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The Need for Free MedicationsKolten BushUniversity of South Florida College of NursingCapstone PaperDue July 19, 2015Word Count: 3146The Need for Free MedicationsThe overall goal of community health nursing is to promote health and wellness, not only in the individual, but also in the population as a whole. There are studies and programs such as Healthy People 2020 that look at major health concerns for the community. Programs such as this address the needs of the area based on evidence based practice and research and try to find the best ways to prevent future health disparities for the population. A disparity that is concerning to the population is the lack of individuals being able to afford their medications due to their economic conditions, which can have a lasting effect on the county as whole. ?Sarasota County is just off the West coast of Florida and is known for their white sandy beaches and the perfect place to retire to. However, even though this may look like the perfect paradise, there is a large homeless population as well as substance abusers that live in Sarasota. The area is mostly urban, being about 555 square miles with the average population about 87 people per square mile as of 2010 and the total population for the county at 396,962 (, 2014). The three major employers in the county are: Sarasota Memorial Health Care with over 4500 employees and then a close second is Publix Supermarkets with over 4070 employees. Wal-Mart being the third largest employer in Sarasota has 1847 employees (, 2014). Within Sarasota County, there are many different healthcare systems, with hospitals and clinics all over the county. There are two main hospitals, Sarasota Memorial Hospital, which is an 806-bed hospital, and the other is Doctors Hospital of Sarasota, which has 155 beds (SMH, 2014). Sarasota Memorial Hospital also has many different places that are affiliated with them that are not connected to the hospital, such as heart centers, urgent care centers as well as surgery centers. Reviewing the population as a whole in Sarasota County, there are a vast number of socioeconomic factors that play an important role in the society. According to the Sarasota County Health Profile for 2006-2010, the percent of families below the poverty line for Sarasota County was 6.7% compared to the state, which was at 9.9% (Florida Charts, 2013). In the health profile, it also explains that the percent of the population over 25 years of age without a high school diploma was 9.4% and 14.7% for the county and state respectively (Florida Charts, 2013). One other statistic that showed the percent of the population older than 5 years of age that did not speak English. This statistic demonstrated that the percentage was lower, 5.0% for the county, compared to 11.8% for the state (Florida Charts, 2013). By examining the county as a whole, 91.9% percent of the population is Caucasian with English being the primary spoken language, which relates back to the lower percentage of those who do not speak English (Florida Charts, 2013).Whether one is examining an individual, or an entire community, the overall goal is to become healthier. However, the question in everyone’s mind is: “how do I do that?” ?When studying a county health profile, it is easy to pinpoint current health strengths and weakness within the community. There are a few strengths that stand out in Sarasota, and those include the access to health care, the accessibility of the area for exercise, and the county’s overall socioeconomic status. ?One of Sarasota’s strongest points would be their access to health care and their utilization of their health resources. There are the two hospitals, with the main one being Sarasota Memorial hospital. There are many different clinics that see patients for a variety of reasons with many different specialties. There are also detox centers, homeless shelters where doctors and nurses are there on a daily basis, community health clinics, and clinics for the less fortunate. The Senior Friendship Center is a clinic that is geared toward the uninsured elderly population over the age of 50 and has helped several residents of the county who couldn’t find help elsewhere. Sarasota has a plethora of opportunities for receiving health care, which is a considerable strong point. Another strength is their access to exercise. The streets are lined with sidewalks and bike lanes to help residents have opportunities to exercise outside. There is the Ringling Bridge in Sarasota that people can walk or run. It has a beautiful view of the water, going across the bridge there and back is 1.1 miles (Emporis, n.d.) and is the perfect spot to enjoy exercise. Having access to exercise is a key point to staying healthy and if more people can take advantage of Sarasota’s beauty and get out and exercise, the community would be much healthier as a whole. The counties socioeconomic status was the last strength that was observed. Even though the county has a growing homeless population, the community as a whole is doing economically better than the rest of the state. The median household income at $49,388 is more than two thousand dollars higher than the state average (Florida Charts, 2013). The percent of total poverty level is also lower than the state average. A strong economic region creates an overall healthier community because the people in the community will have the funds to receive better healthcare. However, there are some weaknesses seen within the community that needed to be addressed. ?Some of these include, filling prescription medications for those who are uninsured, the growing rate of the homeless population, and the growing trend of behavioral risk factors as well as mental health deficits that are becoming an issue to the population’s health. Those individuals who are at poverty level, below poverty level, or even homeless have a hard time keeping up with their health simply because they can’t afford their medications. There are a lot of programs out there that help with this, but are these people being taught about the assistance programs, or is there a stigma that goes along with it where the patients don’t want to seek out help? The growing number of homeless people within the society is another weakness that stands out. The homeless population can have an effect on the economy because the majority does not have health insurance, leading to the hospital having to pick up the costs when they are treated. The homeless population does not have the proper access to health care which leads to this population not being as healthy as they could be. This drives down the overall health status of the county. As of 2013, the Herald Tribune reported that there are 1460 single