Vulnerable Populations

PresentationLaToya Gipson

Identification of

Vulnerable

Population• 19.3% of U. S. Population resides in rural

areas (AHRQ, 2013)

• Rural is defined in terms of:

• Low population size and density

• Distance from urban areas

• Low degree of urbanization

• Few types of economic activity

(Cogan, 2012)

• Any area not categorized as

urbanized areas or clusters (HRSA,

2012)

Identification of

Vulnerable

Population• In 2009, approximately 50 million

Americans without health insurance (Sabik

& Dahman, 2012)

• Individuals living in rural areas are more

likely to be uninsured

• In 2004-2005, rate of rural uninsured

23% as compared to 19% urban

uninsured (Ziller, Lenardson, & Coburn,

2012)

Health Disparities• Premature mortality (death before age 75)

• Unintentional injuries

• Suicide

• Chronic Obstructive Pulmonary Disease (COPD)

• Cigarette smoking

• Cardiovascular disease

• Chronic health conditions (Arthritis, Diabetes, Hypertension)

• Higher death rates from cancer

(Eberhardt & Pamuk, 2004; Hartley, 2004)

Health Disparities• Less likely to participate in preventive

health services

• Lack of health insurance

• Barriers to access of care (Ziller et al., 2012)

• Special health concern for uninsured women in rural areas - lack of utilization of screening mammography

• Between 1993 and 2005, mammography rates found to be the lowest among uninsured at 38.3%

• Contributes to being diagnosed at a later stage of disease, thereby increasing mortality rates from breast cancer (Sabatino, Coates, Uhler, Breen, Tangka, & Shaw, 2008)

Clinical Question

“Will the quarterly addition of a mobile

mammography unit to an existing breast

health program improve compliance

rates in uninsured women residing in

rural areas?

Interdisciplinary

Plan

Mobile mammography

(Atkins, Madhaven, LeMasters, Vyas, Gainor, & Remick, 2013: Vyas, Madhavan, Kelly, Metzger, Schreiman, & Remick, 2013)

Interdisciplinary

Plan• Qualifying patients

• Women residing in designated rural

areas or surrounding areas serviced by

breast health program

• Uninsured

• Has received a normal clinical breast

exam (CBE) within the last 3 months or

found to have a normal CBE on the day

of program

• Must not have any pre-existing breast

concerns

• Those who have not had screening

mammography within the last year

• At least 40 years of age

Interdisciplinary

Plan• Team will consist of

• Advanced Practice Registered Nurse

(APRN)

• Radiologic technician

• Radiologist

• Driver of mobile unit

Interdisciplinary

Plan• Patient services include

• CBE if not current

• Education regarding breast health

• Mammography screening

(Fontenoy, Langlois, Chang, Daigle,

Pelletier, Guertin, Theberge, &

Brisson, 2013)

Stakeholders• Residents and future residents of rural

communities served

• Participants in the program

• APRN, Driver, Radiologic Technician,

Radiologist

• St. Luke’s Episcopal Medical Mobile Ministry

• Susan G. Komen of Shreveport

• Local media

• Sponsors

• State and local officials

Challenges to

Program

Implementation• Cost

• Grant writing – Healthy People 2020

• Public campaigns, grass roots

fundraising

• Utilizing volunteers instead of paid

staff

• Establishing small teams

• Rental of mobile units

• Use of digital technology

(HealthyPeople.gov, 2014; Bongiorno & de

Chesnay, 2012; Naeim, Keeler, Bassett,

Parikh, Bastani, & Reuben, 2009)

Challenges to

Program

Implementation• Resident Participation

• Early and persistent advertising

• Providing education regarding the

importance of screening in breast

health

• Being culturally sensitive

• Demonstration of a non-judgmental

attitude

• Use of incentives

Quality and

Effectiveness of Plan• Based on client participation

• Use of questionnaires to evaluate

service and recommendations for

future events

• Comparison of compliance rates for

mammography referrals the previous

year using the breast health program

to the rates of mammography

performed with the use of mobile

mammography

Use of Technology• More than 200 million people (77%) in

North America have Internet access

(Curley, 2012)

• Nearly 80% of Americans own a cell phone

• 73% participate in text messaging

(Kratzke, Wilson, & Vilchis, 2012)

Use of Technology• Patients should be informed of

reputable Internet sites for finding

information regarding breast cancer

and screening recommendations

(Fayed, 2010)

Use of Technology• Text message reminders

• Notification of mammography

• Breast cancer prevention

messages

(Kratzke et al., 2012)

