Hispanic Women With Type II Diabetes

Implementation of mobile web app (Glucose Buddy) for medication reminder and health education to increase treatment adherence among Hispanic women with type II diabetes
Outcome Synthesis
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Outcome Synthesis
Abstract
Type II diabetes mellitus (T2DM) is today an increasing and significant health problem. Hispanic-Americans are amongst the ethnic groups most at risk given that obesity is highly prevalent in Hispanics than in any other ethnic group. The problem of poor adherence to prescribed treatments is considerably complex. Adherence to therapy in patients who have T2DM is dependent on various variables, including variables that are specific to the provider, to the patient, and to the treatment. The proposed solution to improve adherence to diabetes medication among Hispanic women is the implementation of mobile web app for medication reminder and health education. Several studies carried out over the past few years contribute to the body of evidence that the use of mobile web apps actually help to increase medication adherence. Medication reminders and educational messages provided to patients using mobile phones have been shown to increase adherence to medication and to improve patient outcomes.
Statement of the Problem
Diabetes is understood as a group of illnesses that are characterized by high blood glucose levels caused by defects in the production of insulin, insulin action, or both. This medical condition could result in severe complications as well as premature death (Tiv et al., 2012). Even so, diabetic individuals can undertake the necessary steps to control this medical condition and reduce the likelihood of complications. Type 2 Diabetes Mellitus (T2DM) is the most prevalent type of diabetes in the United States and is mostly avoidable. In adults, T2DM is known to account for between 90%-95% of all the diagnosed cases of diabetes; the rest being adult-onset diabetes type 1 (Longhurst, 2014). In the year 2012, diabetes cases cost America about 245 billion USD; this sum is expected to go up with the rising numbers of diagnosed people. In the same year 2012, diabetes resulted in $69 billion in reduced productivity as well as $176 billion for direct medical expenses (Longhurst, 2014).
Researchers have reported that people of Hispanic ethnicity have a greater risk of developing T2DM compared to non-Hispanic whites. Among Hispanic women, the prevalence of total diabetes – undiagnosed and diagnosed – is about 16.9%. The prevalence increases substantially with age and reaches over 50% for Hispanic females by the time they are aged 70 years (Virginia, 2014). A lot of ethnic minorities in the United States have restricted access to health care owing to their lower socio-economic status. Diabetic Hispanic women face several barriers to the adherence to diabetes medication regimen. These barriers include the following: cost – Campos (2007) stated that roughly 60 percent of diabetic Hispanic adults have a yearly income of under $20,000 relative to about 28 percent of diabetic whites. Cost of medicines is a significant reason as to why some patients with diabetes decrease their frequency or dose of insulin therapy. Treatment cost contributes to the hesitancy of patients to seek treatment of their diabetes, to continue adhering to the insulin therapy, and to raise dosages of insulin as required in order to effectively control hyperglycemia (Campos, 2007). Another barrier is miscommunication. Barriers in terms of language could avert the provision of sufficient care. It does so by preventing or limiting exchanging of communications between the Latino diabetic women and their healthcare providers resulting in a loss of vital and critical cultural information, poor shared decision-making, misunderstanding of doctors’ instructions, as well as ethical compromises for instance, difficulty in getting informed consent (Fenerty, West & Davis, 2012). Miscommunication contributes significantly to poor adherence to insulin therapy.
Limited access to drugs has been shown to be a key contributor to the non-adherence to medication regimen by Hispanic women who have diabetes. Researchers have reported that diabetic Hispanic adults are nearly 40% more likely to be non-adherent to their diabetes medication regimen 12 months after a preferred medicine list was implemented for the Medicaid program of their state (Simone 2013). In addition, Hispanic patients who have complicated treatments also have a high likelihood of being non-adherent to diabetes medication (Simone 2013).
Low health literacy is also a noteworthy barrier among Hispanics. According to Vervloet, van Dijk and Santen-Reestman (2011), health literacy is understood as a person’s capacity to read, comprehend and make use of healthcare information in order to make effective and sound healthcare decisions and follow treatment instructions. Campos (2007) observed that low health literacy is especially common amongst Hispanic adults who are diabetic and this could make it hard for them to comprehend educational materials or written medicine instructions. Low health literacy in patients who have T2DM is correlated with poor outcomes such as a smaller chance of them having proper glycemic control as well as higher chance of developing retinopathy. Moreover, female Hispanic patients have the tendency of relying much on family and friends, and this could give rise to misinformation or confusion. Cultural belief is the other barrier. A lot of Hispanic patients believe that diabetes is a way in which God punishes people – fatalism. They feel that they cannot do much to change their destiny (Campos, 2007). Cultural beliefs such as these might impede the ability of a female Hispanic patient with T2DM to successfully manage her diabetes.
Background and Significance
Type II diabetes mellitus (T2DM) is today an increasing and significant health problem. Hispanic-Americans are amongst the ethnic groups most at risk given that obesity is highly prevalent in Hispanics than in any other ethnic group (Gazmararian, Ziemer & Barnes, 2009). Drugs do not work in patients who do not take them and adherence to medication is of great importance. Adherence to a medication regimen is basically understood as the degree to which a patient takes medicines as prescribed. The problem of poor adherence to prescribed treatments is considerably complex. Compliance to therapy in patients who have T2DM is dependent on various variables, including variables that are specific to the provider, to the patient, and to the treatment. Non-adherence to therapy is complicated even further when religion and cultural factors are computed with the Hispanic community (Whittemore, 2007).
