Introduction
Every community in the world would likes staying a healthy lifestyle. A healthy community enjoys many benefits such as longer life span, more developments, excellent growth, in addition to a stress-free life. The public healthcare providers and partners in health initiative should be more aware of the general health status of the community. The main common health assessment tools of used in measuring the state of health of the community are mortality rates, life expectancy, years of potential life lost, and the population statistics (Lewenson & Truglio-Londrigan, 2010, pp. 43-47). Delivery of quality health care acts as a major challenge for many nations across the world, the United States being the most affected. Despite the efforts by the health care sector to increase the quality of healthcare and improve patient outcome, chronic diseases continue to affect people in different communities in U.S. according to Winkfield (2014), the condition of healthcare facilities plays a significant role in determining the quality of health care services offered. In addition, the performance of the government in collaboration with the department of health plays a major role in influencing the quality of health of the U.S. people.
The following assessment focuses on the health condition affecting the Bradenton community in Florida. Healthy People 2020 have a list of health issues that affect people in the U.S. The paper assesses the chronic kidney disease in the community. Chronic kidney disease causes a gradual loss of kidney to the victim, especially if not early diagnosed (Healthy People 2020, 2014). The problem affects a large number of people in the community, calling upon health care experts’ intervention to minimize or totally eradicate chronic kidney disease cases in Bradenton. The Healthy People 2020 aim at reducing the number of people affected by chronic kidney disease in the United States. Moreover, the group works to improve care in people with chronic kidney disease and reduce kidney failure caused by diabetes (Healthy People 2020, 2014).
Demographics
The biophysical environment/consideration
Bradenton is a city found in Manatee County, Florida. It stands as the largest city in Florida with an approximate population of 50,000 people according to 2012 statistics. The people of Bradenton demonstrate the modern lifestyle living model because of the presence of a comfortable and civilized environment.
Behavioural consideration
The community promotes a healthy lifestyle by pursuing health and life fulfilment activities that promote the quality of life and well-being of every person. Moreover, the community has a number of economic activities that give them revenues and help them acquire their basic and secondary needs.
Socio-cultural Considerations
The Bradenton community upholds unique social and cultural practices distancing them from other communities in Florida. The community is governed by a democratic mode of governance where they democratically elect their leaders. Most people in the area speak English language, although some speak Spanish, and French. The community values education and most of its members have attained higher levels of learning.
Health consideration
The city has numerous health care centers and hospitals where people receive treatments depending on their location. The high standards of living experienced by the people of Bradenton contribute to the high spread of chronic kidney disease because they lack proper nutrition education programs. The rate of employment is moderate with 30 per cent of the adult population working in formal sectors. U.S. financing has a strong relationship with the current economy. The high growth rate of health care spending in the U.S. exceeds the country’s Gross Domestic Product (GDP), the population, and inflation rates. Lack of adequate financing because of the current economic status affects the provision of healthcare services in major cities like Florida. The health care cost has raised because of the dramatic increase in health care spending bearing in mind only a small amount of GDP share is devoted to health care. Lack of adequate health care facilities and workforce in some communities like the Bradenton community in Florida promotes increase in chronic disease prevalence (Florida Health, 2014HealthH).
Chronic kidney disease demographics in Bradenton
Chronic kidney disease affects more than 10 per cent of adults in United States. The current Florida statistics show that Bradenton has more than 5,000 people suffering from the kidney failure condition. Chances of contracting chronic kidney diseases increase with age; the disease mostly affects the population of 50 years and above. The 2013-2014 statistics show that more than 4,000 of the total population compose people of ages between 50 and 100 years. In addition, the National Kidney Foundation’s study of 2013 found out that people associated with high blood pressure, diabetes, and come from families susceptible to such conditions as high blood pressure and diabetes have higher chances of contracting the chronic kidney disease. The changing demographics of the disease shows that more people the affected population are more than the recorded value.
