Practicum Final Paper
Costa Ndayisabye
Concordia University of Nebraska
Submitted April 20, 2016
Abstract
Practicum was an important opportunity for me to demonstrate what I have been learning for approximately the past two years in the profession of public health and to experience the reality of public health settings in real life Linda Campbell from the University of Georgia, one of the American Psychological Association staff, stated that “Practicum isn’t practicing anymore. It’s the real thing” (Chamberlin, 2016). I spent 75 practicum hours in Texas at the Amarillo Department of Public Health under supervision of Casie Stoughton who is the director. My plan was to work five hours a day for 15 days.
Introduction
The City of Amarillo Department of Public Health Overview
The City of Amarillo Department of Public Health, located at 1000 Martin Road in Amarillo, Texas, is accountable to for implementing public health programs, mainly diseases prevention and health promotion to residents of Randall and Potter counties. The department is funded by the city of Amarillo. The director of the department is a Registered Nurse and has a Master’s in Public Health.
The City Amarillo Department of Public Health is organized into four small sections:
- Disease Reporting: In this section the public health staff works closely with medical laboratories, school nurses, day cares centers, and other medical facilities to track any probable diseases. It is under this program that health education is provided to the citizens.
- Immunization Program: This program has the objective to reduce “vaccine preventable diseases in Potter and Randall counties”. The Public Health Department has a mobile immunization clinic that is used during health promotion campaigns.
- Refugee Services: The city of Amarillo receives an approximate 450 refugees each year, all of whom come from various countries with low public health attention. The Department of Public Health provides the new Amarillo residents (refugees) with an integration session on the American health system. Furthermore, refugees benefit from the city public health initial health screenings, immunizations and healthcare references.
- HIV/ STD prevention: This program is responsible for assessing and treating sexually transmitted diseases of the clients. It is under this section where residents get important information regarding STD prevention.
Due to the high demand of workers in the meat packaging factories and newly created windmill businesses, the population of Amarillo is growing day by day. The population of Amarillo is growing day by day, which has a significant impact on the community. However, despite of the growing amount of businesses, the city still has substantial number low-income communities. According to a report from City-Data.Com (2013), the city of Amarillo has 42% of indigents who did not complete high school and are not living in families. With such a large number of indigents, the City Public Health Department has a crucial responsibility to monitor their health and ensure they are getting any medical assistance they need Briefly the Amarillo Public Health Department’s responsibility is to oversee the quality of care of the residents overall.
There are two main healthcare partners that the city department of public health works with to ensure indigents are receiving care they need. These are JO Wyatt and Northwest Women’s and Children’s Healthcare Center (WCHC).
JO Wyatt and WCHC are health centers that provide care to eligible low-income population in the city of Amarillo. Based on the city public health board meeting, it has been necessary to conduct quality assessments of the different services that are provided by JO Wyatt and WCHC. I was, therefore, assigned to evaluate quality of care based on a quality indicator report assembled by the City Public Health Department and compared to the national standard reports.
Discussion
The first day of my internship, the Director of the Amarillo Public Health Department and the assistant Director briefed me on the entire duties of the city as far as public health is concerned. They both told me that the city’s major public health major concern is the quality of health that is being provided to poor communities. Both JO Wyatt and WCHC clinics that closely work with the city to provide health care for indigents do not have a quality standard of the services they render. I was, therefore, also assigned the task of gathering health care quality data that portrayed the national standards in different sections of health care and comparing the data with the reports provided by the JO Wyatt and WCHC health care centers.
Data from the JO Wyatt and WCHC reports were combined into one comparative report (Appendix 1), which I utilized as a governing tool for the data extractions.
Data Extraction
Finding reports that indicate national standards of quality of care needed by Americans is very difficult. I conducted the data extraction process from the Agency for Healthcare Research and Quality (AHRQ), which is mostly responsible for developing and maintaining Quality Indicators (QIs) that can be used to measure health care performance. QIs evaluation and comparison were therefore very important tools for my internship. According to Farquhar (2008), “QIs are evidence based and can be used to identify variations in the quality of care provided on both an inpatient and outpatient basis.”
Electronic searches from the Department of Health and Human Services, MEDLINE, CDC, and peer reviews from PubMed, Google and Cochrane database were also used to extract important evidence. Additionally, there were also independent publications on quality of health care on specific service that were reviewed for this evaluation. Quality indicators were obtained and compared to the report from the Amarillo Department of Public Health denoted ADPH as discussed in the following paragraphs. It is important to note that evaluation report provided by APHD covered information from 2006 to 2014.
