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Discuss a Primary Care-Focused Visit Devoted to Wellness and or Disease Affecting Women and Health-Enhancing Strategies That You Would Include in the Visit

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Improving the health status of women will require improved use of preventive health care services and health care behaviors. Understanding the current status of women’s health and aspects of women’s health care experience in the United States can help clinicians take steps to expand utilization of preventive services and to empower women to make better and more informed choices about their health. A wide variety of initiatives have been implemented by the federal government, state governments, academia, the private sector, and communities to improve health promotion and disease prevention among women.

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Health needs and services for various populations have come to the forefront as states work to make their systems more efficient and consider covering additional people under federal health reform implementation. This brief, the third in a series about women’s health, highlights diseases and health challenges common to women, opportunities to improve access to care and effective treatment, and strategies to prevent conditions and health problems before they become problematic and expensive. Women, who are key in maintaining healthy families, access the health system more than men, both for themselves and on behalf of their children. Many become pregnant and give birth, a significant health event, then typically become their child’s primary caregiver, a role that greatly influences household health overall. Elder and long-term care issues affect women more often because they live longer; have higher rates of disability and chronic health problems; and lower incomes than men on average, which puts them at greater need for state and community resources, such as Medicaid. Across her lifespan, a woman’s health status matters to herself, her family and to state budgets. Legislators are wrestling with tight budgets and changing health laws—including the realities of implementing federal health reform under the Affordable Care Act (ACA)

If women’s needs are overlooked in these discussions, however, states lose important opportunities to improve the health of residents and gain partners in creating a healthier society. Women experience unique health care challenges and are more likely to be diagnosed with certain diseases than men. Chronic diseases and conditions—such as heart disease, cancer and diabetes—are the leading causes of death for women. Nearly half of adults—133 million people—have a chronic illness, and half of those have two or more chronic conditions. Thirty-eight percent of women suffer from one or more chronic diseases, compared to 30 percent of men. According to the Centers for Disease Control and Prevention (CDC), 75 percent of all U.S. health care dollars treat people with chronic conditions. Managing chronic disease is often difficult for the uninsured, and women are more likely to lack insurance.

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The Patient Protection and Affordable Care Act of 2010 (ACA) instituted annual wellness visits (AWVs) and implemented a new payment structure for Medicare AWVs. 1 Payment for AWVs has been tied to addressing specific clinical content and implementing a health risk assessment (HRA) that covers 34 required elements, including demographics, health status, psychosocial and behavioral risk factors, activities/instrumental activities of daily living, and the development of a personalized health plan (Hughes C., 2012). When the ACA incorporated systematic financial support for longitudinal health planning and prevention in AWVs, it created a long-awaited opportunity for primary care practices to more effectively align their mission (improving the health and well-being of a community) with the sustainability of their organization. Although payment for Medicare AWVs is a step in the right direction, much work needs to be done to identify and test effective approaches to implementing AWVs in community settings

There are numerous gaps in our knowledge pertaining to the role and effective participation of patients in AWVs, the types and specific content of HRAs that may improve process and health outcomes, how AWVs should be structured, what resources and education clinicians and practice staff might need to make AWVs effective, how patients can be empowered to meaningfully participate, what personalized wellness plans should include and how these plans can be communicated to others, how wellness plans and care goals can be documented in a problem-oriented medical record, how practices can efficiently and appropriately respond to complex behavioral health needs emerging from AWVs, and how systematic patient follow-up can be provided to reach the goals set in AWVs (Nagykaldi ZJ, Voncken-Brewster V, 2013).

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In a word, cervical cancer screening and pelvic examinations—the most commonly associated elements of the WWV—no longer warrant annual implementation for most women

However, Epidemiologic evidence suggests that a number of other important and evidence-based preventive services, screenings, and interventions need to be a priority if the WWV of today is going to deliver on its promise to reduce a woman's risk of disease, disability, illness, and death. WWV recommendations need to continue to evolve, as epidemiologic evidence, community, and individual needs change over time. Evidence-based and timely prevention has the potential to reduce healthcare costs, disability, and death while improving the quality and quantity of women's lives. It is time for health care providers and policymakers alike to rebrand the WWV visit of today as a yearly comprehensive visit for RLP, prevention, screening, and health promotion—not just a pap smear and pelvic examination anymore.

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Hughes C. Medicare annual wellness visits: don’t forget the health risk assessment. Fam Pract Manag. 2012;19(2):11–4.

Nagykaldi ZJ, Voncken-Brewster V, Aspy CB, Mold JW. Novel computerized health risk appraisal may improve longitudinal health and wellness in primary care: a pilot study. Appl Clin Inform. 2013;4(1):75–87.

Resources for Physicians on Motivational Interviewing. Connecticut Children’s Medical Center; [Last Accessed: 06/15/2016]. http://www.connecticutchildrens.org/our-care/nutrition/resources.

Jansen KL, Rosenbaum ME. The State of Communication Education in Family Medicine Residencies. Fam Med. 2016;

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