Epidemiology surveillance data
The U.S. lacks the necessary and appropriate surveillance program capable of taking care of all aspects of chronic kidney disease cases despite the effects caused by the disease. The Center for Disease Control and Prevention (CDC) has come up with an initiative aimed at supporting national surveillance system for CKD. The proposed surveillance system will be able to analyze trends of the disease, highlight risk factors, and advice on the best care practices that can help prevent the disease in all cities of the United States (Saran, Hedgeman, Plantinga, Burrows et al., 2010, p. 152). Figure 1 shows the chronic kidney disease prevalence in the community for the populations aged 20 years and above. The Non-Hispanic black and the Mexican Americans are at higher risks of contacting the disease compared to Non-Hispanic White. In addition, females aged 20 years and above have higher risks of contacting the disease compared to their male counterparts. The graph shows that the number of victims would increase by the year 2020 if the health care sector fails to come up with an intervention program.
Figure 1: Age-adjusted prevalence of CKD in Florida (20 years and above) (Source: Center for Disease Control and Prevention)
Figure 2: Factors leading to CKD (Source: Center for Disease Control and Prevention)
Figure two represents various conditions that contribute to chronic kidney disease and their percentage influence. Diabetes forms the major cause of CDK with 44 per cent of Bradenton population. High blood pressure becomes the second major cause with 28 percent. The statistics show that almost 70 percent of the community suffering from diabetes and high blood pressure are at higher risks of contacting the chronic kidney disease.
An interventional program to improve health outcomes of the population
Cases of chronic kidney diseases have increased in prevalence in the U.S. contributing to significant mortality and morbidity. Center for Disease Control and Prevention and the Healthy People 2020 believe that an effectively implemented an evidence-based practice would help reduce and eventually eradicate cases of chronic kidney diseases. Primary care physicians in the Bradenton community have the responsibility of educating people on different practices that could help control the disease and minimize its prevalence by the year 2020. In addition, the availability of technology and the wide spread of internet services serves as the best tools to assist in the implementation of the evidence-based program for improving healthcare in the community. Primary care physicians play a major role in reducing progression and spread of CKD, but most primary care offices in the city have limited resources to control and treat the disease. Most health care providers have no idea on how to utilize some of CKD diagnosis machines. Moreover, the complex care associated with other illnesses that lead to CKD such as diabetes and high blood pressure limits the ability of physicians to offer effective treatment.
Nutrition management acts as the best evidence-based program for preventing high prevalence of chronic kidney disease in Bradenton. The program was recommended after a close look at the major causes of the disease. CDC claims that the disease is associated with diabetes and high blood pressure, which are caused by poor nutrition and poor lifestyle. A nutrition management program will focus on people of all ages, but the most targeted group consists of adult patients diagnosed with CKD. The community randomized trials will test the level to which nutrition management program promotes evidence-based care and helps improve the clinical outcomes of reduced CKD prevalence in Bradenton Florida. The community composed of well educated and technologically advanced people. The program will be implemented through mobile-health (M-Health) services.
The Bradenton community requires quick intervention towards the chronic kidney disease problem in order to free people from high death rates and access health more easily. The main areas that show challenges to the community are availability of health care providers and nutritionists, presence of disease control and mitigation programs, and presence of high-quality health care centres equipped with necessary disease diagnosis resources. The use of mobile health technology (M-Health) would assist in implementing the nutrition management program more effectively. M-health integrates computer science, information science and nursing science to manage and transmit communication data, knowledge and information in nursing practice. The program supports nurses, patients and other healthcare providers in improving health outcomes of the community.
Application of health care innovation in Bradenton Florida helps in increasing the quality of life and well-being among people in the community. The availability of resources such as money and skilled workforce would help the community implements all the program strategies and promotes quality patient outcome. Moreover, the program will create an enormous impact in the health care industry by reducing mortality and morbidity cases through decreased cases of chronic kidney disease. As healthcare sector continuous growing in Florida, healthcare experts introduce new ideas like the above-proposed nutritional management program implemented through M-Health applications.
Program design
The program focuses on the following categories of people.
- People suffering from diabetes, or whose family members had a history of diabetes
- Individuals with a family history of chronic kidney disease
- Individuals with high blood pressure, or have one of their family members diagnosed with the problem
- Persons 50 years and above
- African American, Native Americans, Asian Americans, and Hispanic Americans living in Bradenton Florida.