The risk of weight gain, for some patients, might put forth a substantial influence on their adherence to diabetes therapy, whilst for other patients the cost of drugs or the risk of hypoglycemia might be more significant factors. Physicians have to discuss these issues with their patients and come up with a patient-centric treatment plan in order to attain optimal adherence to treatment (Linn, Vervloet & van Dijk, 2011). It is of note that diabetes that is not controlled in a proper way opens a pathway for several other serious medical complications which include hypoglycemia, hypertension, dislipidemia, heart attack, and stroke. According to the American Diabetes Association (2014), 50% of persons with diabetes die due to cardiovascular disease, particularly stroke and heart disease. Other complications include blindness and eye problems or diabetic retinopathy which comes about because of blood vessels inside the retina that may cause loss in vision; kidney disease which brings about kidney failure, a serious complication that calls for a kidney transplant or chronic dialysis; and amputations such as lower-limb amputations (American Diabetes Association, 2014).
Diabetes can also affect pregnancy negatively since it increases the likelihood of large infants, birth defects, in addition to other complications which could be dangerous to both the mother and the infant. Other complications of diabetes are nephropathy, peripheral neuropathy, heart disease, dental disease, mental health problems like depression, and nervous system complications. In America, diabetes is the main cause of newly diagnosed adult blindness and the main cause of kidney failure (America Diabetes Association, 2014). In the year 2010, diabetes was the 7th main cause of death in America. The contribution of diabetes type II to death is likely to be substantially underreported on death certificates. People who have diabetes have two times the risk of death of any cause relative to people of similar age who are not diabetic (America Diabetes Association, 2014).
In the United States, diabetes affects roughly 29 million persons and 8 million of these may really not be diagnosed of their condition or they are not aware of it. It affects over 10 percent of all Hispanic Americans – 2 million (Longhurst, 2014). Hispanic women are seventeen times more likely to die from diabetes compared to non-Hispanic Caucasian women. Although countrywide more men compared to women have been diagnosed with T2DM, Hispanic women have a higher diagnosis rate relative to Hispanic men (Campos, 2007).
Systems Context
For this research study, the context is Tri-City Medical Clinic in Los Angeles, California. This health center is a relatively small for-profit clinic operated under just a single nurse practitioner (NP) and one physician. The clinic’s employees consist of an office manager and 3 medical assistants. Tri-City clinic does not have the latest state-of-the-art technological medical equipment considering that the clinic’s management and top leadership are not very keen on adopting new technology or implementing innovative changes to improve the clinic’s efficiency or service delivery
At this health facility, staff members use paper charting but of late, two new computers have been procured and the management is deploying electronic medical software. The management of this health center is dedicated to delivering excellent medical services compassionately and with benevolence. Tri-City Medical Clinic has the reputation of providing high quality and all-inclusive care to patients and the close relatives of patients. This facility is basically a family clinic and most patients who come here for treatment have medical insurance.
Since Tri-City is just a fairly small clinic with few staffs, the physician actually takes double responsibilities in carrying out a number of activities of the clinic. The physician, for example, is in charge of making sure that every staff member reports to work punctually and every operation and activity in the clinic runs effectively and efficiently as it should. It is worth mentioning that this role is imperative in making sure that every activity carried out within the clinic is actually done properly. Another key staff at Tri-City Medical Clinic is the nurse practitioner. This person assumes the functions of the physician when the physician is absent from the health clinic. Moreover, the nurse practitioner has the role of conveying any relevant information from the physician or the assistant department to other nursing staffs as well as their assistants. Through this communication channel, the lower-rank staff members are also able to communicate to the physician.
Definition of clinical outcome, satisfaction outcome, and cost outcomes
Clinical outcome: in this research study, adherence to diabetes medication is the clinical outcome that will be measured. Adherence to diabetes medication is the extent to which the diabetic Hispanic women will take drugs for managing the disease as prescribed by their doctor or health care provider at the health facility. Increased adherence to medication regimen greatly decreases hospitalizations as well as emergency department visits for persons who have diabetes (Curkendall et al., 2013). Clinical outcome is essential given that it determines both the progression and prognosis of disease. It is worth mentioning that the efficacy of diabetes medications in managing the disease would be achieved if the Hispanic women stick to the treatment regimen.
Satisfaction outcomes: in this study, two satisfaction outcomes would be measured; satisfaction of staff members and satisfaction of patients. Staff satisfaction is vital since it increases their morale to continue working and helping the patients manage their medical condition. The level of satisfaction of the staffs at the health care facility would be measured. Satisfaction of the diabetic patients would also be measured. It is worth mentioning that satisfaction of the patient is a key variable which determines the probability of a successful treatment regimen.
Cost outcome: this study will also entail measuring the estimated charges saved in treating patients (Linn, Vervloet & van Dijk, 2011). The currency U.S. Dollars ($USD) will be used in measuring the cost outcome. Moreover, the cost per patient will be measured. This would only be applicable to Hispanic women with diabetes and receiving the treatment. It is expected that adherence to medication regimen would result in a reduced cost not only to the diabetic Hispanic patient, b...