Barriers to Preventative Care

Barriers to Preventative Care

Application of Course Knowledge

My clinical practicum setting is at Ampla Health, a family medical clinic in Yuba City, California. The patient population I commonly see are adolescents and adults. Based on recommendations from the US Preventive Services Task Force (USPSTF) and Healthy People 2030, two important preventive care screenings for this population are screening for depression in adolescents aged 12-18 years and screening for high blood pressure in adults.

At my clinical site, providers follow the USPSTF guidelines to determine appropriate preventive screenings for patients. During annual wellness visits, providers review the patient’s medical history and risk factors and make screening recommendations based on the USPSTF guidelines. For example, all adolescents are screened for depression using the PHQ-9 during well-child visits. Adults are screened for high blood pressure at least annually, with more frequent monitoring for those with elevated BP or high risk. Providers also consider factors like family history and social determinants of health when determining which screenings to prioritize.

Overall, I would describe the quality of preventive care at my site as good. Providers are diligent about addressing recommended screenings and immunizations during well visits. I have not observed overt disparities or bias in care; however, there are still gaps in screening rates between vulnerable groups like uninsured patients versus privately insured patients. Screening opportunities are more likely to be missed for complex patients with multiple comorbidities, mental health issues, or unstable social situations. Additionally, patient education about screenings is not always tailored to literacy or cultural/linguistic needs.

Screening recommendations are generally presented verbally, supplemented by handouts. For some screenings like colorectal cancer, at-home test kits are provided directly to patients over 50. While interpreters are used to bridge language barriers, health literacy is not formally assessed. Providers explain the purpose of screenings but do not consistently confirm patient comprehension. There is room for improvement in leveraging teach-back, visual aids, and other strategies aligned with health literacy best practices and CLAS standards.

To increase preventive screening rates in vulnerable groups, I recommend implementing population health management tools like registries to identify gaps in care and track recommended screenings. Screening benchmarks can be set for vulnerable groups like diabetic patients to drive improvement. Patient navigators and community health workers could provide culturally tailored outreach and connect patients to needed services. Partnering with community organizations serving vulnerable populations would facilitate education and access. Offering screenings during expanded hours or via mobile clinics could also improve screening rates among marginalized groups.

Integration of Evidence

The USPSTF recommends screening for major depressive disorder in individuals aged 12 to 18 years. Screening should be implemented with adequate systems to ensure accurate diagnosis, effective treatment, and appropriate follow-up (Mangione et al., 2022; Siu et al., 2016). This guideline is supported by a systematic review finding adequate evidence that screening improves the accurate identification of adolescent depression in primary care settings. Additionally, the review found that treatment of adolescents screened and identified with major depressive disorder leads to clinical improvements (Siu et al., 2016). This source supports screening adolescents for depression to enable early intervention.

According to Healthy People 2030, only 71.5% of adults had their blood pressure measured by a healthcare professional in the past two years, below the target of 92.6% (Office of Disease Prevention and Health Promotion, n.d.). Strategies to improve screening rates include patient reminder systems, electronic health record tools, and blood pressure measurement at every healthcare visit (Office of Disease Prevention and Health Promotion, n.d.). This source provides evidence-based strategies to improve adherence to high blood pressure screening recommendations.

References

Mangione, C. M., Barry, M. J., Nicholson, W. K., Cabana, M., Chelmow, D., Coker, T. R., Davidson, K. W., Davis, E. M., Donahue, K. E., Jaén, C. R., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Ruiz, J. M., Silverstein, M., Stevermer, J., & Wong, J. B. (2022). Screening for depression and suicide risk in children and adolescents. JAMA, 328(15), 1534. https://doi.org/10.1001/jama.2022.16946

Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030. U.S. Department of Health and Human Services. https://health.gov/healthypeople

Siu, A. L., Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W., Ebell, M., García, F. A. R., Gillman, M., Herzstein, J., Kemper, A. R., Krist, A. H., Kurth, A. E., Owens, D. K., Phillips, W. R., Phipps, M. G., & Pignone, M. P. (2016). Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA, 315(4), 380–387. https://doi.org/10.1001/

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Week 5Barriers to Preventative Care
Discussion
Practicum Site: Ampla Health (Family Medical Clinic) in Yuba City California

Purpose
The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising scholarly literature. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared. This discussion will support the professional formation of the nurse practitioner role.

Barriers to Preventative Care

Course Outcomes
This assignment enables the student to meet the following course outcomes:
• CO 2: Identify appropriate patient diagnostic tools with consideration of the costs, risks, and benefits to individuals. (PO 5)
• CO 3: Analyze clinical practice guidelines for application in the primary care setting. (PO 5)
• CO 6: Demonstrate novice-level proficiency in prioritizing patient needs. (PO 5)
Due Date
Initial posts are due to the discussion forum by Wednesday at 11:59 p.m. MT. Peer responses are due by Sunday at 11:59 p.m. MT. Students must post on a minimum of two separate days. A 10% late penalty will be imposed for discussions posted after the deadline Wednesday at 11:59 p.m. MT, regardless of the number of days late. NOTHING will be accepted after 11:59 p.m. MT on Sunday (i.e., the student will receive an automatic 0).
Total Points Possible
This discussion is worth a total of 50 points.
Preparing the Assignment
Follow these guidelines when completing each component of the assignment. Contact your course faculty if you have questions.