Using the NHQDR (2021) select one measure of health disparity and describe the role of the DNP prepared clinician and telehealth to address the identified health disparity


Struggling to meet your deadline? Get your work done on time by experts. Don’t wait – ORDER NOW!

The Agency for Healthcare Research and Quality (AHRQ) (2021), National Healthcare Quality and Disparities Report (NHQDR) provides a snapshot of health and healthcare delivery since 2003.  The report uses data from various state and national entities to compile this report indicative of the nation’s healthcare system since 2003.  Although the report illustrates data until 2018; it should be viewed as the status of the nation prior to the pandemic.

The NHQDR (2021) identified disparities in healthcare using the measures:  race and ethnicity, income, insurance status, and residence.  Telehealth can help address inequality and lack of access to healthcare services and impact health outcomes. As telehealth continues to infuse into the delivery of healthcare, its challenges related to serving the needs of vulnerable populations in the United States are becoming increasing evident.

Using the NHQDR (2021) select one measure of health disparity and describe the role of the DNP prepared clinician and telehealth to address the identified health disparity.  Conclude your initial post by identifying challenges associated with the use of telehealth and its application in addressing inequalities related to healthcare.

Here is the correct APA format for the NHQDR (2021) document:

Agency for Healthcare Research and Quality (AHRQ) (2021) National Healthcare Quality and Disparities Report (NHQDR). Executive Summary.  https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr-final-es.pdf

Here is the link to the report: /content/enforced/304845-NSG600_MC_Fa22_12W/2021qdr-final-es.pdf

Post your initial response by Wednesday at 11:59 PM EST. Respond to two students by Saturday at 11:59pm EST. The initial discussion post and discussion responses occur on three different calendar days of each electronic week. All responses should be a minimum of 300 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and referenced.  A minimum of 2 references are required (other than the course textbook). These are not the complete guidelines for participating in discussions. Please refer to the Grading Rubric for Online Discussion found in the Course Resource module.

As a Doctor of Nursing Practice (DNP) it is important to recognize barrier that patients are faced with when it comes to healthcare. Access to healthcare services is one of the most important aspects that must be addressed in it comes to healthcare disparities. Residence location is one of the accesses to care disparities that has gained attention by the Agency for Healthcare Research and Quality (AHRQ) (2021). Healthcare services that are appropriately utilized provide for early detection of illnesses which allow for diagnosis and intervention from a proactive perspective. When chronic illnesses are detected and treated early in the disease process quality of life and life expectancy can be increased. Individuals living in rural areas or non-metropolitan areas have limited access to care in comparison to individuals who reside in a metropolitan area (Coombs et al., 2021).

Telehealth has grown significantly over the past 20 years, especially with the expansion that happened with the COVID-19 pandemic (Barbosa et al., 2021). A specific population that has been affected by access to care and residence location is that of opioid users. Although opioid overdoses are at an all time high, access to opioid treatment comes with many limitations. Opioid users often do not have access to transportation to receive care in metropolitan areas and therefore may go untreated for chronic opiate use disorder (Hailu et al., 2023).

Throughout the public health emergency prescribing of controlled substances over telehealth was lifted which allowed for increased access to care in opioid users. The public health emergency is ending in April of 2023 and therefore the restrictions of prescribing controlled substances based on the Ryan Haight Act will begin again. The Ryan Haight Act requires that before a provider prescribes a controlled substance an in-person examination must be performed (Huskamp et al., 2021).  This is not something that can be done through telehealth services, therefore requiring the patient to go to a physical location to receive services.

The Drug Enforcement Administration (2023) has released new proposed rules that will take place when the public health emergency ends. The proposed rules would allow for a provider to give a 30-day supply of controlled medications without an in-person examination; however, the practitioner would not be allowed to provide the patient with any further prescriptions until this in person requirement is met. This places a significant barrier to providing potentially life-saving medications to many patients and especially those with opiate use disorder (Hailu et al., 2023).

As a DNP, advocating for better access to care is important. The effort to increase access to care the DNP will provide commenting and recommendation on this specific rule changing through the DEAs Federal eRulemaking Portal (Drug Enforcement Administration, 2023). This advocacy will be to allow continued treatment of patients via telehealth with controlled substances, especially individuals with opiate use histories that are in need of medication assisted treatment. A telehealth DEA registration is recommended for individuals who will be prescribing via telehealth with a required bi-annual training for DEA renewal. This will facilitate individual providers to have accountability for telehealth prescribing by allowing the DEA to track the number of prescriptions being prescribed by telehealth versus in person.

