Contemporary health promotion emphasises the concepts of lifestyle, risk, and preventive health behaviour alongside the broader societal concerns of the environment, public policy, and culture.
Individuals may be vulnerable to health care quality problems for one or a combination of underlying reasons, including those pertaining to their financial circumstances or place of residence; health, age, or functional or developmental status; or ability to communicate effectively.
Other personal characteristics, such as race, ethnicity, and sex also have been shown to be associated with differential experiences in obtaining quality health care.
Furthermore, characteristics of the evolving health system -- such as an eroding safety net -- can interact with personal characteristics to contribute to vulnerability. There is a clear need to increase the level of attention paid to vulnerable groups, including both those who, because of their chronic illness or disability, have many interactions with the health system, and those who have difficulty accessing the system and may be most likely to fall through the cracks during this period of rapid health system change.
In the Consumer Bill of Rights and Responsibilities, the Commission articulated that consumers have the right to considerate, respectful care, free of discrimination.
In this chapter, the Commission extends this work by specifically addressing ways in which the particular needs of vulnerable populations should be accounted for in the design of systems for health care delivery, quality measurement, and payment.
The lack of evidence of effective approaches to enhance the health and functional status of persons with chronic illness or disabilities suggests the need for significant additional investment in research and innovation for health care and rehabilitation programs serving these patients.
In addition, telemedicine and similar innovations, incentives for health care professionals to practice in underserved areas, and enhanced availability of prehospital emergency services should be assessed as approaches for improving the access to care of those facing geographic barriers to appropriate care.
Development and evaluation of health care quality measures and measurement methods for vulnerable populations should be supported. A focus on vulnerable populations in the design of quality measurement initiatives is valuable, in part, because their experiences may provide new insight on systemwide problems.
Attention to vulnerable populations should be integrated within general quality measurement strategies, recognizing that quality measures and measurement methods tailored to vulnerable groups will, in some cases, be required. Payments to health plans and providers should promote quality health care and improved health and functional status for all patients, including vulnerable populations.
Adjusting payments for differences in health or functional status is especially important for Medicare, Medicaid, and other payers that have significant enrollment of individuals with chronic illness or disability so that health plans and providers have an incentive for developing innovative models of care that best serve these individuals.
Risk-adjusted payments are also critical to sustaining the safety-net mission of certain providers that provide a disproportionate amount of care to vulnerable populations, such as community health centers, rural health clinics, and academic health centers.
The Federal government should convene high-level stakeholders to determine how best to implement risk-adjusted payments for Medicare. Payment systems also can be better aligned with quality care for vulnerable populations by being broadly based across groups of providers and related health care services to encourage multidisciplinary, coordinated care; providing coverage for health care delivery approaches that have been demonstrated to improve outcomes, functional status, and satisfaction; and rewarding quality performance through financial incentives.
Among others, these groups include the uninsured, the poor, the elderly, children, those living with mental or physical disabilities, racial and ethnic minorities, and the terminally ill.
The vulnerability that these groups experience usually can be attributed to one or some combination of three factors: Not all sources of vulnerability can be fully explained by these factors, however, raising important questions for further research.
Economic Status and Geographic Location Individuals may be vulnerable by virtue of their financial circumstances or geographic location. These factors can present obstacles to obtaining needed health care and can result in increased exposure to health risks. These barriers to access can lead to a lack of continuity, delays in obtaining care, and limited choices about where and from whom care may be received Newacheck et al.
These patterns of utilization can contribute to adverse health care outcomes, including higher rates of preventable hospitalizations Billings et al.
Poverty and lack of insurance can result not only in decreased access to health care, but also increased risk of poor health. Any of these factors can magnify exposure to environmental risks such as secondary tobacco smoke, poor sanitation, or lead exposuresafety risks such as traffic hazards and family violencesocial and psychological stressors such as fear of crimeand lack of infrastructure supports such as counseling or educational services that contribute to an increased burden of poor health.
For example, a recent study of Medicare enrollees in managed care plans found that nonelderly individuals with disabilities, the frail elderly, the functionally impaired, and persons in fair or poor health were much more likely than the general beneficiary population to report problems with access to care Nelson et al.
Many of these same groups also have been shown to be vulnerable to access problems in fee-for-service Medicare PPRC, These vulnerable groups may be especially prone to difficulties in using the health care system, including discontinuity and lack of coordination among multiple providers, inability to obtain care from providers who have expertise in treating their conditions, and difficulty in receiving approvals for treatments that are expensive or not widely used.
In addition, individuals with some conditions, such as mental illness or HIV disease, may face or fear undue stigma that makes it difficult to receive appropriate care.
Developmental status and age can also be associated with vulnerability.
Children have health and developmental needs that are markedly different from adults, and require age-appropriate care.
Developmental changes, dependency on others, and different patterns of illness and injury require that attention be paid to the unique needs of children in the health system IOM, The elderly also have unique health care needs due not only to the increased incidence of illness and disability, but also to the multiple and complex interactions of other types of physical and social consequences of aging.
Communication Barriers Vulnerability can in some cases be attributed to limitations in the ability to communicate with providers and other actors in the health care system. Communication difficulties may be associated with a person's level of education or development, language or cultural differences, health condition, or physical or mental disability.Being a public health nurse means you’ll work in public health clinics to improve the overall health of at-risk populations, including children.
A Public Health Nurse promotes and protects the health of people within a community. inequalities, working with national and local government, the NHS, industry, academia, the public and the voluntary and community sector.
We exist to serve the public through the public health system, a . Healthcare Is A Major Issue For Homeless Nursing Essay. Print Reference this. Published: 23rd March, Community health partnerships, or CHP's for short, bring together the public, voluntary organisations, local authorities and health services.
there is inadequate research on the role of the nurse working with homeless people in the. Public health nurses (PHNs) work in schools, homes, clinics, jails, shelters, out of mobile vans and dog sleds.
public health nursing at the community and systems practice levels as well as the conventional individual/family within populations, establishes priorities, and plans, implements, and evaluates public health programs and.
HHS awards nearly $ million to help community health centers, academic institutions, and rural organizations combat the opioid crisis. Now Open for Applications The NHSC Students to Service (S2S) Loan Repayment Program (LRP) application cycle is open.
Primary & community health. Primary care. Information about primary care, working with general practice and private providers, Primary Care Partnerships, service coordination, integrated chronic disease management, and workforce development.