Timely Care
Appointment with Primary Care Provider From the research I conducted, I found well-timed care depends on states or cities. Reports reviewed did not explicitly find a national law that standardizes time patients should wait to get the needed health care service. However, there were evaluations that provide the best health quality as far as wait time is concerned. A report published by Rosenthal (2014) from the New York Times indicated that the twin cities of Dallas-Forth Worth had the lowest wait time for new patient appointments with family practice physicians, which is five days compared to Boston, where new patients could wait up to 60 days. The report from the APHD indicated that patients who visit JO Wyatt and WCHC clinics have a wait time of two days indicated which I found reasonable.
Initial Prenatal Checkup
The current report found that contained Quality Indicators was the Survey of Patient Appointment Wait Times published by the Merritt Hawkins (2014). This report indicated that Boston has the highest cumulative average for obstetrics/gynecology physician appointments in the country and Dallas has the lowest. The same report mentioned that Boston has the longest average physician appointment wait times of the 15 metro markets surveyed: 72 days to see a dermatologist, 66 days to see a family physician, 46 days to see an ob/gyn, 27 days to see a cardiologist, and 16 days to see an orthopedic surgeon. On average, new patients will have to wait up to 45 days or more to be visited by a specialist in Boston. The national wait time average was 28 days while time range depicted on the Quality Indicator sheet from the city of Amarillo Public Health Department indicated a four-day difference compared to the cumulative average for OB appointments in Dallas.
Percentage of Children Two Years Old with Up-to-Date Immunizations
Before extracting necessary data to compare with the report from the Amarillo Public Health Department, I discussed with the director whether or not parents who visit JO Wyatt and WCHC health clinics understand why their toddlers need vaccines. According to CDC, vaccines have a positive impact on children’s health (2015). It helps to prevent people from different types of disease such as hepatitis A and B, haemophilus influenzae type B, influenza, pneumococcal disease, rotavirus, polio, chickenpox, diphtheria, tetanus, pertussis, measles, mumps, and rubella (CDC, 2015). The report from the APHD showed that 88% of children 2 years old got the updated required vaccine, while the national average was 78% as reported by the Children Trends Data Bank (2015).
Percentage of Diabetics Referred for Eye Exam
According to the APHD director, some of the indigents served by JO Wyatt and WCHC have diabetes and the staff try to ensure that patients are receiving appropriate care they need to delay the severity of the disease. One of the most important exams is to regularly check their clients with diabetes to determine if they have any risk of diabetic retinopathy and, if so, refer them to an ophthalmologist for treatment. The report from the APHD mentioned that an average of 82% of clients with diabetes were referred to the eye clinic for the period 2006-2014. The was no a current national QI for retinal eye exam; however, a 2013 report published by the National Committee for Quality Assurance asserted that only 52% of diabetics went thorough retinal testing (NCQA, 2015).
Percentage of Diabetics Receiving Blood Sugar Control Individuals with diabetes may have a consistently high blood sugar level. Having a regular control protocol can help to reduce risks related to many other health problem. During the search I conducted, I did not find specific data that tells the number of U.S. citizens with diabetes who receive blood sugar test regularly. However a report produced by the Nation Institute for Diabetes and Digestive and Kidney Diseases stated that “Nearly 24 million people in the United States have diabetes, 2 out of nearly 180,000 people are living with kidney failure as a result of diabetes” (NIH, 2014) which means 100% of individuals diagnosed with diabetes should go through microalbuminuria screening (2014). Data obtained from the APHD report indicated that 95% of indigent people with diabetes received blood sugar testing in the period of 2006-2014. Keeping this percentage high can help to prevent hearth diseases of the population served by both JO Wyatt and WCHC centers.
Women Referred for Mammograms
Even though there was no available data that indicates the national average number of women who are referred for mammograms, the Qis reported by both JO Wyatt and WCHC clinics mentioned that an average of 76% to 88% were referred and got mammograms respectively for the period of 2006-2012 (report attached).
Length of Time to Eligibility Approval As above mentioned, JO Wyatt and WCHC centers primarily treat Medicare, Medicaid and uninsured patients and qualified Amarillo indigents who need to prove their eligibility. The eligibility process is analyzed by the clinics and clients are informed of the results. After assessing different information that provided the eligibility requirements, I found both JO Wyatt and WCHC have four days until they decide on a benefit application, while for in the State of Texas it takes up to 30 days for to receive a response.
