health care profession is undergoing fundamental change due in part to new laws and regulations. These laws and regulations, although well intended may result in unintended consequences for the nursing profession overall. In the future, the role of a nurse will be fundamentally altered. For one, regulation such as the Affordable Care Act will result in an entire population of insured patients needing care. As such, the role of a nurse will ultimately be predicated on a more individualized basis with specialization in certain aspects. Caring for diabetes is no different in this regard. The public is particularly prone to diabetes primarily due to dietary and lifestyle considerations. As such, the topic of proper care and prevention of this issue is paramount to community health. The population at risk, due in part to regulation, is now society as a whole. This presents interesting challenges and opportunities for the overall health care profession as they now much adjust to changing dynamics within the profession. For example, baby boomers are now reaching retirement. How will their age affect the ability to provide diabetes care that is effective from a cost and mitigation standpoint? Younger individuals are now required to have health care, however, may do not see the benefit of health care at such a young age. How will the young embrace the threat of diabetes in regards to their daily activities? How will this affect the costs of those who are already registered? These questions all relate to the health care profession, and overall diabetes care. What is interesting is that circumstances prevailing in the industry alter not only the quality of care for diabetes, but how individuals are treated for it as well.
One dimension of the overall diabetes problem that is rarely mentioned is that of economic considerations. According to the Centers for Disease Control (CDC), in 2007, the United States had almost 24 million diabetics, including nearly six million undiagnosed cases, and nearly 57 million prediabetics. Health concerns, particularly diabetes impacts society in a litany of ways. For one, individuals are less productive when they are not properly utilizing their treatments. In short, healthier works are more productive. They take fewer days off. They also have the ability to work longer hours to produce more goods for society. Illness associated with absenteeism, tardiness, and lack of productivity can cost society billions of dollars. Various studies have been conducted to measure productivity loss in the workplace due to worker illness. Results show that not only does the business suffer when a worker is absent from the job, but productivity loss can also occur when a worker is suffering from illness and attempting to work. The American College of Occupational and Environmental Medicine also cites idle assets and benefits paid to absent workers as additional costs an employer must deal with when productivity is lost due to illness. Furthermore, the costs of hiring and training replacement workers can be a significant expense to employers that is often difficult to measure across broad areas of industry.
Proper treated, diagnosis, and prevention are critical components to the overall health of the general population. In particular home health care will be subject to many economic constraints. Aspects such as the affordable care act create new dimensions to diabetes care and treatment. For, the costs of treatment continue to increase impacting the manner in which patients receive care. In some instances, patients cannot receive care due to the high overall cost. A study entitled, Economic Costs of Diabetes in the U.S. In 2012, was commissioned by the American Diabetes Association and addresses the increased financial burden; health resources used and lost productivity associated with diabetes in 2012. According to the study, the total estimated cost of diagnosed diabetes in 2012 is $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity. The study also provided guidance regarding diabetes expenditures, the largest components of medical expenditures were:
1. hospital inpatient care (43% of the total medical cost),
2. Prescription medications to treat complications of diabetes (18%),
3. Anti-diabetic agents and diabetes supplies (12%),
4. physician office visits (9%), and
5. Nursing/residential facility stays (8%).
As such, the economic dimension of diabetes as it relates to home health care is significant. Home health care in particularly is more costly, created a lack of overall care that could be obtained within a more established hospital or facility. In particular, tertiary levels of care, which often utilize the largest amount of specialized labor, cost the most. Home health care services at the tertiary level may create cost constraints that alienate those lower on the socio-economic ladder. This impact the community at large as individuals can not afford costly home health care, subsequently created a lack of overall productivity. Further costs impact the ability for individuals within the primary, secondary, and tertiary level to provide best in class service.
People with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes (Stewart, 2006). For the cost categories analyzed with the study, care for people with diagnosed diabetes accounts for more than 1 in 5 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. Indirect costs according to the study included:
1. increased absenteeism ($5 billion) and
2. reduced productivity while at work ($20.8 billion) for the employed population,
3. reduced productivity for those not in the labor force ($2.7 billion),
4. inability to work as a result of disease-related disability ($21.6 billion), and
5. Lost productive capacity due to early mortality ($18.5 billion).
Another dimension regarding diabetes care is one of psychological. As mentioned in detail above, the economic impact on both the community and the individuals is large. So large, that diabetes related treatment, illness and lost productivity account for $245 Billion. Another dimension contributed to this tread is the psychological aspects of treatment and coping with the disease. Diabetes is unique in that it incorporates multiple elements of prevention. For instance, the overall treatment process may require careful adherence to an insulin regimen, adherence to an individual diet prescription, and adherence to an exercise program. All of which requires scheduling, consistency, and proper planning. Many illnesses may only require one of these elements. Diabetes however, for proper treatment, may require all three. These tasks can be rather daunting on those who are not properly prepared psychologically. Studies have proven that psychological impact can be a factor in regards to proper mitigation of the disease.
