Who’s to Blame for Poor Health?

We hear it over and over and probably say it to our patients: to be healthy, follow a proper diet, don’t smoke, and be active. And if diagnosed with an illness, adhere to the agreed-upon plan of care. Sounds simple—and when patients return time and again with the same issues, we often blame them (secretly, of course) for not taking care of themselves.

But for how many of our patients is what we’re asking them to do less a matter of personal choice than a function of the neighborhood in which they live and the limitations imposed by their socioeconomic circumstances?

Many people don’t live within walking distance of a grocery store that offers fresh vegetables and fruit. Or if they do, they may not be able to afford the more nutritious choices, which are often more expensive. Many urban areas lack playgrounds. Air pollution and substandard housing materials can cause asthma and heart disease. Being born into poverty can result in poor nutrition, contributing to poor health, as well as limited access to health care, education, and job opportunities.

Social determinants of health, before we called them that.

Nurse and social worker Lillian Wald understood this when she and colleague Mary Brewster established the Henry Street Settlement in New York City’s Lower East Side, where she offered health care, […]

What if Our Antibiotic Prescribing Practices are Wrong?

How often have you emphasized to patients, family, and friends that they must finish their prescribed antibiotics, even if they feel better? A provocative new analysis in BMJ takes a close look at why standard antibiotic protocols may promote, rather than prevent, antibiotic resistance.

The authors’ arguments center around two key points:

  • The length of a course of antibiotic therapy is not evidence based, but rather “set by precedent [and] driven by fear of undertreatment.”
  • Typical, prolonged courses of these drugs cause endogenous or colonizing bacteria to become antibiotic resistant. It is these “collateral” organisms, they argue, and not the organism that has actually caused the infection, that drive the spread of antibiotic resistance.

Individualized antibiotic courses.

The BMJ authors present a strong argument for more individualized courses of antibiotic treatment. Unfortunately, when the news media picked up this story, much of what was written and broadcast erroneously suggested that everyone should simply stop their antibiotics when they feel better. […]

A Crucial Public Health Lesson: Let the Women Speak

” . . . people have their own hope and power which they need to discover.”

Illustration by Gingermoth for AJN.

Do some public health projects fail to live up to their ambitions because they were conceived in a conference room rather than in dialogue with those they are trying to help? It seems possible. Terms like client or community “buy-in” are now fashionable, but maybe what’s really meant by such terms is that people are given a chance to state their needs and their concerns ahead of time. And that someone is listening.

In this month’s Reflections essay by nurse practitioner Mark Darby, he remembers a valuable lesson once imparted to him through example by a Dominican priest. “Shut Up and Let the Women Speak” doesn’t flatter the younger version of the author who once visited the Dominican Republic on a medical mission. […]

Despite Outreach Cuts, Open Enrollment for the ACA Underway

Open enrollment for insurance through the Affordable Care Act (ACA) starts tomorrow, and ends December 15, allowing people half the time to enroll compared with previous years. There is much confusion and misinformation surrounding the ACA, particularly after recent executive orders by President Donald Trump to stop cost-sharing reduction (CSR) payments.

In addition, budgets for ACA advertising and outreach have been slashed by the Trump administration this year, which will inevitably lead to fewer people getting covered.

Bridging the ACA outreach gap.

To help bridge the gap left by the reduction in outreach, advocacy groups such as Get America Covered are reaching out to inform the public about enrollment. And nursing groups such as the American Nurses Association have stated their commitment to informing patients on how and when they can enroll. Below is some information for patients who might be confused about the law and how it currently stands. […]

High Opioid Overdose Numbers Spur State, City Initiatives

State 2015 overdose death rates compared with national rate. (CDC image)

As we report in an October news article, recent studies have shed light on the growing scale of the opioid crisis in the United States. Among the latest statistics:

  • 33,000 Americans died in 2015 from an opioid overdose, a high percentage from the use of synthetic opioids such as illegally manufactured fentanyl.
  • The diagnosis of “opioid use disorder” climbed 493% from 2010 to 2016 in Blue Cross Blue Shield claims.
  • Around 4.31% of Americans ages 12 or older use prescription pain relievers for nonmedical uses.

Increasing Naloxone availability.

The findings underscore the urgent need to take steps to combat the crisis—a need that has prompted states and cities to attack the issue using various methods. Baltimore’s health commissioner, for example, issued a standing order for naloxone to be available at all of the city’s pharmacies. Brown University and the Rhode Island School of Design collaborated to create NaloxBoxes—emergency naloxone boxes installed at city social service centers that enable any bystander to administer a rescue dose.

Speeding access to addiction treatment.

And, to minimize delays in patients’ receipt of medication-assisted opioid addiction treatments like methadone, New York State has reached agreements with two insurance companies to end their requirements for prior authorization for such treatments. […]

2017-10-23T08:50:26+00:00 October 23rd, 2017|Nursing, Public health|1 Comment