model has been used in a wide range of health-associated behaviors, such as smoking cessation, physical activity, diet, and condom use. The model postulates that change is a process that occurs over time and that individuals move through a series of distinct stages in order to adopt new behaviors (Aghamolaei, Tavafian and Sh, 2008). The model has been used to develop interventions that target specific stages of change in order to promote behavior change. The Trans-theoretical Model has been found to be a useful tool for understanding and predicting readiness for changing and offering tailored interventions that facilitate movement through stages until the desired outcome.

I also agree with the post that the Health Information technology is an amazing tool that could be better employed in the clinic for a number of activities. These include access to food trackers, fitness, screenings, interactive reminders of appointments and medication refills as well as providing access to tailored and accurate health information. Relying on social determinants in healthcare is essential since helps in formulation of clinic and community support systems that would positively influence the environment that lead to risk behaviors, improved patient satisfaction and health outcomes.

Post 3

I agree with the post that in any orthodontic office, the main concern is the success in treatment and overall maintenance of health during treatment. Considerably, environmental actions such as altering social, physical and economic environment can help promote behavior change. For instance, one of the most important behavior change in orthodontic treatment is reducing the desire to snack throughout the day which requires frequent removal of aligners. Orthodontic treatment usually lasts for a period of 18 to 24 months. During this time, patients are required to maintain good oral hygiene, follow instructions for wearing braces, and avoid hard and sticky foods. In order to ensure that patients adhere to their treatment plan and achieve the desired results, it is important for orthodontists to promote behavior change. Orthodontic treatment can be successful only if patients are willing to make necessary changes in their daily routines.

References

Aghamolaei, T., Tavafian, S. S., & Sh, Z. (2008). Physical activity and the stages of change: application of the Trans Theoretical Model. Payesh (Health Monitor), 7(3), 0-0.

David B. Nash, Alexis Skoufalos, Raymond J. Fabius, & Willie H. Oglesby. (2021). Population Health: Creating a Culture of Wellness: Vol. Third edition. Jones & Bartlett Learning.

Wein, H. (2019, April 22). Shape your family’s habits. National Institutes of Health. https://newsinhealth.nih.gov/special-issues/parenting/shape-your-familys-habits.