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Published On: Wed, Aug 27th, 2014

The Role of Nurses in Population-Based Health Care

Think back to the last time you were sick. Most likely, you visited a doctor, who evaluated your symptoms and developed a treatment plan based on your unique illness and situations — and your doctor’s professional opinion as to the best course of action.

While doctors are well-trained and educated, and most are more than qualified to provide adequate care, there are disparities in access to information and resources as well as differences in opinion in how specific diseases should be treated.

For example, in the early 1990s, the National Heart, Blood and Lung Institute concluded that inhaled corticosteroids are the best treatment for asthma patients, but only about 30 percent of asthma patients are actually prescribed the medication today, despite inappropriate treatment being the leading cause of death among asthmatics. Experts attribute this issue to several factors, most notably that not all doctors are kept apprised of developments in recommended protocols or have consistent communication regarding best practices.

However, changes in the health care landscape — stemming, in large part, from the Affordable Care Act — aim to eliminate those disparities to improve quality and patient outcomes. Taking a cue from health care delivery in other countries, the American delivery model is shifting from individual-based health care to population-based, or population focused, care. And as with any paradigm, there’s a great deal of confusion about what population-based health care, and what it means for providers, particularly nurses.

photo/ CDC

Defining Population-Based Care
Many health care providers struggle to define population-based care, as it encompasses a number of different approaches to care delivery and definitions of best practice. However, the simplest explanation of population-based health care is that it is assessing the health care needs of an entire population, or group with shared characteristics and developing prevention, treatment, and maintenance plans based on what’s most effective for that population. To some extent, population based health care is already in practice; mammograms for women over age 40 and prostate exams for men over age 50 are standard, for example.

More specifically, population based care aims to provide:

Public health education and prevention. Health care providers are encouraged to incorporate more education into their services, providing education on everything from substance abuse and mental health to obesity. The idea is to prevent disease and injury from taking hold in the first place.

Standardized treatment. This begins with vaccines for babies, and extends through treatment plans for both chronic and acute conditions. Protocols are based upon the observed best practices for those conditions — in other words, the “standard” treatment would be the one that has worked for hundreds, even thousands of other patients.

Drawbacks to Population-Based Care

While proponents of population-based care argue that it will improve outcomes, since everyone in the population will receive the same care that has been proven to work, there are some who feel that this model is a “cookie cutter” approach that is in direct opposition to the patient-centered care that’s been the standard in American hospitals for the past few decades. Doctors note that there are always exceptions to “standards” — a particular drug treatment may not be appropriate for all patients, for example, due to contraindications or cost — and that medicine isn’t “one size fits all.” However, the success of this delivery model in other countries shows that it can be effective, and the major issue is simply that providers aren’t sure what it means for them.

Changes in Education

The nursing profession is changing thanks to the shift toward population-based care, and as a result, nursing education is changing as well. Some of the new skills, included in some graduate nursing programs, that nurses are being called upon to develop include:

  • Behavioral science. Behavior modification is a major part of population-based care, as nurses will need to provide more education to build awareness of common health issues and change behaviors to improve outcome.
  • Epidemiology. Nurses will need to understand how disease spreads, its causes and effects and the patterns of disease. Their knowledge in this area will not only allow them to contribute to effectively treating patients, but also to the body of knowledge that forms the foundation of population-based practice.
  • Management. The shift toward population-based care and greater emphasis on outcomes means that nurses will need to hone their case management and documentation skills.

The Affordable Care Act will undoubtedly change the face of American health care going forward, and as more providers shift toward population-based care, those changes will become more pronounced. Your health care team will always strive to keep you as healthy as possible, but how they do that will look very, very different.

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