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Parish Nurse–Initiated Interdisciplinary Mobile Health Care Delivery Project

https://doi.org/10.1111/j.1552-6909.2010.01112.xGet rights and content

ABSTRACT

Parish nurses and a school of pharmacy faculty collaborated on a mobile health project to bring screening and preventive services to low-income neighborhoods. Outcome measures indicated that older women were most likely to use these services. This project fostered a positive, trusting client–provider relationship that formed the basis of clients' motivation to make lifestyle changes. Future direction includes collaboration with an academic nursing center to expand services in chronic care management.

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Access and Need for Preventive Care

The current economic crisis has given rise to an increasing number of unemployed and uninsured Americans. Current estimates place the number of uninsured Americans at nearly 50 million, with another 25 million classified as underinsured (Hadley, 2003). With the cost of living steadily escalating, even those insured by Medicare have less money to spend on supplementary insurance or medications due to modest fixed incomes from Social Security and pension plans. These uninsured and underinsured

Setting and Target Population of the Mobile Project

The client base of the mobile health delivery project resides in the city of Pittsburgh and in the surrounding communities of Allegheny County. The population tends to be classified in the 65 and older age bracket, with the mean age of clients being 64 years old. According to 2000 and 2007 data from the U.S. Census Bureau (2009b), Pennsylvania has the second highest percentage of the population aged 65 and older, with Florida ranking first. Specifically comparing the population distribution of

Project Planning

Prior to this project, volunteer parish nurses used the mobile health van during special community screening programs and health fairs in parish communities. Although the screening programs and health fairs were advertised in advance and local newspapers featured articles about the mobile health van project, attendance at the events tended to be small. Additionally, the screening tests were often too expensive for the churches to afford to continue supporting the mobile health van. However, the

Barriers

As the project gained momentum in each of the four sites, a key barrier was immediately encountered. Food pantry clients were reluctant to access care offered in the van for health screenings. The vast majority of clients would collect their food items and leave. This was disappointing but did not come as a total surprise. The team acknowledged that it takes time to form a trusting relationship. Underserved neighborhoods have a history of services that come and go due to lack of funding. For

Findings Related to the Client Demographics

Over a 39-month period, from September 2005 through December 2008, the mobile health delivery screening project recorded 1,617 client visits. Although the majority of the participants were clientele of food pantries, typically low-income medically underserved, a small percentage of clients were volunteers from the sponsoring church. Analysis revealed that 1,115 visits (69%) were from women, supporting the goal that the target population of low-income women was reached. The average age of the

Outcomes Regarding the Screening Services

A variety of free health screenings and consultation services were offered. Screenings included total cholesterol, high density lipid (HDL) cholesterol, blood glucose, blood pressure, bone density, body mass index (BMI), and body fat analysis. Because of the incidence and impact of cardiovascular disease, diabetes, osteoporosis, and obesity on the U.S. population, these particular screenings are particularly valuable. During this time period, a group of 502 women received 1,915 screenings (768

Findings Related to Blood Pressure Screening

Total blood pressure (BP) screenings numbered 768. Three hundred women had BP readings over 140 systolic and 90 diastolic. Table 1 summarizes the number and percentage of women whose systolic or diastolic pressures were in the hypertension range according to national guidelines (U.S. Department of Health and Human Services, 2003).

Findings Related to Cholesterol and Glucose Screenings

To analyze total cholesterol, HDL cholesterol, and blood glucose, the Cholestech LDX was used (Cholestech LDX, 2009). This equipment allows point-of-care testing and the ability to provide the client with results in approximately 5 minutes. The blood sample for the test is acquired from a simple finger stick. The Cholestech LDX is a Clinical Laboratory Improvement Amendments (CLIA) waived test. It has been certified by the Cholesterol Reference Method Laboratory Network (CRMLN). This

Findings Related to Bone Density Screening

Bone density screenings were provided to the clients using the Achilles by GE (GE Healthcare Achilles, 2009). The Achilles is a portable bone ultrasonometer that measures the bone density of the calcaneus. The results are reported as a T-score and a Z-score (GE Healthcare Achilles). Since the Achilles is a screening device that estimates the bone density of the heel, the results are utilized to predict potential future fracture risk and to determine the need for more complete bone density

Findings Related to BMI and Body Fat Analysis

The Tanita TBF-300A was used to perform body composition analysis including body mass index (BMI) and percent body fat (PBF) on the clients based on the bioelectrical impedance analysis method to determine body composition by sending a low-level, safe electrical signal through the body. The instrument measures the strength and speed of the electrical signal passing through the body and uses this information to calculate various body composition parameters.

When BMI was taken into account, 61.9%

Discussion of Results

Hypertension, hyperlipidemia, diabetes, osteoporosis, and obesity are chronic diseases that afflict a large number of Americans, including women. For example, the 2001 to 2004 prevalence of hypertension in adults in the United States is 26.7% among both sexes and 26.6% among females. Hypertension incidence has increased since 1988 to 1994 where the prevalence of hypertension was 21.7% among both sexes and 20.0% among females (National Center for Health Statistics, 2007). Comparable data was

Clinical Implications

The use of a mobile unit to deliver screening services to low-income neighborhoods addresses two potential barriers to clients' attitudes toward such a program. First, the location is one in which residents feel familiar and hopefully comfortable. Furthermore, the outreach was connected to a neighborhood church, traditionally seen as a safe haven with a reputation for serving others. This sense of being a safe haven fosters a positive, trusting client–provider relationship that is the basis for

Future Directions for the Project

Future directions include increasing collaboration to expand services to include wellness and chronic disease management. The obvious choice in seeking another collaborator was the neighboring school of nursing that operated an academic wellness and chronic disease management nursing center with community sites in the same Pittsburgh neighborhoods served by the mobile health van project. The community outreach sites established by the school of nursing faculty to serve the elderly closely

Funding and Sustainability

Historically, partnerships and collaborative agreements have been described as essential elements to survival of academic nursing centers (Trofino et al., 2000). Seeking a collaborative and interdisciplinary partnership has become an essential strategy toward sustainability of the NMWC, as it also is for the mobile van project. The idea of using data to define collaboration for preventive health care of women is in place for both projects.

Securing funding to sustain projects is always a

Summary

Inner-city neighborhoods and declining small towns are home to many of society's marginalized individuals. Nurses need to be creative to reach those most at risk, especially aging women and women who often are the initiators of health-related activities for their families. Delivering screening and follow-up services in trusted community settings is enhanced markedly by collaboration and partnering with other health care providers.

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