adults that reported that they are homeless (Cummings, 2013). Over the years, Sarasota has been known as a place to retire, which brings money into the area when the older folks settle down and enjoy their investments. This influx of money drives the cost of living to go upward, which only makes it harder on the poor individuals that lead to many becoming homeless. County statistics show that the majority of the population is within 45-64 years of age, with 60% of the population being 45 and over (Florida Charts, 2013). One last weakness that should be addressed is the behavioral risk factors such as poor eating habits, lack of exercise and smoking that lead to many health issues for the Sarasota County population. Looking at the statistics, dating from 2002 to 2010, the County Health profile describes how the population has had an increase in the percentages in those with cardiovascular disease, diabetes, hypertension and those who are overweight (Florida Charts, 2013). ?Another weakness deals with the mental health aspect in suicide. Those with depression tend to have suicidal thoughts occur throughout their life and this especially occurs within Sarasota County. The suicide rates in Sarasota over a 3 year period per 100,000 people is much higher than the state average, with them being 18.1 and 13.8 respectively (Florida Charts, 2013). An important health priority would be educating those who are struggling to afford their medications. There are many organizations and programs that help out with this but do the people actually know about these? If the population can be educated on how to receive their medications for a reduced rate, or even free, fewer readmissions in the hospital should occur for that particular population. ?Not only is high medication cost hurting those in the United States, but in Canada as well. One research study in Canada showed that 1 out of 10 Canadians did not refill or renew their prescription because the cost out weighed the need for the medication (Canadian Medical Association Journal, 2012). If these patients aren’t continuing their prescriptions, then the chances of their condition worsening elevates and, in the end, they are back in the hospital and the cycle repeats itself. According to Healthy People 2020, the Determinants of Health Model is, “The range of personal, social, economic, and environmental factors that influence health status” (“Determinants of Health,” 2014). The community health nurse can use this model as a guide when looking at interventions for his/her patients, as well as the community as a whole. The responsibility of increasing public awareness and education on programs that are out there for people to receive their medications cheaper would fall under the Health system and Lifestyle. ?If people were aware of the programs that can help with the funding aspect of receiving their proper medications, than this population of people would remain much healthier. The ability to afford medications would impact the health system because then there would be fewer readmissions to the hospital. Readmissions are quite costly and only make it harder on those people in poverty. Studies have shown, through the Affordable Care Act, that if they can prevent 30-day hospital readmissions, which would eliminate 1.6 million readmissions, saving approximately 15 million dollars (Kocher, Adashi, 2011) would be beneficial to not only the community but the nation’s health system as well. The priority health issue would also fall under Lifestyle because the selected impoverished population group is dealing with their struggles of living in poverty and taking their medications is not of high importance. Many people who are in these types of situations tend to have a lifestyle where they may not want to seek help for health care needs based on the stigma of being poor and uninsured. However, expressing the needs for medication compliance can be the start towards a new lifestyle for these people. According to the article, “Medication Adherence”, the author states that numerous studies have shown that patients with chronic illnesses are only taking 50-60% of their prescribed medications even though it is known that medication therapy can prolong the quality of life for most illnesses (Bosworth, 2010). A population diagnosis for the requirement of more education on medication programs could be the population in poverty who can’t afford their medications because they are unaware of the programs for medication assistance, are experiencing worsening conditions as evidenced by hospital readmissions.There are many different health priorities that exist within the community; however finding a way to address the issues and implement them can be tough. Increasing the awareness for those who are struggling financially is the policy that needs to be addressed. Not only can people not afford their medication, but are dealing with trying to put food on the table and take care of their kids properly. The first aspect of the policy would address the community. If the community could be educated on programs that offer financial assistance to refilling prescriptions then the community will become overall healthier. Implementing health promotion and the importance of continuing the medication that is prescribed would be the first aspect of the policy to address. Following would be going out into the community and setting up tables with brochures in areas of Sarasota that are dealing with poverty. Addressing the county statistics and looking at the neighborhoods that are struggling with income will narrow down where to start promoting the idea. Also reaching out to pharmaceutical companies, as well as those companies such as Publix, CVS, Needymeds, and RXassistance (NAMI, 2015). These establishments offer reduced or even free medications, however a large majority of the population are unaware of these programs. Many people living in poverty also don’t want to face the stigma associated with being unable to afford their medications. Health care providers and funding sources would be beneficial to talk to for this health need, to help implement the education for the policy. Every time someone walks into a hospital, clinic, homeless shelter, or mobile clinic, the staff should ask about how they receive their medications and take the time to teach the patients how to get reduced or free medications. At Publix, there are 10 free medications that the pharmacy gives out, however, they are lacking in advertising in doctor’s offices explaining this, and they are only primarily seen in the store itself. If these people do not do their grocery shopping in Publix, they would never know. There are quite a few programs out there, but if the funding sources were established to push for more