For one, the human brain is extremely sensitive to blood sugar levels. To be able to think and function, the brain requires blood sugar levels to be tightly controlled. If your blood sugar increases to dangerously high level patients tend to feel tired and sleepy. In addition, patients may develop low blood pressure, and a rapid and erratic heartbeat, which can cause you to lose consciousness and slip into a coma (Mahan & Escott-Stump, 2000). All these symptoms can engender fear and influence a patient’s psychological well-being dramatically. For home health care patients these psychological concerns can dramatically discourage individuals from taking the proper forms of treatment. Patients often tend to look at diabetes, particularly type 1, as a “Death Sentence,” when in reality millions of individuals have lived fulfilling and prosperous lives.
Intervention is a key aspect of nurse’s responsibilities regarding the overall diabetes treatment process. Nurses help facilitate the overall treatment of diabetes through proper diagnosis. This primary tool used by the overall health care profession is the overall screening of clients. This is particularly true for those with high risks such as obesity, age, gender, race and family history. Early diagnosis of diabetes can prevent serious complications from occurring in the future. Proper identification, therefore, is a deterrent that helps abate the effects of diabetes on the overall population of those who are exposed. Normally, primary prevention is aimed at preventing the development of diabetes altogether. The secondary and tertiary levels are aimed at controlling diabetes once it does occur. Education therefore is paramount to individuals in the primary prevention phase (Mahan, 2000). Diabetes is unique in that the risk for occurrence is high for those with family history, those that are overweight, and individuals above 40. Armed with this information intervention on the primary level consists of proper education for those identified families with high risk. As such, these steps help prevent or avoid the overall disease. Using this intervention technique, individuals are educated about health habits, the value of discipline and the importance of created a strong psychological foundation. For instance, during this intervention phase, those received home health care may be given information regarding health eating habits, methods in which to stay physically active and so forth (Polonsky, 2012).
The second form of intervention occurs during the secondary and tertiary phases. The intervention occurring during this phase is particularly important as diabetes must first be diagnosed. In addition, intervention during the secondary phase is particularly profound if the diagnoses occurred relatively early. This intervention methods usually required individuals to check their blood sugar levels regularly after every meal. If the patient is overweight, this intervention method would provide assistance in losing the proper amount of weight while also avoiding activities such as smoking or drinking alcohol. Doctors and others with specialized knowledge are also consulted to help provide a health and diet routine. This phase of intervention is arguable the most important as it helps prevent diabetes from becoming aggravated or chronic.
Interventions at the Tertiary level are often very profound. This form of intervention is generally aimed at preventing diabetes related disorders and amputations. During this intervention programs, patients are subjected to regular checkups, medications, diet restrictions. This phase often required very specialized practitioners designed to help prevent serious complications such as heart disease, foot disease, and asthma. This intervention method often requires patients to get their A1C tests during 3-month intervals, along with foot and eye examinations.
In conclusion diabetes can be a very costly and psychological taxing ordeal. Particularly due to its unique methods of prevention and detection, diabetes costs society and its communities roughly $250 Billion a year. In addition, these costs continue to rise at an alarming rate. Further compounding the issue are the vary stages of intervention and their high cost of implementation. Particularly at the tertiary level, costs tend to create lack of productivity, increase health care costs for society, and increased absenteeism. As such the best manner in which to lift the burden of health care on the home health care segment and society in general is to focus on prevention. Aspects and habits such as diet, and exercise can all be used to save billions of dollars for all stakeholders involved.
1) Mahan LK, Escott-Stump S (2000). Krause’s Food, Nutrition & Diet Therapy. 10th Ed., WB Saunders Co. Philadelphia; Reuters (2010)
2) Polonsky, K.S. (2012). “The Past 200 Years in Diabetes.” New England Journal of Medicine 367 (14): 1332 — 1340
3) Stewart WF, Ricci JA, Chee E, Hirsch AG, Brandenburg NA (June 2007). “Lost productive time and costs due to diabetes and diabetic neuropathic pain in the U.S. workforce.” J. Occup. Environ. Med. 49 (6): 672 — 9
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