The Nutrition management program will utilize technology through individual mobile phones to alert people on the best nutrition combination to take in order to avoid high blood pressure or diabetes. For patients suffering from these conditions, the program will advise them on how to have balanced meals that will promote weight loss and reduce the percentage of salt and sugar intake to the body. The M-Health program uses mobile telephone gadgets to notify people about various health issues. The ideas shared on mobile networks include educating people on how to live a healthy lifestyle, knowledge on symptoms of certain diseases, the best hospitals to access health care services, and how to cater for the sick at home. It forms an interactive process between a patient and a nurse that occurs over the mobile.
The mobile health program must be documented in the nutritionists’ databases. Documentation forms a major aspect in any program implementation because it promotes effective communication. The accuracy and timeliness of healthcare provider-patient communication improve when a program is effectively documented (Savel and Foldl, 2014). Nurses can be involved in the process of improvement by ensuring that they feed all the necessary information to the internet and pass it to the mobile gadgets of all M-Health registered users. Any mobile gadget can receive health care information from the program. Those whose phones cannot connect to the internet will require registering for text messages alerts on their phones. Each text message will cost the user little amount of money to cater for mobile provider cost. On the other hand, those with internet-enabled phones, especially the smartphones will have the added advantage because the program can be downloaded and installed in the smartphone.
Program development
Implementation strategy
The main objective of the program is to provide people of Bradenton in Florida with evidence-based clinical guidelines that relate to dietetic management of people suffering from chronic kidney disease and their families. In order to effectively implement this program, the implementation team should gather the following information from health care experts.
Firstly, the team should know the exact level of glomerular filtration rate (GFR) that the patient should have in order to undertake the nutrition management program. The GFR checks the working of kidneys by estimating the amount of blood passing through the glomeruli per minute. The GFR depends on the age; ethnicity; gender; weight; height; and blood creatinine measurement of an individual (Medline Plus, n.d). Secondly, the team must understand the specific measures the best reflect the nutrition status or a change in nutrition status in chronic kidney disease. In addition, the team must realize the goals of a nutrition intervention, and the correct nutrition interventions to optimize nutrition status in CKD management and take care of malnutrition. Finally, the team must gather information regarding the best methods of implementing the nutrition program and ensure maintenance and improvement of health care in the community.
In addition, the program implementation team will search for relevant information from the major libraries in the city concerning evidence-based practice guidelines for the management of chronic kidney disease. The nutrition elements of the following materials help in achieving the above objective. Knowledge of the above information will help in the effective implementation of the program because the team will understand the general framework for handling target groups. These publications include:
- Caring for Americans with Rental Impairment
- Kidney disease outcomes quality initiative
- Medical reports from American Diatec Association on CKD medical therapy
- European Dialysis and transplant Nurses Association Therapy guidelines for nutritional care
M-Health technology will be implemented in two stages. The first stage involves educating the health care providers in Bradenton on how to use the internet and post nutrition advises to M-Health subscribers. The second stage will be the real application of the program to the people in the community. A team of researchers will be deployed to the community to monitor the implementation of the program. Their main duties include educating people on how to subscribe to the program using their mobile phones. The team will collect information from the community regarding issues associated with the program such as benefits and challenges faced. Statistics such as the number of subscribers, positive feedbacks, and the impact of the program to the community will be analyzed to evaluate the quality of service delivery.
Program interventions
Technology helps bring reliable and effective clinical practical guidelines that help improve the health of a community. Nutrition management program is expected to assist in the prevention and control of major dietetic related diseases such as CKD in the community and improve the quality of health care. The intervention of technology through the use of mobile networks will help in spreading information to people in the grass root on how to control the disease. The program implementation team will help people in downloading and installing the application on their phones. In addition, the health care sector will conduct many awareness campaigns aimed at educating the community more about the program and call upon more people to subscribe to M-Health program regardless of their health status.
