Preventive Measures, Diabetes And The African American Community

Introduction

One of the pressing issues in medicine is that people do not go their primary care physicians proactively. As a result we have seen a continuous rise in health problems and a continuous decline in good health. Statistics confirm that the lack of resources available to people are a major contributing factor in this epidemic. This issue can not be ignored. The U.S. Department of Health and Human Services (HHS) had to take notice. They completed several studies to help determine where some of the problems are and how they can be rectified or modified at least. The conclusion was that preventive practices were overall the determining factor in circumventing a lot of health concerns becoming problematic and in some cases fatal.

Another area of concern for this modern way of concern from the physician's perspective was making sure that they are able to serve and meet their patients' needs. According to the Agency for Healthcare Research and Quality (AHRQ, 1996) at one point there was a "growing scope of and complexity of medical information, physicians are finding it increasingly difficult to stay abreast of current medical knowledge. This growth in physician-targeted medical information is evident in the proliferation of subspecialty journals, the growing presence of clinical-economic studies, and the escalating marketing efforts of a range of actors. Policymakers and managed care providers have entered the fray, vying to affect physician practice with an expanding array of clinical guidelines, profiling, and utilization review.The rapidly increasing availability of information has coincided with fundamental change in the structure and delivery of care...Access to medical information and dissemination of findings is central to the management of costs and clinical outcomes." Even physicians had to take notice in the way they handled their practices. Practicing preventive medicine is at minimum dually beneficial: it heightens the patient's awareness of ways to obtain and maintain good health but it also serves as a benefit to the government and its entities as a way to monitor any emergent trends that have the possibility to incur unanticipated expenditures.

One last point is the need to focus on certain communities. It is has shown through scientific study that certain communities are more prone to certain diseases compared to others such as diabetes. The National Institute of Diabetes and Digestive and Kidney Diseases (NDEP, 2005) states that "African Americans are twice as likely as whites of similar age to develop type 2 diabetes..." They also state that "3.2 million African-Americans...have diabetes, one third of who are undiagnosed." It is hard to imagine the cost of treatment associated with that many people being inflicting with this disease. If African - Americans were more likely to seek out preventive professional help from the medical community this diagnosis would decrease the cost associated with it as well. "Diabetes is one of the leading causes of death and disability in the United States. Total health care and related costs for the treatment of diabetes run about $132 billion annually." (NDEP, 2004))

Cost of Prevention

Cost analysis has to be a considerable factor when promoting prevention. If people only went to the doctor when they were sick and/or to find out that this "sickness" had progressed to an irreversible disease healthcare cost would skyrocket. Insurance companies and associated organizations rather pay for ways to help reduce the number of times a person becomes ill or prevent ways to have to deal with hospital costs if an illness progresses to that point. "Cost analysis studies identify the personnel and other resources used to deliver prevention services and calculate the monetary value of those resources to various stakeholders, such as society as a whole, community providers, or government funding agencies. These studies provide information about the start-up and implementation costs of a prevention program - useful information to program managers who may be considering whether to implement a specific prevention approach. Cost studies also allow program managers to address questions about the program resources (usually personnel) that contribute the most to overall costs. Answers to these questions can be useful for considering alternative resource mixtures to limit program costs." (Honeycutt, Clayton, Khavjou, Finkelstein, Prabhu, Blitstein, Evans, & Renaud, 2006)

The effectiveness (CEA) and benefit (CBA) also has to be considered when looking at these programs. The CEA compares two or more prevention approaches projecting the differences between having no program comparative to which one to select. The CBA focuses on the fiscal aspect, comparing the benefits for programs with various outcomes. "The idea is that the cost of prevention is offset by savings in future disease costs." (Honeycutt, et al., 2006)

Implementation of Prevention Programs for Certain Diseases

In a project called Steps to a Healthier US (which was funded by the HHS), 'actions steps' are outlined in a study called Prevention: A Blueprint for Action that help bring attention to underserved and susceptible populations. A few of them included:

* "To focus the attention on the long-term implications of gestational diabetes mellitus (GDM), the National Diabetes Information Clearinghouse of the NIDDK/NIH will produce a booklet. The National Diabetes Education Program's Small Steps. Big Rewards. Prevent Type 2 Diabetes campaign will also b expended to include focus on GDM." (HHS, 2004)

* "Incorporate the findings from the recently released reports on health literacy from the Institute of Medicine and AHRQ into diabetes information and communication activities." (HHS, 2004)

* "CMS should assess utilization of the new Medicare benefits (beginning in 2005) establishing coverage of an initial preventive physical exam, and diabetes and cardiovascular disease screening tests, to ensure beneficiaries are taking advantage of these service and getting the care they need to better manage their diabetes." (HHS, 2004)

Diabetes in the African-American Community

The Diabetes Prevention Program (DPP) was a major clinical trial involving 3,234 people. It was found that were at high risk for type 2 diabetes could prevent the onset of it by reducing 5 to 7 percent of their body weight and getting at least 30 minutes of exercise. Type 2 diabetes was reduced

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