Poor Diabetes Control in Miami-Dade County, Florida
Subject: Public Health
Diabetes is a chronic disease that affects a patient’s blood sugar level and leads to a range of negative consequences. While the prevention of this health issue in the Hispanic population is widely discussed at the national and state levels, little attention is paid to how people manage their disease. In the US, there are 50.5 million citizens identified as Hispanics, which is equal to 16 percent of the total population of the country (Schneiderman et al., 2014). Among the key areas of concern, it is possible to note depression, poor access to health services, and unawareness of how to properly handle diabetes issues.
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In Miami-Dade County, the overall prevalence of diabetes among the Hispanic population is lower than the average value in Florida (8 percent against 9.2 percent) (“Adults with diabetes,” 2016). However, they are more likely to have poor diabetes control and, as a result, a lower quality of life. In particular, the recent study by Kenya et al. (2015) found that 80 percent of participants had depression, which leads to medical costs that are five times higher than average ones. Also, 83 percent of patients failed to have proper medication adherence (ethical matters) and felt overwhelmed, which reflects socioeconomic issues (Kenya et al., 2015). It becomes evident that the current policy is insufficient to address the given problem. In terms of nursing practice implications, diabetes control awareness should be promoted by nurses via proper explanations of the value of treatment, lifestyles, nutrition, and timely consultations with specialists. Responses to Peers’ Posts Post 1 The post by Kendra raises a very relevant health issue of opioid abuse policy and limitations it sets on pain management. The situation seems to be deteriorated due to the fact that barriers to accessing medical opioids force people to seek them on the streets and use illegally. In this connection, nurses are well positioned to recommend a change in the current policies as they frequently work with patients having severe and chronic pain (Marie, Arnstein, & Zimmer, 2018). One of the ways to resolve the problem is to minimize opioid risk by aligning research, practice, and policy to provide patients with a full range of pain management options. Today, the increased accessibility of Naloxone that reverses opioid overdoses seems to be the most effective measure to reduce drug abuse mortality. Post 2 Indeed, opioid use disorder (OUD) is a critical issue that remains unresolved even though some actions were already implemented, as discussed in the post by Ryan. While buprenorphine (BUP) prescription is regarded as one of the key options to treat patients with OUD, some alternatives also exist, for example, methadone (MET). In their recent multi-site trial, Hser et al. (2014) compared parameters related to retention treatment and continuous illicit opioid use, focusing on patients who were prescribed with either MET or BUP. In the course of a 24‐week trial, it was found that the provision of the former caused better retention with regard to opioid dependence (74 percent) compared to 46 percent result of the latter (Hser et al., 2014). However, the increased doses of both medications also led to better outcomes, and BUP was associated with lower continuous use of illicit opioids. The main concern is whether the intake of these medications should be increased to improve retention or not: what is the adequate and safe dosage and when patients should be transferred on MET or BUP? References Adults with diabetes. (2016). Web. Hser, Y. I., Saxon, A. J., Huang, D., Hasson, A., Thomas, C., Hillhouse, M.,… Ling, W. (2014). Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi‐site trial. Addiction, 109(1), 79-87. Kenya, S., Lebron, C. N., Chang, A. Y. H., Li, H., Alonzo, Y. A., & Carrasquillo, O. (2015). A profile of Latinos with poorly controlled diabetes in South Florida. Journal of Community Hospital Internal Medicine Perspectives, 5(2), 1-7.
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Marie, B. S., Arnstein, P., & Zimmer, P. A. (2018). Pain and opioids: Call for policy action. The Journal for Nurse Practitioners, 14(1), 40-44. Schneiderman, N., Llabre, M., Cowie, C. C., Barnhart, J., Carnethon, M., Gallo, L. C.,… Avilés-Santa, M. L. (2014). Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: The Hispanic community health study/study of Latinos (HCHS/SOL). Diabetes Care, 37(8), 2233-2239.