The main aim of implementing the nutrition management program is to describe the best diets for the people suffering from CKD and their families to prevent disease prevalence in the coming years. The program is expected to last for two years and a study conducted to investigate its impact on improving the health of the community. The diet therapy maintains proper nutritional status, treats complications, and slows down disease progression. Proper diet slows down the progression of the disease in through controlling blood pressure by reducing sodium intake, managing diabetes, and reducing excessive protein intake to the body. Table 1 shows sample tests and their relevance to the program.
| No | Test | Intervention |
| 1. | Glomerular
Filtration Rate (GFR) |
Assess the kidney function: Done repeatedly to determine the effect of proper nutrition
Ø Stable GFR shows positive results of the program Ø Reduced GFR shows increase in CKD infections (poor nutrition management) |
| 2. | Urine Albumin-to-Creatinine Ratio (UACR) | Assess response to therapy and monitor progression of CKD
Ø High ratio reflects high progression risks Ø Decreased ratio shows the program is working |
| 3. | Blood Pressure | Determines the presence of hypertension
Ø Low sodium intake Ø Weight reduction |
| 4. | Reduce Albuminuria | Reduction or constant amount of albumin lost in the urine
Ø Non-diabetic: 0.8g protein/kg/day Ø Diabetic: 0.8-1.0g protein/kg/day. Patient’s diet depends on the CKD status |
Table 1: The main tests for the nutrition management program intervention
Program timeline
The nutrition management program will continue for 12 months, from October 2014 to October 2015. The one-year term will be necessary to record different changes in disease prevalence in the community. Table 2 shows the program timeline.
| NO. | ACTIVITY | DURATION |
| 1. | Planning phase | October 2014 |
| 2. | Gathering relevant information | November-December 2014 |
| 3. | Implementation | January –October 2015 |
| 4. | Reporting | November 2014 |
Table 2: Program Timeline
Conclusion
The Bradenton community should live a happy lifestyle free from health problems such as cases of chronic kidney diseases. Community assessment process helps in identifying and determining solutions to problems affecting a population in the community. The health care sector has a duty of ensuring health-related quality of life and well-being of every person in the world regardless of their age, gender, race, ethnicity, financial status, or political affiliates. The above report clearly analyses the Bradenton community from Florida in United States. The main health problem identified in the region was the high prevalence of chronic kidney disease. The project proposed a nutrition management program that will provide patients and their families with dietetic recommendations using their mobile gadgets. The M-health program would be more efficient bearing in mind that most people in the community possess mobile phone gadgets. Application of the program is likely to yield better results and improve the health status of people in the community.
References
Center for Disease Control and Prevention. (2014). 2014 National Chronic Kidney Disease Fact
Sheet. Retrieved from
http://www.cdc.gov/diabetes/pubs/factsheets/kidney.htm
Florida Health. (2014). Florida Vital Statistics Annual Report 2013. Florida: State of Florida
Department of Health. Retrieved from http://www.flpublichealth.com/VSBOOK/pdf/2013/Intro.pdf
Healthy People 2020. (2014). About Healthy People. Foundation Health Measures. Health-
Related Quality of Life and Well-Being. Retrieved from http://healthypeople.gov/2020/about/QoLWBabout.aspx.
Lewenson, S. & Truglio-Londrigan, M. (2010). Public health nursing assessment tool.”
Nursing Outlook 58. 2: 1-57.
Medline Plus. (n.d.). Glomerular filtration rate: MedlinePlus Medical Encyclopedia. U.S
National Library of Medicine. U.S. National Library of Medicine, retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/007305.htm
Saran, R. et al. (2010). Establishing a national chronic kidney disease surveillance systems in the
United States. Clin J Am Soc Nephrol 5, 152–161,
Savel, T. G. and Foldy, S. (2014). The Role of Public Health Informatics in Enhancing Public
Health Surveillance.” Morbidity and Mortality Weekly Report (MMWR), 61. 3, 20-24
Winkfield, E. (September 2014). LAmerica’s Healthcare Crisis: Is There a Solution? Retrieved
from
http://realtruth.org/articles/090203-005-health.html
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