Task 1 - Proposed Population-Based Intervention
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Jan 9, 2024
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D224 – Task 1
Western Governors University
D224: Global and Population Health Dr. Margaret Pearce
10/11/2023
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D224: Global and Population Health
A.
Description of Location and Subpopulation
Camden County in Missouri is the area I have selected to collect and review data on. This county
is currently where I reside and am employed. I feel it will be beneficial to understand the Social Determinants of Health (SDOH) of my own county to help determine interventions for the SDOH for the patients of my community. The subpopulation that I identified that is at risk is the elderly. Camden County is home to Lake of the Ozarks, which is a well-known tourist attraction with a high population of citizens that come to this area to spend their retirement. • The size of the community and the specific subpopulation
The most recent county population is 43,239 with 74% of the population living in a rural area and 26% living in an urban area of the county. The percentage of the population that is over the age of 65 is 29.8%. • Gender
There are 21,550 males (49.8%) and 21,689 females (50.2%) in Camden County. • Age
Camden County has a significantly higher median resident age (52.6 years old) compared
to the Missouri median age (39.2 years old). In Missouri, the percentage of adults that are
over the age of 65 is 18.0%. As mentioned above, Camden County’s percentage of residents over the age of 65 is 29.8%.
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• Race
Camden County residents are primarily Caucasian with a 92.2% majority that includes 39,546% residents. 3.2% of the population is of two or more races, 3.1% is Hispanic, and 0.8% is African American. • Income
The average median household income is $56,450 which his lower than the state average of $61,847
• Educational level
People 25 years of age or older with a high school degree or higher: 91.6% People 25 years of age or older with a bachelor's degree or higher: 23.1%
• Percentage living in poverty
13.3% of the population in Camden County live in poverty. This is 5.56 higher than the national average. • Crime rates
Murders: 2 Rapes: 12 Robberies: 0 Assaults: 81 Burglaries: 33 Thefts: 94 Auto thefts: 21
Institutionalized population: 349
• Occupations
Unemployment as of March 2023 was at 3.6% which his higher than the Missouri average of 2.7%. Healthcare and social assistance occupies an average of 20% of the jobs
for both men and women. This is below the Missouri average of about 24%. Retail trade
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and accommodation & food services in Camden County is significantly higher than the state average. • Access to healthcare, transportation, and food sources
There are 6 grocery stores in Camden County which is about 1.48 stores per 10,000 residents. This is .4% lower than the state average of 1.88 stores per 10,000 residents. Camden County has a significantly higher amount of full-service restaurants than the state average per 10,000 residents. There are 100 residents which equates to 24 restaurants per 10,000 people compared to the state average 7.37 restaurants per 10,000 people in Missouri. 73.5% of the population drives a car alone with 10.5% of the population carpooling. Only 0.4% of the population use a bus, 0.8% walk, and 1.1% use a
motorcycle, taxicab, or other means of transportation. There are minimal resources in the county for city transportation. The average travel time to work is 23.7 minutes. There is 1
healthcare organization in Camden County that includes an Emergency Department. There is also a County Health Department and a privately owned walk-in clinic. 14.8% of
the population under the age of 65 are currently without health insurance. • Health and nutrition rates
Camden County has a higher than average adult diabetes rate (9.5% compared to 8.8%) but slightly lower adult obesity rate (29.0 compared to 29.6) than the state average. The most prevalent underlying causes of death in Camden County include lung cancer, acute myocardial infarction (heart attack), atherosclerotic heart disease, and COPD.
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A1. Describe environmental concerns relevant to the subpopulation.
The subpopulation I identified does a have a few environmental concerns that include their vulnerability to the changing weather of the Midwest. In Missouri, the temperature in the summer’s often range from 85-105 degrees Fahrenheit in combination with moderate to high humidity. In the winter, the temperatures range from -5 to 30 degrees Fahrenheit. With the low temperatures, power outages can occur leaving hundreds to sometimes thousands of people without power. In addition, Camden County has a landscape consisting of windy roads and steep hills. With the cold weather and precipitation, these roads become very dangerous to drive on in the winter leaving the subpopulation sometimes stranded in their homes. A2. Discuss how the demographics of the identified subpopulation compare with the
larger community population, and discuss how data supports the health concern for this subpopulation.
The subpopulation of Camden County I identified (the elderly community) differ greatly from the rest of the community population. Camden County is considered a “vacation destination” and is often a county where older people come after retirement. The rest of the population (children and middle-aged) differ in their current stage of life than the subpopulation and are either in school or working.
Camden County has a significantly higher median resident age (52.6 years old) compared to the Missouri median age (39.2 years old). In Missouri, the percentage of adults that are over the age of 65 is 18.0%. As mentioned above, Camden County’s percentage of residents over the age of 65 is 29.8%.The data supports the health concerns for this subpopulation because the top 4
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causes of death for Camden County include mostly chronic conditions that are developed in people of the elderly (65+) population. B.
