NURS FPX 6616 Assessment 2 Summary Report on Rural Health Care And Affordable Solutions

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Capella University

NURS-FPX 6616 Ethical and Legal Considerations in Care Coordination

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Summary Report on Rural Health Care and Affordable Solutions

This paper examines the availability of inter-professional healthcare providers and resources in Potter County, Pennsylvania, aimed at mitigating the high mortality rates resulting from opioid overdoses. The analysis will shed light on the cultural competencies necessary for the healthcare team to utilize evidence-based data effectively. Additionally, it will address ethical considerations that must be observed in light of potential legal issues within the organizational framework.

Specific Population Needs and Community

With a population of under 17,000, Potter County is predominantly composed of non-Hispanic whites, accounting for 97% of its residents (Pew Research Center, 2018). According to the Pew Research data, 22% of the population is aged 65 or older, while 14% live below the poverty line. The primary health concern in this area is opioid use disorder (OUD), which has seen a significant rise over the past twenty years. The community’s needs are underscored by international literature highlighting the necessity of accessible medication-assisted treatments and overdose reversal medications. Analysis from the Pennsylvania Overdose Information Network (ODIN) indicates that individuals aged 20-39 are most affected by drug overdoses (Barboza & Angulski, 2020).

Factors Contributing to Drug Overdose

Several factors contribute to medication overdoses, including poverty, lack of education, and limited healthcare resources. Opioids are used in various forms, such as prescription medications, injections for pain relief, and in combination with other pain medications. Two main categories of barriers exist: consumer-based and provider-based. Consumer-based issues include the scarcity of clinics, physicians, and medication treatment options in the area, where increased availability correlates with higher treatment utilization. Surprisingly, younger individuals experience more challenges accessing these services than older adults. Provider-based barriers involve a shortage of qualified personnel and adequate infrastructure, while acceptability issues include time constraints, self-doubt, and a lack of confidence among providers. Overall, these interrelated factors necessitate improved access to overdose reversal medications and enhanced medication availability.

Current Inter-professional Team Providers and Resources

Avera Gettysburg Hospital serves as a healthcare provider in Potter County, striving to establish an interdisciplinary team comprising expert specialists, primary care providers, advanced technology, and innovative research. The hospital conducted a Community Health Needs Assessment (CHNA), which highlighted barriers affecting both consumers and providers. In response, the hospital has expanded its services, implementing wellness programs that promote lifestyle changes, such as biking and walking tracks, along with enhanced hospice and home care services.

Current resources, including remote health services, education, and systemic changes, aim to improve health and medication services. These enhancements are supported by Inter-professional Education and Collaborative Practice (IPECP), which fosters collaboration among diverse healthcare providers for improved patient outcomes (Martin et al., 2021).

Interventions for Opioid Overdose

Interventions addressing opioid overdose occur at micro, meso, and macro levels (Qudah et al., 2022). At the micro level, educational initiatives aim to shift consumer and provider attitudes, overcoming barriers related to opioid medication for non-Hispanic whites. This approach focuses on building self-confidence, skills, and positive health habits. The meso level employs psychosocial strategies, integrating recovery coaches and behavioral health centers, both onsite and remotely. Additionally, rehabilitation facilities and timely access through technology are incorporated into the interventions. At the macro level, policies, regulations, and FDA oversight contribute to positive outcomes. Overall, these interventions utilize alternative therapies and medications to combat opioid use disorder.

Cultural Competency Areas for the Team

The interdisciplinary team is not culturally homogenous, reflecting the diverse backgrounds of the communities they serve. It is essential for healthcare professionals to cultivate cultural competency skills that mitigate barriers faced by patients. Cultural competence involves respecting and acknowledging the varying values and choices within a specific community. The U.S. Department of Health and Human Services (HHS) has established Culturally and Linguistically Appropriate Services (CLAS) standards to promote such competencies in healthcare (Hilty et al., 2020).

Given that non-Hispanic whites comprise the majority of the population, the healthcare team must understand the cultural practices and beliefs influencing their lifestyles and decision-making. Issues like self-medication, intravenous drug use, and accidental overdoses have resulted in fatalities. The team should be educated on these cultural elements to facilitate effective communication with residents. Developing language skills and understanding community values will enable the team to create patient-centered, individualized health plans, ultimately addressing the root causes of opioid use disorder through psychosocial interventions and medical care.

Technology-Based Outreach Strategies

To address availability and accessibility issues for both consumers and providers, technology-based strategies have been integrated. Given the barriers posed by inadequate infrastructure and a lack of qualified specialists, technology serves as a crucial bridge. Consumer-based challenges include long distances to care facilities and the unavailability of medications and specialists, contributing to high opioid overdose rates. With fewer than 10% of physicians practicing in rural counties across the United States, interdisciplinary team collaboration via technology emerges as a viable solution.

Telehealth and telemedicine represent key strategies in this initiative (Butzner & Cuffee, 2021). These approaches enable healthcare providers and patients to utilize mobile and digital health solutions. Diagnoses can be conducted through video conferencing or electronic medical records, while wearable devices and sensors provide essential monitoring for older adults in Potter County. Remote monitoring proves particularly beneficial for disabled and pregnant women in the community.

