LOCAL PRACTICE PROBLEM
According to Russell et al (2017), diabetes is the seventh leading cause of death in the United States (US) and affects more than 29.1 million Americans. Its prevalence is reported to have doubled in the last 30 years with disease management costing $245 billion each year (Russell et al., 2017). Not only does diabetes require life-long therapy, but it increases hospitalizations with an increased risk of strokes, heart attacks, kidney disease, and even amputations (Russell et al., 2017). This information is more national but has been added to show the comparison to the local area of Los Angeles, California. According to the Los Angeles County Department of Public Health, the population is 10,192,376. Of this number, 1 in 10 people have diabetes and 46% have prediabetes (Los Angeles County Department of Public Health [LADPH], 2017). Diabetes is also ranked the 7th leading cause of death in Los Angeles and in 2016 the cost of care was over $6 billion (LADPH, 2016 & 2017). Other health risks that increase with the diagnosis of diabetes as mentioned above and the cost of care for diabetes in Los Angeles puts a tremendous strain on the healthcare system. With statistics as such, the county of Los Angeles has to target the areas impacted and develop programs to assist with prevention and management. The LAPDH seeks to identify barriers such as access to healthcare, disparities among groups, track health trends, and even compare LA County with national data with aims to decrease the prevalence of diabetes (LADPH, 2017). When providing care, consideration has to be given to early diagnosis and comorbidities. Nurses are having to take care of more patients with diabetes and other comorbidities associated with diabetes. The emergency room nurses see an increased amount of patients due to hyper/hypoglycemic episodes and more patients are being seen with dialysis initiation (Burner et al. 2019). These nurses are also educated/trained to approach patients of the Latino population as many refuse to get consistent care due to lack of documentation (Burner et al. 2019). This again affects the quality of care given to the patients because the emergency room is no place to try and manage this often chronic problem.
The LADPH is a major stakeholder in the diabetes practice problem. Along with the tasks identified above, the LADPH also partners with other organizations such as the Latino Diabetes Association (LDA). The LDA is important to LA county as the Latino population is one of the largest affected by diabetes (LADPH, 2017). I found it amazing that the LDA is partnering with Cal State L.A. Electrical and Computer Engineering and Computer Science Departments for a mobile app for Type 2 Diabetes (Latino Diabetes Association, 2018). I loved it because I had already read the article from Russell et al (2017) that produces great results from text-messaging to reduce A1c levels and improved patient outcomes. Another organization leading the way in L.A. County is UCLA. UCLA has the Gonda Diabetes Center which was founded in 2000. The goal of this organization is to educate patients, the public, and healthcare members about diabetes, provide diabetes care, and conduct diabetes research (UCLA Health, 2019). Staffing there is a combination of physicians, dieticians, certified diabetic educators, and they partner with the Gonda Vascular Center (UCLA Health, 2019). There is also a large collaboration with cardiologists and nephrologists.
Diabetes is a major health concern in my setting. This Federally Qualified Health Center(FQHC) is in an underserved area with mostly Latinos and African Americans. These individuals make up the largest portion of the diabetes population in LA County (LADPH, 2017). If I had to take a guess, I would say over 60% of the patients have diabetes. The current practice is to give patients paper glucose logs for 1-2 weeks and have them complete self-monitoring and return to the appointment with the log completed. This is problematic because many do not return for appointments and when they do the logs are rarely ever completed. Although the forms are given in their language, many report not understanding the instructions. Of the few that attempt the paper log, it is rarely ever complete. There are often times or complete days missing. This makes it extremely difficult to manage the patient. As a provider, you do not want the patient going without medication but proper management is essential; even more when insulin is involved in treatment. I am looking forward to implementing lost cost interventions and knowledge that will improve patient outcomes in this setting.
Burner E, Terp S, Lam CN, Neill E, Menchine M, Arora S. (2019). Access to care, nativity, and disease management among Latinos with diabetes in a safety-net healthcare setting. AIMS Public Health. 6(4) 488-501. doi:10.3934/publichealth.2019.4.488. PMID: 31909069; PMCID: PMC6940585.
Latino Diabetes Association. (2018). Our programs. https://lda.org/
Los Angeles County Department of Public Health. (2016). Diabetes Continues to Increase in Los Angeles County. http://publichealth.lacounty.gov/diabetes/docs/Press_Release_Diabetes_Continues_to_Increase_in_LA_County_November2016.pdf
LA County Department of Public Health. (2017). Key Indicators of Health by Service Planning Area. http://publichealth.lacounty.gov/ha/docs/2015LACHS/KeyIndicator/PH-KIH_2017-sec%20UPDATED.pdf
Russell, N.M., Vess, J., Durham, C., & Johnson, E. (2017). Text-messaging to support diabetes self-management in a rural health clinic: A Quality Improvement project. Online Journal of Nursing Informatics, 21(2).
UCLA Health (2019). Gonda (Goldschmied) Diabetes Center. https://www.uclahealth.org/endocrinology/gonda-diabetes-center?utm_source=google&utm_medium=Yext
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