assistance and awareness, the health of the community will only increase. A community health nurse can spread the word by going door to door in low income areas explaining the necessity of medication adherence and help the poor community reach out to these companies that give financial assistance. The goal of a community health nurse is to advocate for the patients, and if this can prevent hospital readmissions, then that is a huge step in the right direction. Once reaching out to the community for those who are already on medications, the next step is to start teaching about these programs the moment a person is prescribed a medication. This will involve the secondary level of prevention with the individual. If the health care providers, as well as the nurses’ and pharmacists can be more knowledgeable on this health priority, then they can have a huge impact to help push for these programs that exist. If a patient is reminded when he or she speaks to their doctor and pharmacist, while they explain the medication and then again when being discharged with the nurse, the idea of free or reduced medications will remain with them. If community health nurses can start a case study that looks at patients that begin these prescription programs, and then examine the rate of which they are being readmitted to the hospital or following up with their doctor for the same reasons as before, there should be a positive trend. Community health nurses should hold conferences or meetings with hospital staff for both doctors and nurses as well. ?Reaching out to the pharmaceutical companies as well as the companies such as Needymed and Rxassistance to join, will make a major impact on our healthcare providers. After reaching out to the community and the providers who are on the front line for teaching about their prescriptions and how to receive their medications, it is time to evaluate. The tertiary level of prevention will fall into place at the community level. Monitoring compliance by reaching out to those patients 1 month later and asking about their success in using the prescription assistance programs would be a way to get any necessary feedback. Then adjust any discrepancies that have arisen after evaluating those people using the programs. A health policy that should be implemented is that from day one when a patient is admitted to a hospital or steps foot into a health clinic or any other medical facility, there should be a form, brochure or some sort of information attached when filling out the rest of the patients information. These forms, brochures or pamphlets will describe the impact of medication adherence and the effect of how costly medications are these days. Especially if the patient is being newly diagnosed with diabetes, hypertension or heart failure, these medications will be taken for a long time or even the rest of their life. As stated earlier, hospital readmission are costing the healthcare system, millions of dollars each year, and if this policy can cut out even the smallest chunk of that, it is a step in the right direction. The key focus would be on a primary intervention level and to reach out to the community for those who have already been diagnosed with an illness. The major stakeholders that would be involved would include community members as well as healthcare providers and some funding sources. The healthcare system would view this as a positive situation to reach out to those who are in need of financial assistance because of the decrease in readmissions and other health issues that would only continue to worsen if left untreated. However, the opposing forces would most likely be from the pharmaceutical companies making the medications. Unfortunately, society is out to make money, and if people are receiving free medications than someone is losing money. ?They will most likely have a big influence on this proposal, however, a sliding scale can be used just like in health clinics when patients pay their copay. This number can be based on the family's total income and financial needs, depending where they are at in relation to the poverty level. It is understood that handing out free medications everywhere to those who can’t afford them cannot be done, but if a sliding scale is used, it will counter their argument. When evaluating how to get started, first would be to reach out to the assistance programs and work out an agreement on how to get more public attention, especially to those who are most in need. The need is to have advertising about this in the places where people in poverty are spending the majority of their time. Sarasota County has a growing population of homeless people and with the facility that has been observed in community health, it has been seen that there are patients that come in who can’t afford their medications, however, they aren’t on medication assistance plans. If these ideas can be implemented for the need of more advertising and education on the benefit of taking their medications and having these prescription assistance programs help refill them, then it will only benefit the health of the underprivileged population. Sarasota county will benefit from this with the population being able to afford their medications and be able to be consistent with taking their required prescriptions, will keep the population healthy and away from the hospital.Medication assistance programs exist everywhere in society, however, the majority of the people in the Sarasota community aren’t aware of these programs, or are unsure how to get started. It is something as simple as this to make the community a healthier one, and a community health nurse can help to make this happen. ReferencesBosworth, H. (2010). Medication Adherence. Improving Patient Treatment Adherence, 68-94.Cummings, I. (2013, October 9). Survey: 1,460 homeless adults in Sarasota County. Herald-Tribune. Retrieved July 17, 2015, from of Health. (2014). Retrieved June 27, 2015, from . 2020/about/foundation-health-measures/Determinants-of-HealthFlorida Charts. (2013). Retrieved June 27, 2015, from , R., & Adashi, E. (2011). Hospital readmissions and the affordable care act. JAMA, 306(16), 1794-1795.Law, M., Cheng, L., Dhalla, I., Heard, D., & Morgan, S. (2012). The effect of cost on adherence to prescription medications in Canada. Canadian Medical Association Journal, 184(3), 297-302.Mental Health Medications. (n.d.). Retrieved June 27, 2015, from estimates, July 1, 2014, (n.d.). Retrieved June 27, 2015, from Bridge, Sarasota. EMPORIS. (n.d.). Retrieved July 6, 2015, from - Main Campus Map. (n.d.). Retrieved June 27, 2015, from 20 Private Employers ‐ Sarasota County. (n.d.). Retrieved June 27, 2015, from Data/Major Employers.pdf ................
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