Saturday, April 20, 2013

Interventions


A current intervention that addressed my problem that was tested focused on the idea that having one’s peers as a form of social support when dealing with chronic illness will actually improve and influence the behaviors of those who have the illness. For this study, they looked at background information about how this model worked in other situations and in other places, for example, for people with hypertension. The intervention that they implemented was used in west Baltimore city. Basically, they first recruited members of the community to become community health care case managers in their specific communities. They then trained these workers extensively about what the program entailed and about diabetes. These community healthcare workers made weekly in home visits and phone calls with patients. They did everything from helping the patients to keep their appointments to making sure they were taking their medications appropriately to monitoring for signs of complications. The key determinant they addressed was that there were increasing hospitalizations and emergency room visits for patients with diabetes who were on Medicaid.
                A possible strategy that identifies the issue of food deserts is to incorporate more farmers’ markets within these communities. By doing this, residents have more consistent access to quality, healthy foods. Perhaps these farmers markets should also be actively advertised within the communities and hold other attractions so that residents are more likely to attend. Maybe there’s something there for kids, which can then lead to the parent having to take the child to the event and indirectly will be susceptible to purchasing some of the produce.
                Another possible strategy is to provide incentives to patients who come in regularly for their checkups and for physicians who will agree to see these Medicaid patients. Such incentives could be pay bonuses for physicians and healthy meal vouchers at their local grocery store for the patients. This is just a way to get the diabetic patients in the hospital and seen by a professional that can track their progress and analyze if there are any potential complications in the future so that they can be reduced.  This addresses the issue of Baltimore residents being of low socioeconomic status and many are on some type of public health insurance.
                Lastly, because a large majority (over 70%) of residents in Baltimore are associated or affiliated with some type of religious group, perhaps it would be a good idea to get these institutions involved as well. For instances, churches can hold health fairs, sponsored screenings, or day-clinics to get their members to be aware of the statistics. Perhaps health professionals can enter these institutions and provide presentations on the epidemic that is present in the African American community. This is more of a primary method, aiming at educating Baltimoreans about diabetes and how to prevent the illness.
           Options

Decision
Criteria

Intervention 1:
Food deserts
Intervention 2:
medicaid


Intervention 3:
churches

Effectiveness
2
               2.5
1.5

Feasibility
2.5
1
               2.5

Sustainability
2
2.5
2

Cost
2
1
2

Cost effectiveness
2
2
2

Political acceptability
2.5
1.5
2

Social will
2.5
1.5
2.5

Potential for unintended risks
3
1.5
3

Potential for unintended benefits
3
3
3

Total/conclusion
21.5
16.5
20.5

The best intervention seems to be the first one based on the idea of food deserts. This scored the highest from the decision criteria, which all seemed appropriate for determining the best interventions. 

2 comments:

  1. Nice job on your post! I thought that all of your interventions were really solid and practical measures that could potentially be introduced in Baltimore. One thing I was wondering about was the effectiveness of the program that's already in place. Can or should this program be expanded? How does it rate in the decision matrix? But I did like the intervention you chose. I think this could even be expanded a bit by having the farmer's markets accept food stamps. I believe the one on Greenmount does this and it could get more people to actually purchase the food. Great job again!

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  2. Thanks for your post. As I have posted on other blogs and as a review,
    primary prevention seeks methods to avoid the occurrence of disease, secondary methods seek to improve the treatment of existing disease and tertiary methods seek to reduce the negative impacts of existing disease. For the purposes of this project, you can think to substitute "problem" for disease.

    With regard to food deserts, I would argue that "addressing food deserts" focuses your problem but does not clearly identify an intervention. The follow-up question to addressing food deserts will be: how will you go about increasing farmers markets and what will you do during seasons where there is not produce in the region?

    Good job. I look forward to reading your next post.

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