The current healthcare system in the US poses substantial challenges to the geriatric care providers, leading to low-quality medical procedures and little attention to both clinical and nonclinical issues with regards to socioeconomic determinants. With approximately 50% of aging patients failing to receive recommended treatment for chronic diseases, the question regarding the efficiency of the established quality measures in practice appears (MacLeod et al., 2018).
This paper evaluates the issue of ineffective clinical guidelines in addressing multiple chronic illnesses in the elderly adults, emphasizing the public health policies, barriers to the solution’s implementation, implications for funding, and further recommendations.
Contemporary evidence-based practice of using quality measures and clinical practice guidelines (CPGs) in health assessments does not prove to be the most effective in treating geriatric patients. As explained by MacLeod et al. (2018), focused on one condition, CPGSs cannot provide healthcare professionals with comprehensive guidance for care delivery in case of multiple chronic disorders, deteriorating physical, and mental health.
Furthermore, by following general recommendations, practitioners frequently fail to consider individual nonclinical social and environmental factors, critical in the process of healthy aging. Such discrepancies lead to low health literacy and an increased need for elderly adults to have repeated diagnostics (MacLeod et al., 2018). To resolve the issue, practitioners should take steps to individualize the health assessment process of geriatric patients by adjusting CPGs to the demand of aging through the creation of the integrated health care system. As followed by Joling et al. (2018), the vast majority of quality indicators (QI) fail “to meet standards of high methodological quality,” calling for an urgent need for policy revisions (para. 2).
Consequently, critical solutions to the aforementioned issue include the development of integrated healthcare programs for seniors, updating CPGs, QI, and raising awareness of chronic conditions among geriatric patients.
Since the issue of PPACA in 2010, there has been a number of attempts to incorporate integrated healthcare in public policies. According to Rowe et al. (2016), nursing professionals demonstrated noticeable improvements in treating elderly adults with multiple chronic illnesses under the Transitional Care Model (TCM). Reports on TCM repeatedly showed a positive association between lowering health costs and increasing quality of care for aging (Rowe et al., 2016). Another governmental program, aimed at extending the scope of the integrated health care delivery, is called the Interventions to Reduce Acute Care Transfers (INTERACT).
The initiative dealt with the issue of repeated hospitalizations and redundant diagnostics, resulting in increased healthcare expenditures (Rowe et al., 2016). Last significant attempt to reform the public health policy is connected to the Healthy People program. Senior participants of the project could receive utmost, updated information on their ongoing illnesses and preventative methods with accordance to their socioeconomic determinants (Rowe et al., 2016). Despite the initial successful results of the aforementioned policies in addressing the low-quality care of geriatric patients, the efficiency of the projects proved to be short-lived due to a number of constraints.
Significant barriers to the implementation of proposed initiatives are connected to the nonclinical issues, ineffective dissemination, and lack of funding. As suggested by Osborn, Doty, Moulds, Sarnak, and Shah (2017), economic and social vulnerability of geriatric patients is a primary factor which prevented the passage of the proposed resolution. Despite the significant reductions in Medicaid programs for the elderly adults, the insurance companies fail to face the challenge of complex care coordination for individuals with 3 and more chronic conditions (MacLeod et al., 2018).
In other words, the beneficiaries of the social coverage who have multiple reoccurring diseases lack enough finances to enroll in integrated healthcare programs. Such barrier prevents them from taking advantage of the individualized CPGs and holistic approach to diagnostics, developed in the new public health policies.
As mentioned earlier, one of the constraints to the implementation of the proposed solution was a lack of funding. For instance, Hirschman, Shaid, McCauley, Pauly, and Naylor (2015) stated that though initiated in Congress, the TMC model was heavily funded by local healthcare insurers. In this case, insufficient governmental support eventually led to the poor results of the project, failing to incorporate an integrated healthcare approach. Little information exists about the funding of INTERACT and Healthy People programs, suggesting that major drawbacks of the initiatives are associated with non-monetary related factors.
Apart from the public funding, innovations may receive private grants from the nonprofit organizations, businesses, or individuals believing in the program’s cause. According to Adirim, Meade, and Mistry (2017), updating ineffective clinical guidelines and quality measures is a time-consuming process which requires substantial financial support. After the protocol is developed and approved on the governmental level, CPGs may be recognized and endorsed by the specific private segments of healthcare.
Taking into consideration the implications of recent research, it is clear that the treatment of geriatric patients requires a holistic approach, wherein healthcare professionals, legislators, and local insurance providers come to collaborate. Instead of delegating the funding inquiry, along with the formation of the policies’ objectives, to the government alone, healthcare professionals should join the process by advocating for the better implications of CPGs and QI.
As mentioned by MacLeod et al. (2018), most of the discrepancies in the industry come as a result of miscommunication between the government representatives and general practitioners. It is recommended for the officials to outline the public health policies with accordance to the practical concerns of the medical professionals, related to evidence-based data and clinical experience. Similar to the way legislators present citizens’ rights, healthcare providers should publicly support the needs of the geriatric patients in cooperation with the insurance programs.
References
Adirim, T., Meade, K., Mistry, K. (2017). A new era in quality measurement: The development and application of quality measures. Pediatrics, 139(1), 1-8. Web.
Hirschman, K., Shaid, E., McCauley, K., Pauly, M., & Naylor, M. (2015). Continuity of care: The transitional care model. OJIN: The Online Journal of Issues in Nursing, 20(3). Web.
Joling, K. J., Van Eenoo, L., Vetrano, D. L., Smaardijk, V. R., Declercq, A., Onder, G., … Van der Roest, H. G. (2018). Quality indicators for community care for older people: A systematic review. PLOS ONE, 13(1). Web.
MacLeod, S., Schwebke, K., Hawkins, K., Ruiz, J., Hoo, E., & Yeh, C. S. (2018). Need for comprehensive health care quality measures for older adults. Population Health Management, 21(4), 296-302. Web.
Osborn, R., Doty, M. M., Moulds, D., Sarnak, D. O., & Shah, A. (2017). Older Americans were sicker and faced more financial barriers to health care than counterparts in other countries. Health Affairs, 36(12), 1-10. Web.
Rowe, J. W., Berkman, L., Fried, L., Fulmer, T., Jackson, J., Naylor, M., … Stone, R. (2016). Preparing for better health and health care for an aging population: A vital direction for health and health care. Perspectives, 1-9.