In the beginning of the internship, it was difficult to understand the complex context of public health settings in the city. It was also difficult to get a response from the department staff as the busy Director could hardly ever be reached. However, I found that communicating with her through emails got a reply in three days or more. I noticed that the director was at the center of everything, which limited other department employees from being involved in the management of the department. For example, I scheduled a meeting to with the Director and had to wait and reschedule three times before we were able to meet to discuss some challenges I had encountered in completing tasks I was assigned to do.
Personal Assessment
Without the courses I have taken in the public health programs, I would not have been able to accomplish the internship at the Amarillo Public Health Department. It was through the skills I attained from my courses that I had the confidence to prove to the APHD Director and her assistant that I was the right choice for an internee. I was able to discuss with them the various skills I had learned to prevent to reduce infectious and chronic diseases, especially from the course MPH 520 Concepts of Environmental Health. What I learned in this course helped me to understand the concept of disease prevention that the city of Amarillo is involved in which are designed to ensure residents have reduced health risks.
Conducting the evaluation of health care quality indicators, I was able to apply the skills learned in MPH 525 Health Policy and Management more specifically on individual rights versus population rights in public health and the law. Additionally, I managed to ask and understand the concept of ethical principles and how they apply to access to healthcare, health promotion and disease prevention in the community. Furthermore, I learned and discussed with the staff at the APHD issues regarding individual’s rights to the health care. I shared my personal experience when I had an appointment with PCP at one of the health centers that mostly serves low-income communities under Medicaid. For this appointment I was asked to fast and to arrive at 10:00 a.m., which I respected and arrived on time. After checking in, I met the LVN for vital signs at 12:00 p.m. and then put in the doctor’s waiting room. I waited until 1:25 p.m. and had not seen anyone, at which time I decided to leave the room and go to reschedule my appointment. I am sure many patients have faced the same experience all over the country. This happened this year 2016 after I had stepped into the public health bay. I knew most of patients there, would not know how to professionally address this issue. As a result of this experience, I decided to do something that has changed health center effectiveness a great deal. I knew my rights because of various understandings regarding public health settings I had learned from my class, which included a patient’s right to health care.
Given the soaring number of communicable diseases, the government is now being forced to restructure its healthcare system with much emphasis on public health. I believe to implement programs to reduce preventable diseases governments have a sole choice, which is to involve skills from Public Health practitioners. Skills obtained from the course MPH 588 – Marketing in Public Health were crucial and helped me to discuss with the APHD staff on the usefulness of creating more strategies that will help to prevent diseases.
Conclusions and Recommendations
Among other duties the main work I performed at the Amarillo Public Health Department was to gather national Quality Indicators and compare it with the report from the two major partners of the city that are JO Wyatt and WCHC centers. It was a meaningful experience to me as a new public health professional. I was able to learn the weaknesses and strengths of the APHD and the two clinic data and also knowing how their health care QIs stand nationally. It is a privilege for the more than two hundred thousand Amarillo residents to have a public health department that serves them locally as the absence of an effective public health system at local levels is one the primary causes that hinder the implementation of public health programs.
My recommendation is that the APHD should design an annual monitoring and evaluation plan that would assess the quality of care that is provided by their partners. Another recommendation I discussed with the director of the APHD was to design patient questionnaires that could be used to compare with corresponding clinic reports. A further critical point I discussed with the director was to plan for public health campaigns that will increase awareness and encourage the community, especially the indigent population, to adopt healthy behaviors.
As a member of APHA, I believe public health advocates play a significant role as mediators between federal and state governments. For example, the APHA commitment to ensure reasonable access to care, to protect funding for core public health programs and services and to eliminate health disparities has been one of the vital plans undertaken by public health professionals.
References
Child Trends Data Bank (2015). Immunization. Retrieved from http://www.childtrends.org/?indicators=immunization
Centers for Disease Control and Prevention (2015). Parents’ guide to childhood immunizations. Retrieved from http://www.cdc.gov/vaccines/pubs/Parents-Guide/default.htm
City-Data.Com (2013). Amarillo, Texas (TX) poverty rate data. Retrieved from http://www.city- data.com/poverty/poverty-Amarillo-Texas.html
Farquhar, M. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2664/
National Committee for Quality Assurance (2015). What is the Current State of Quality of Care in Diabetes? Retrieved from: http://www.ncqa.org/PublicationsProducts/OtherProducts/QualityProfiles/FocusonDiabetes/WhatistheCurrentStateofQualityofCare.aspx#sthash.BSac0rdy.dpuf
Nation Institute for Diabetes and Digestive and Kidney Diseases (2014). Kidney disease of diabetes. Retrieved from http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/kidney-disease-of-diabetes/Pages/facts.aspx