References

Agency for Healthcare Research and Quality. (2021). National healthcare quality and disparities report (NHQDR) [Executive Summary]. https://doi.org/https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr-final-es.pdf

Barbosa, W., Zhou, K., Waddell, E., Myers, T., & Dorsey, E. (2021). Improving access to care: Telemedicine across medical domains. Annual Review of Public Health42(1), 463–481. https://doi.org/10.1146/annurev-publhealth-090519-093711

Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among u.s. adults with mental health challenges: A population-based study. SSM – Population Health15, 100847. https://doi.org/10.1016/j.ssmph.2021.100847

Drug Enforcement Administration. (2023). DEA announces proposed rules for permanent telemedicine flexibilities [Press Release]. https://doi.org/https://www.dea.gov/press-releases/2023/02/24/dea-announces-proposed-rules-permanent-telemedicine-flexibilities

Hailu, R., Mehrotra, A., Huskamp, H. A., Busch, A. B., & Barnett, M. L. (2023). Telemedicine use and quality of opioid use disorder treatment in the us during the covid-19 pandemic. JAMA Network Open6(1), e2252381. https://doi.org/10.1001/jamanetworkopen.2022.52381

Huskamp, H. A., Riedel, L., Uscher-Pines, L., Busch, A. B., Barnett, M. L., Raja, P., & Mehrotra, A. (2021). Initiating opioid use disorder medication via telemedicine during covid-19: Implications for proposed reforms to the ryan haight act. Journal of General Internal Medicine37(1), 162–167. https://doi.org/10.1007/s11606-021-07174-w

I have decided to focus on the health disparity of income identified by the Agency for Healthcare Research and Quality (AHRQ) (2021). I chose this disparity because I have personal experience with it. Fourteen years ago, I was a single mother with four children living below the poverty level. I had no financial help from anyone, and I know what it’s like to live day by day, prioritizing survival and providing for my daughters over my own health care. As a Hispanic woman with English as a second language, it was not easy, but I was able to persevere and complete my education. Today, I have a better quality of life.

As a future DNP, I am committed to helping and advocating for my community. To that end, I am creating a program in partnership with a community pharmacy to sponsor at least five uninsured patients per year by providing free medical care and medication. This program is just the beginning, and I plan to continue to seek out opportunities to address health disparities in my community and beyond. Research has shown that the integration of telehealth, electronic measurement tools such as phone applications and online health monitoring tools, and nursing interventions have enabled patients to take control of their health (Jezewski et al., 2022). While we didn’t have telehealth as we do now fourteen years ago, if we had, my life would have been much easier as I wouldn’t have had to miss work for doctor appointments. Easy access is undoubtedly the best feature of telehealth. Evidence suggests that patients with low income had the largest increase in telehealth usage due to its affordability (Qian et al., 2021).

Telehealth has its faults and challenges, as not everyone has access to the latest smartphone with unlimited internet or a good connection. Research studies have shown that internet connection stability and suitability for telemedicine through video conferencing may vary due to geographic location and internet plan limitations affecting internet bandwidth (Zhai, 2021). Creating telehealth stations in community centers can be a potential solution to improve access to telehealth services for patients. Community centers, such as community health centers, are often located in areas with a high concentration of low-income or underserved populations who may have limited access to healthcare services. By establishing telehealth centers in these community centers, patients who might not have access to technology or reliable internet connections at home can still access telehealth services in a convenient and accessible location.

There are many other barriers in reference to telehealth like the platforms are more prone to privacy and security risks, patients might not be technology savvy to connect to the visit (Gajarawala & Pelkowski, 2021). While there may be more barriers to accessing healthcare than the ones I have mentioned, I believe that as a provider and future DNP, it is crucial that we identify the specific barriers in our communities. Once identified, we can develop evidence-based strategies to guide our care and improve access to healthcare. I firmly believe that as nurse practitioners, we can shape the healthcare industry and improve access to care for vulnerable populations. It starts with us, and by working together, we can make a difference.

References

Agency for Healthcare Research and Quality (AHRQ) (2021) National Healthcare Quality and Disparities Report (NHQDR). Executive Summary.  https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr-final-es.pdf

Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth benefits and barriers. The Journal for Nurse Practitioners: JNP, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013

Jezewski E, Miller A, Eusebio M, Potter J. targeted telehealth education increases interest in using telehealth among a diverse group of low-income older adults. Int J Environ Res Public Health. 2022 Oct 16;19(20):13349. doi: 10.3390/ijerph192013349. PMID: 36293929; PMCID: PMC9602760.

