NURS-FPX4050: Ethical and Policy Factors in Care Coordination

Preliminary Care Coordination Plan

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Healthcare Concern

Type 2 Diabetes is a chronic disease that usually develops for years without having any clinical symptom. Apart from the United States, this is one of the most common type of diabetes around the world with the other two being Type 1 and gestational diabetes. According to the CDC ( 2019), Type 2 diabetes accounts for about 85-95% of the diagnosed cases in the United States.  Also, diabetes, in addition to other diseases of affluence that includes cardiovascular and obesity disease, is one of the major health concern in the United States. Statistics indicate that by 2025, the number of patients living with diabetes all over the world is going to increase to over 330 million (CDC, 2019). This will account to about 6.5% of the global population, and by 2035, it is possible that the number could rise to about 600 million.  In the united states, about 100 million adults are living with pre-diabetes or type 1 and 2 diabetes, according to the Center for Disease Control and Prevention statistics.  It is estimated that the number will continue to rise over the years.

Type 2 diabetes is a chronic disease that usually develops for years with no clinical symptom. It is one of the most common types of diabetes all over the world with other common types being gestational or type 2 diabetes.  This is because Type 2 diabetes accounts for 85% -95% of all the diagnosed cases (CDC, 2019).  This also includes other diseases of affluence that include cardiovascular and obesity diseases, which are a major healthcare concern in the 21st century.  

By 2025 it is also estimated that the number of patients administered to hospices due to the growing condition of diabetes is going to increase (CDC, 2019).  One of the main factors that contribute to the constant increase is the number of people with Type 2 diabetes is due to the changes in lifestyle, acculturation when it comes to immigrant Americans a and social and economic advancement including quick urbanization (Dellinger, 2018).  Some of these conditions are due to a sedentary lifestyle which does not conform to ensuring healthy nutrition that also includes eating large quantities of processed food, sugar, stress, and exhaustion.  The issue does not only apply to immigrant and minority groups but to Anglo Americans with medium or low social status of the common American (Goodlin, 2018).  The main issue is that the condition applies to the general American population, regardless of social status.  In this regard, diabetes is a health concern and an economic one as well because the biggest population falls among the middle-aged of professional and economic activity. 

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Health Goals for a care coordination plan in collaboration with the Patient.

In the United States, diabetes is growing to be a serious disease which can often be managed using physical activity diet and the appropriate use of insulin in addition to several medications to control the patient blood sugar. In this regard, the Patient under hospice care is often at risk of increased risk of several health complications that include vision loss, premature death, stroke, heart disease, amputation of the toes, legs or feet and kidney failure. 

One of the major care plan when it comes to hospice care for a patient with Type 2 diabetes will be to ensure that he or she avoided hypoglycemia which can be more important than only looking at the glycaemic control according to researchers.  In reference to the Goodlin, (2018) about 12% of diabetic patients under hospice care with Type 2 diabetes often reside in a nursing home will experience hypoglycemia in a couple of 180 days of admission and a glucose reading which should be under 70mg/dL.  In regard to severe hypoglycaemia, a glucose reading under 50mg/dL is likely to be experienced at about 5% of hospice patients in respect to nursing homes in about 180 days of admission as per Dekalb Medical Center, Address 2701, North Decatur Road Decatur,  GA 30033-5995, Tel (404) 294-8500.

It is possible that the risk can be greater for a patient that receives insulin were the cumulative incidence of about 38% is going to be much greater for hypoglycemia, and 18% of people in sever episode in about 180 days of admission, this includes the risk occurring during the first 20 days. The incidence of Hyperglycaemia is about 9% overall and 35% in the Patient with insulin.   

As part of the care plan would also entail encouraging the Patient to make use of oral glucose, especially if the patient is on insulin. This is because the Patient in insulin is likely to have a higher HbA1c level at the baseline level, and they are also likely to experience various glucose tests during care while in hospice. (0.6 tests per day for vs. 1.7 tests per day while on insulin; P<0.001).  According to Dr. Laura, it is also important the hospice hospital for people with Type 2 diabetes must be equipped with durable medical equipment because at extreme level diabetes condition may progress and the Patient should not be taken out of care and support (Monaco, 2017). 

An available community resource to encourage care

In the community, it is realized that Type 2 diabetes management has very limited preventive behaviors.   Among the community resources would be to establish opinion leaders in terms of public health, going to schools and community social centers to educate and encourage the proper eating habit, health practices, and positive mental attitudes.  Also, it is important to ensure the creation of audiovisual and find interpreters who will be used in providing knowledge of diabetes and the different categories of health behaviors that will ensure proper self-care (Monaco, 2017).  Health education for those diagnosed with type 2 diabetes needs also to continue/ the results that come around the average, also means that their main tool to be used in the community is health education for the said group of patients.  In this regard, the categorization of the behaviors of people living with diabetes will also encourage gauging the strength that exists in the relationship between individuals and the satisfaction they get in their lifestyles.  In most cases, getting a high satisfaction for the life they lead is most important, and any tool, including diet plans, needs to consider this (Dellinger, 2018). 

Conclusion

 In summary, diabetes continues to be one of the major concerns in hospice care, since a higher population of American continue to choose a lifestyle that encourages the development of diabetes.  It is also evident that patients with high intensity of health behaviors can be educated to have better health behaviors.  There is a significant relationship between health and lifestyle, which is a major focus in hospice care.  Self-management education is also important because not all hospices have durable medical equipment to sustain the rising number of people looking for hospice care.

References

CDC. (2019, February 28). CDC Press Releases. Retrieved July 21, 2019, from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

Dellinger, A. M. (2018). Legal Requirements for Confidentiality in Hospice Care. Ethics in Hospice Care: Challenges to Hospice Values in a Changing Health Care Environment, 43-48. doi:10.4324/9781315809823-6

Goodlin, S. J. (2018). Hospice Organizations' Role in Health Care Improvement. Ethics in Hospice Care: Challenges to Hospice Values in a Changing Health Care Environment, 71-80. doi:10.4324/9781315809823-10

Harvard Catalyst Profiles. (2019, July 21). Retrieved July 21, 2019, from https://connects.catalyst.harvard.edu/Profiles/display/Person/164651

Monaco, K. (2017, December 28). Study: Too Much Hypoglycemia in Diabetic Hospice Patients. Retrieved July 21, 2019, from https://www.medpagetoday.com/endocrinology/diabetes/70155

Yennurajalingam, S. (2018). Hospice Approach to Palliative Care. Hospice and Palliative Medicine and Supportive Care Flashcards, 329-346. doi:10.1093/med/9780190633066.003.0017