References

Agency for Healthcare Research and Quality [AHRQ], (2013). Residents of rural areas. Retrieved from

http://www.ahrq.gov/research/findings/nhqrdr/nhdr13/chap11.html

Atkins, E., Madhavan, S., LeMasters, T., Vyas, A., Gainor, S. J., & Remick, S. (2012). Are obese women more likely to participate in a mobile mammography program? Journal of Community Health, 38, 338-348. doi: 10.1007/s10900-012-9619-z

Bongiorno, A. W., & de Chesnay, M. (2012). Developing population-based programs for the vulnerable. In M. de Chesnay & B. A. Anderson (Eds.), Caring for the vulnerable: Perspectives in nursing theory, practice, and research (pp. 395-404). Burlington, MA: Jones & Bartlett Learning.

Cogan, C. (2012). Barriers to healthcare access for Latino service workers in a resort community. In M. de Chesnay & B. A. Anderson (Eds.), Caring for the vulnerable: Perspectives in nursing theory, practice, and research (pp. 339-356). Burlington, MA: Jones & Bartlett Learning.

Curley, A. L. C. (2012). Using information systems to improve population outcomes. In A. L. C. Curley & P. A. Vitale (Eds.), Population based nursing: Concepts and competencies for advanced practice (pp. 133-154). New York, NY: Springer Publishing Company.

Eberhardt, M. S., & Pamuk, E. R. (2004). The importance of place of residence: Examining health in rural and nonrural areas. American Journal of Public Health, 94(10), 1682-1686. doi: http://dx.doi.org.ezproxy.nsula.edu

References

Fayed, L. (2010). Top 7 Breast Cancer sites. Retrieved from: http://cancer.about.com/od/breastcancer/tp/cancersites.htm

Fontenoy, A., Langlois, A., Chang, S., Daigle, J., Pelletier, E., Guertin, M., Theberge, I., & Brisson, J. (2013). Contribution and performance of mobile units in an organizedmammography screening program. Canadian Journal of Public Health, 104(3), 193e-199. Retrieved from http://eds.a.ebscohost.com.ezproxy.nsula.edu/eds/pdfviewer/pdfviewer?vid=1&sid=c43b72f8-068e-4380-a544-6a2f21921053%40sessionmgr4003&hid=4102

Hartley, D. (2004). Rural health disparities, population health, and rural culture. American Journal of Public Health, 94(10), 1675-1677.

Health Resources and Services Administration [HRSA], (2012). Defining the rural population. Retrieved from http://www.hrsa.gov/ruralhealth/policy/definition_of_rural.html

HealthyPeople.gov (2014). Access to health services. Retrieved from

httpwww.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

Kratzke, C., Wilson, S., & Vilchis, H. (2013). Researching rural women: Breast cancer

prevention information seeking behaviors and interest in internet, cell phone, and text use. J

Community Health, 38(1), 54-61. doi:10.1007/s10900-012-9579-3

References

Naeim, A., Keeler, E., Bassett, L. W., Parikh, J., Bastani, R., & Reuben, D. B. (2009). Cost- effectiveness of

increasing access to mammography through mobile mammography for older women. Journal of the American

Geriatrics Society, 57(2), 285-290. doi: 10.111/j.1532-5415.2008.02105.

Sabatino, S. A., Coates, R. J., Uhler, R. J., Breen, N., Tangka, F., & Shaw, K. M. (2008). Disparities in

mammography use among US women aged 40-64 years, by race, ethnicity, income, and health insurance

status,1993 and 2005. Medical Care, 46(12), 692-700. Retrieved from http:/www.jstor.org/stable/40221724

Sabik, L. M., & Dahman, B. A. (2011). Trends in care for uninsured adults and disparities in care by insurance status. Medical Care Research and Review, 69(2), 215-230. doi: 10.1177/1077558711418519

Vyas, A., Madhavan, S., Kelly, K., Metzger, A., Schreiman, J., & Remick, S. (2013). Do Appalachian women attending a mobile mammography program differ from those visiting a stationary mammography facility? Journal of Community Health, 38, 698-706. doi: 10.1007/s10900-013-9667-z

Ziller, E. C., Lenardson, J. D., & Coburn, A. F. (2012). Health care access and use among the rural uninsured. Journal of Health Care for the Poor and Underserved, 23, 1327-1345. Retrieved from http://search.proquest.com.ezproxy.nsula.edu/docview/1033504367?accountid=26272