Potential Legal Issues in Telehealth

To establish a robust urban community in Potter County, awareness and integration of technology must improve to avoid potential legal issues for providers. While many understand the importance of telehealth services, older community members and those with lower education levels may harbor doubts. Accessibility concerns also arise regarding computer and internet availability. Several legal issues may stem from improper telehealth practices (Panter, 2021).

Licensing presents a challenge, as healthcare providers are licensed to practice within specific states, and telehealth often crosses state lines. Therefore, confirming the patient’s state of residence is vital to avoid legal repercussions. Additionally, fostering patient-physician relationships through in-person meetings is crucial for effective service delivery, as face-to-face consultations remain the gold standard. Tele-prescribing poses another legal challenge, as prescribing controlled substances without an in-person examination is prohibited. Moreover, there is potential for fraud and abuse if state and federal regulations are not adhered to. Finally, issues of privacy and confidentiality may arise if data breaches occur.

Ongoing Ethical Care in the System

Residents of Potter County face significant challenges related to availability, accessibility, and acceptability of healthcare services. The high rate of opioid-related fatalities and ongoing opioid use disorder presents an opportunity to enhance healthcare for non-Hispanic whites in the area. Telehealth and telemedicine effectively address concerns surrounding availability and accessibility. However, it is imperative to prioritize ethical standards in the care of opioid-affected individuals. The four foundational principles of ethics—autonomy, beneficence, non-maleficence, and justice—serve as guiding standards for the interdisciplinary team. These principles advocate for patient involvement in autonomous treatment planning and necessitate obtaining informed consent for recording, storing, and sharing patient information among team members (Solimini et al., 2021).

Furthermore, telehealth services are particularly beneficial for vulnerable groups, including disabled and low-income pregnant women, as they mitigate the need for long-distance travel, thereby reducing financial and health-related risks. The right to affordable care is a universal principle, and the Potter County community is entitled to the same access to telehealth resources for their benefit.

Conclusion

Potter County, located in Pennsylvania, is predominantly composed of non-Hispanic whites, who face significant challenges related to opioid use disorder. With a small population and low literacy rates, many residents are older adults living below the poverty line. Key issues of accessibility, availability, and acceptability affect both consumers and providers. The interdisciplinary team at Avera Gettysburg Hospital comprises primary care providers, specialists, and technology integration strategies aimed at improving the psychosocial well-being of the community. Cultural competencies are vital for enhancing healthcare outcomes. While telehealth strategies offer potential solutions, they are accompanied by legal challenges such as licensing, physician-patient relationships, fraud, tele-prescribing, and confidentiality. Nevertheless, the team is committed to advancing telehealth services while adhering to ethical principles.

References

Barboza, G. E., & Angulski, K. (2020). A descriptive study of racial and ethnic differences of drug overdoses and naloxone administration in Pennsylvania. International Journal of Drug Policy, 78, 102718.

https://doi.org/10.1016/j.drugpo.2020.102718

Butzner, M., & Cuffee, Y. (2021). Telehealth interventions and outcomes across rural communities in the united states: Narrative review. Journal of Medical Internet Research, 23(8), e29575.

https://doi.org/10.2196/29575

Hilty, D. M., Gentry, M. T., McKean, A. J., Cowan, K. E., Lim, R. F., & Lu, F. G. (2020). Telehealth for diverse rural populations: Telebehavioral and cultural competencies, clinical outcomes and administrative approaches. MHealth, 6(6), 20–20. https://doi.org/10.21037/mhealth.2019.10.04

Martin, P., Pighills, A., Burge, V., Argus, G., & Sinclair, L. (2021). Promoting interprofessional education and collaborative practice in rural health settings: Learnings from a state-wide multi-methods study. International Journal of Environmental Research and Public Health, 18(10), 5162.

https://doi.org/10.3390/ijerph18105162

Opioid Epidemic. (2019). Department of Health. https://www.health.pa.gov/topics/disease/Opioids/Pages/Opioids.aspx

NURS FPX 6616 Assessment 2 Summary Report on Rural Health Care And Affordable Solutions

Panter, M. (2021, January 25). Potential Legal Implications of Telemedicine and Telehealth. Law Technology Today.

https://www.lawtechnologytoday.org/2021/01/implications-of-telemedicine-and-telehealth/

Pew Research Center. (2018, May 22). Demographic and economic trends in urban, suburban and rural communities. Pew Research Center’s Social & Demographic Trends Project. https://www.pewresearch.org/social-trends/2018/05/22/demographic-and-economic-trends-in-urban-suburban-and-rural-communities/

Qudah, B., Maurer, M. A., Mott, D. A., & Chui, M. A. (2022). Discordance in addressing opioid crisis in rural communities: Patient and provider perspectives. Pharmacy, 10(4), 91. https://doi.org/10.3390/pharmacy10040091

Solimini, R., Busardò, F. P., Gibelli, F., Sirignano, A., & Ricci, G. (2021). Ethical and legal challenges of telemedicine in the era of the COVID-19 pandemic. Medicina, 57(12), 1314.

https://doi.org/10.3390/medicina57121314