NR 511 Week 5 Barriers to Preventative Care
Sample Answer for NR 511 Week 5 Barriers to Preventative Care
My clinical practicum site is a primary care office. We often see patients who are women and are above the age of 50. I have decided to discuss the proportion of females who get screened for breast cancer and the proportion of adults who get screened for colorectal cancer. According to Healthy People 2030 (2021), the proportion of females who got screened for breast cancer was 75.6% in 2021 and the target is 80.3%. The proportion of adults who got screened for colorectal cancer was 58.7% in 2021 and the target is 68.3%. Breast and colorectal cancers are two very prevalent diseases that when caught early can drastically improve the patient’s outcome. Mammograms are used to screen for breast cancer, and they are recommended every other year for women between the ages of 50-74. It is recommended that patients between the ages of 45-75 be screened for colon cancer. The most common methods of screening are getting a high-sensitivity guaiac fecal occult blood test yearly, a colonoscopy every 10 years, or a flexible sigmoidoscopy every 5 years (United States Preventative Services Task Force, 2023).
At my clinical practicum site, the providers use the most up-to-date guidelines posted by the U.S. Preventative Services Task Force (2023). These guidelines are very straightforward and easy to understand. So far, I have observed phenomenal preventative care. My preceptor does an excellent job at making sure she discusses it with every patient at every visit. The other providers in the office seem to have the same mindset. I have really enjoyed my site so far and feel that I have a much greater understanding of preventative care in just a short period of time. I don’t feel that I have witnessed any disparities or bias in the healthcare provided to different populations. My preceptor does a great job of bringing up the screenings in very lay terms. For example, toward the end of an appointment, she will say, “Now when did you last have your mammogram? Have you thought about a bone density scan? You will be due for them early next year.” I think she addresses health literacy and the CLAS standards by breaking topics down so they are easy to understand. She doesn’t use the full name of a test and instead relates it to the disease we are looking to prevent. She is also very respectful if a patient denies the screening but makes sure to leave the patient with a lasting thought about why the screening recommendation is important.
Some changes I would recommend in my own practice setting would be to make sure that the screenings are discussed with every patient and that we remind them that their family members need these screenings too. Another way to increase the frequency of screenings in vulnerable populations is to find other ways to educate patients on the importance of these screenings. For example, every year our county does a huge parade all through town. It has such a great turnout every year because it is a free event and people who may not be able to afford treats for their kids are able to get them for free. To help spread education resources, we could print flyers to hand out during the parade every year. This would hopefully reach more people who may not regularly see a primary care physician. In the office I am currently working in, the providers feel that the annual Medicare visits really help to keep everyone on track with preventative screenings. It’s important to make sure that these screenings don’t accidentally get missed.
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References
A & B recommendations. United States Preventive Services Taskforce. (2023). https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations
Office of Disease Prevention and Health Promotion. (2021). Increase the proportion of females who get screened for breast cancer – C05. Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/increase-proportion-females-who-get-screened-breast-cancer-c-05
Office of Disease Prevention and Health Promotion. (2021). Increase the proportion of adults who get screened for colorectal cancer — C07. Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/increase-proportion-adults-who-get-screened-colorectal-cancer-c-07
Sample Answer 2 for NR 511 Week 5 Barriers to Preventative Care
The practicum setting I am working in is a primary care clinic that is part of a safety net organization. This setting see’s adults 18 and older that are generally underserved and resource limited. The clinic cares for individuals regardless of their ability to pay. In reviewing the populations listed in Healthy People 2030, two preventative care screenings that are recommended for the population of patients seen in this clinic are:
- Increase the number of states, territories, and DC that prohibit smoking in worksites, restaurants, and bars.
- Reduce work-related assaults
Preventative care provided at my clinical practicum site by using their electronic medical record (EMR) which helps to keep track of care gaps that include colon cancer screening, vaccinations as well as mammography screening recommendations. The guidelines that the providers as well as the EMR follow are from the CDC for vaccinations, American Cancer Society for mammograms and the American College of Gastroenterology for colorectal cancer screening guidelines.
The quality of preventative care I have seen during clinic is high. Everyone is in tune with reviewing the care gaps and asking the patients if they are interested in closing those gaps during this visit. Frequent reminders are given to patients at the time of their visit as well as via their MyChart EMR application. Providers address health literacy by communicating to patients in the language of their choice at no additional cost. Language assistance is available for anyone who has limited proficiency in English. Also, their after-visit summaries are printed in their preferred language. This site also has community health advocates who often will join a visit to help advocate for the patient and ensure their needs are being appropriately met. These advocates also connect with the patient to ensure they are following through on provider recommendations and making scheduled appointments.
Changes I would recommend at the practice setting I am working at to increase preventative screening is to address the cancellation/ no-show rate. The population of patients seen in this clinic are resource restricted and transportation is often a barrier to making it to these appointments. The clinic already utilizes no-cost ride sharing options, but this does not capture everyone. Having a complex care department that can connect with the patient ahead of time and ensure that transportation has been secured is an opportunity. Appointments are made for the patients prior to leaving the clinic, it would be great if those clients with limited resources were flagged for a community health advocate to automatically follow up with them. Community health workers provide an important link between marginalized communities and the health care setting, and their work has shown how the management of chronic conditions and preventative care overall reduce healthcare costs (Knowles, et al., 2023).
References:
Healthy People 2030. Reduce work-related assaults. Office of disease prevention and health promotion.
Healthy People 2030. Increase the number of states, territories, and DC that prohibit smoking in
worksites, restaurants, and bars. Office of disease prevention and health promotion.
Knowles, M., Crowley, A., Vasan, A. and Kangovi, S. (2023). Community health worker integration with
and effectiveness in health care and public health in the United States. Annual review of public health, 44(3). https://www.annualreviews.org.