Identify one social determinant of health (SDOH) affecting the subpopulation described
in part A.
One SDOH that greatly affects this subpopulation is the lack of transportation.
B1. Explain how this SDOH is affecting the subpopulation described in part A.
According to the Mayo Clinic, the biggest contributor to mortality and morbidity in the community is smoking. Lung cancer is prevalent in the elderly subpopulation and contributes to be one of the top causes of morbidity and premature death in Camden County. I believe most people in the community are worried about their cardiac and lung health specifically. Unfortunately, the patients are not worried about their cardiac or lung health until they become sick or have a life-changing diagnosis. One controversial community health concern that was discussed in a local newspaper, Lake Expo, was the lifting of mask restrictions for COVID-19 in April 2021. The school board ended the mask restrictions at a time when the majority of the country was strictly enforcing the usage of masks. This was a very controversial topic in the community due to the amount of elderly people with heart & lung issues that live in the area. Since Camden County is surrounded by a recreational lake, the local hospital has a unique variety of emergency room and hospital admission visits. In the summer during the busy season of the lake, the hospital sees an influx of trauma and physical injuries that consume the majority of the
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visits and admissions. In the winter, CHF and COPD exacerbations along with pneumonia consume the majority of the hospital admissions. Based on this data, there are a few things that reduce the quality of life. The elderly subpopulation have travel limitations or cannot drive at all. There is limited transportation options for members of the community, especially with chronic health disorders. Most of the people in this subpopulation are still smokers, which continue to reduce their quality of life. Without access to transportation, the older population are unable attend appointments with their providers to treat and monitor their diseases. Because of this, they will have poorer outcomes or a deterioration in their condition without treatment.
C. Describe
two
resources currently available to the subpopulation that address the SDOH in part B.
Two resources currently available to the older population includes OATS transit and Logisticare Transport through Medicare. The OATS bus is available for seniors Monday-Friday between 10:00 – 2:00 for medical transportation. Although OATS transportation is not free, it does have a
small fee of $4.00 round trip. Logisticare offers free transportation for Medicare patients whose insurance plan includes their transportation services. Appointments must be set up a few weeks in advance for utilization. Besides a taxi, uber, or personal/family transport, these are the only transport services available in Camden County. D. Describe
two
resources that are needed to address the SDOH for the subpopulation described in part A.
1. Explain why
each
resource from part D is needed.
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The first resource that is needed is a 24 hour transportation service that is available on weekends,
holidays, and before/after business hours for all patients >65. This resource is needed so the patients have the capability to make their appointments throughout the day, have transport home for afterhours care or Emergency Department visits, and last minute appointments. Patients who know they have a reliable way to get home to and from their visits will be more willing to attend their appointments and therefore prevent worsening in their condition. A second resource needed to address transportation issues for the subpopulation is the availability of more in-home services and mobile physician services. This would address the transportation problems by allowing the patient to not have to seek out transportation because the
medical team would be coming straight to the patient’s home for assessment and care delivery. E.
Discuss an evidence-based intervention to address the gap between the available healthcare resources and the resources needed to address the SDOH. Include
one
scholarly, evidence-based source published within the last
five
years to support the discussion.
1. Explain how this evidence-based intervention will decrease the resource gap, including
one
specific example.
The evidence-based intervention of providing bus passes, taxi vouchers, and reimbursement for transportation improved healthcare utilization and outcomes of patients with chronic diseases for older adults (Starbird et al., 2019). The resources required includes funding from the community,
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grants, or the health care system to pay for the transportation vouchers. The evidence-based intervention will decrease the resource gap by preventing future transport needs for care needed by older patients. For example, if a patient has reliable transportation for yearly mammogram screenings, this could prevent future end-stage cancer diagnosis by allowing the patient access to
early prevention and detection screenings. If the patient is able to receive the appropriate care, this will reduce the amount of transportation services needed in the future for more appointments
related to a more serious diagnosis that was undetected due to the lack of transportation.
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References
Camden County, Missouri (MO)
. Camden County, Missouri detailed profile - houses, real estate, cost of living, wages, work, agriculture, ancestries, and more. (n.d.). https://www.city-
data.com/county/Camden_County-MO.html Citroner, G. (2022, August 11). CDC COVID-19 guidelines: No more social distancing, quarantine
. Lake Expo . https://www.healthline.com/health-news/updated-cdc-covid-19-
guidelines-no-more-social-distancing-quarantine-or-test-to-stay-for-schools Mayo Foundation for Medical Education and Research. (2022, March 22). Lung cancer
. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/lung-cancer/symptoms-causes/syc-
20374620 Starbird, L. E., DiMaina, C., Sun, C.-A., & Han, H.-R. (2019). A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases.
Journal of Community Health
,
44
(2), 400–411. https://doi.org/10.1007/s10900-
018-0572-3
United States Census Bureau. (n.d.). U.S. Census Bureau Quickfacts: Camden County, Missouri.
https://www.census.gov/quickfacts/camdencountymissouri