Qian, L., Sy, L. S., Hong, V., Glenn, S. C., Ryan, D. S., Morrissette, K., Jacobsen, S. J., & Xu, S. (2021). Disparities in outpatient and telehealth visits during the covid-19 pandemic in a large integrated health care organization: Retrospective cohort study. Journal of Medical Internet Research, 23(9), e29959. https://doi.org/10.2196/29959

Zhai Y. (2021). A Call for addressing barriers to telemedicine: Health disparities during the COVID-19 pandemic. Psychotherapy and Psychosomatics, 90(1), 64–66. https://doi.org/10.1159/000509000

Although there continue to be significant advances in medicine, disparities in healthcare persist. Our nation’s healthcare system has made improvements with quality of care and access to healthcare, however, inequalities remain for populations in nonmetropolitan and rural areas (Agency for Healthcare Research and Quality [AHRQ], 2021). Telehealth, although used out of necessity during the pandemic, was optimistically thought to address the lack of healthcare in rural areas, where almost 20% of the U.S population resides. Rural patients face barriers with access to healthcare that urban patients do not, such as smaller healthcare facilities with less staff and long travel distances to reach healthcare facilities, contributing to rural-urban healthcare disparities (Larson et al., 2022).

Since the pandemic, telemedicine has grown significantly, and is now viewed as a routine method for healthcare delivery. Studies done in 2020 show that nearly half of primary care providers in the U.S. now use telehealth as a result of the pandemic, up from just 18% in 2018 (Larson et al., 2022).  However, new barriers may have been created with the use of telehealth regarding digital literacy, lack of material resources, economic stability, and patients viewing virtual visits as impersonal (Pujolar et al., 2022). This may be common among the elderly, especially those living in rural communities. For those that do have capability, but lack knowledge, having a well-informed provider to troubleshoot technical difficulties may be beneficial. Knowledge and skills related to health information technology and patient care technology to support and improve patient care encompasses the role of the DNP nurse practitioner (American Association of Colleges of Nursing [AACN], 2006). For those with  the proper means, telemedicine may be a cost effective, efficient means of healthcare delivery, with the DNP graduate taking the lead to ensure patients, and providers, are adequately trained. For providers, the DNP graduate can help lessen the learning curve of telemedicine with education regarding technological workflow, regulations, and billing. Additionally, equitable access to telemedicine depends on reimbursement for services and the success of ability to improve internet access (Larson et al., 2022). The DNP graduate is well suited to design and implement health care policy to address inequities in healthcare (AACN, 2006).

The constant growth of the population’s health needs requires a more patient-centered healthcare management, that is more attention should be given to the process of caring rather than on facility operations (Palozzi et al., 2020). The ability to become more patient-centered, or customized, is possible with the use of telemedicine. For those who have capability, telemedicine makes access to specialty care available, which may not have been possible with a face to face visit. Use of telemedicine may be considered a cost-effective strategy that increases patient outcomes (Palozzi et al., 2020). However, the challenge of providing access to high quality care remains for those who lack internet access. Use of public internet access for telemedicine visits makes patients vulnerable to data breaches. Those most at risk may be the elderly, people in lower socio-economic areas, and people in remote access without connectivity, as they will continue to have technology challenges. It is the responsibility of government agencies, medical facilities, digital technology providers, and healthcare service receivers to help in reducing these inequities (Yao et al., 2022).

References

Agency for Healthcare Research and Quality (AHRQ). (2021). National Healthcare Quality and Disparities Report (NHQDR). Executive Summary.

https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr-final-es.pdf

American Association of Colleges of Nursing (AACN). (2006). The Essentials of Doctoral Education for Advanced Nursing Practice. https://www.aacnnursing.org/DNP/DNP-Essentials

Larson, A.E., Zahnd, W.E., Davis, M.M., Stange, K.C., Yoon, J., Heintzman, J.D., & Harvey, S.M. (2022). Before and during pandemic telemedicine use: an analysis of rural and urban safety-net clinics. American Journal of Preventive Medicine, 63(6), 1031-1036. https://doi.org/10.1016/j.amepre.2022.06.012

Palozzi, G., Schettini, I., & Chirico, A. (2020). Enhancing the sustainable goal of access to healthcare: findings form a literature review on telemedicine employment in rural areas. Sustainability, 12(8). doi: 10.3390/su12083318

Pujolar, G., Oliver-Angles, A., Vargas, I., & Vazquez, M.L. (2022). Changes in access to health services during the COVID-19 pandemic: a scoping review. International Journal of Environmental Research and Public Health, 19(3). https://doi.org/10.3390/ijerph19031749

Yao, R., Zhang, W., Evans, R., Cao, G., Rui, T., & Shen, L. (2022). Inequities in health care services caused by the adoption of digital health technologies: scoping review. Journal of Medical Internet Research, 24(3). doi: 10.2196/34144

Struggling to meet your deadline? Get your work done on time by experts. Don’t wait – ORDER NOW!

Order Now! Order Now!