One of the widely used services in the health care sector is the implementation and assessment of interventions which aim to solve problems of social policy. Some of the areas focused on by institutions that have already been proven to lead to adverse health consequences include education, transportation, and even housing (Craig, et al., 2012). Interventions focused on public health aim to prevent illnesses, prolong life, and promote health among a group of individuals or a whole population. It is different from clinical and medical interventions because it focuses on the health status of a population while clinical and medical interventions deal with the prevention and treatment of illnesses and diseases of individuals (Lorgelly, et al., 2010).
Since some interventions focusing on public health are naturally complex, programmatic, and dependent on context, evidences and documents supporting their effectiveness should be properly assessed to cover the intervention’s complexity (Rychetnik, 2010). Health prevention programs uses economic evaluations to help in decision making activities and allocation details. The term economic evaluation refers to the comparative analysis and evaluation of the alternative choices and courses of action involving both health care costs and health care consequences. Some of the health programs that utilize economic evaluations include vaccinations, screening procedures, and even health promotion activities. However, despite the current acceptance of this evaluation method, challenges and short comings still exist. Some of these weaknesses include the need for additional reporting space because economic evaluations require details for items such as resource use, cost, and results of cost effectiveness. Thus, it is necessary that editors and reviewers use quality assurance mechanisms to ensure the validity and quality of the evaluations conducted (Husereau, et al., 2013).
One of the most commonly known high-risk population include the elderly patients at home (Stanley, 2010). They experience numerous medical inaccuracies and adverse health outcomes because of their inability to leave home and stay homebound (Baker, 2016). Some of the health conditions that they experience include mental disorders (like dementia and depression), oral disease, food insecurity which eventually leads to diabetes, hypertension, and asthma, and falls (Feeding America, 2015; Qiu, et al., 2010; Griffin, et al., 2012). To address and solve these health concerns, appropriate health care interventions and programs are implemented and evaluated by various health professionals and health institutions.
Individuals experiencing poor dental health visit physicians rather than dentists. To address this concern, innovative and improved health care models should include various oral expertise and oral health care services since homebound elderly patients have a high risk of acquiring multiple health conditions. However, before the implementation of oral health intervention programs, data on the oral health status of homebound elderly patients should be assessed first. Upon the assessment of the community’s health status, one effective intervention is teaching elderly patients and primary health care practitioners about the effectiveness of the chemical fluoride when it comes to the prevention of oral diseases as well as the common oral diseases affecting the elderly. Access to basic preventive services should also be explored. Some of these preventive services include provision of fluoride varnish in health centers, free oral checkups for homebound elderly patients, and access to different restoration services. Additionally, since there is an inadequacy of dental practitioners who specialize in geriatrics, training of dental hygienists to take over a geriatric dental practitioner positions should be considered. Lastly, because of the fact that homebound elderly patients experience high level of untreated oral diseases, the addition of oral care to the medical health services available for the elderly should be considered. Since majority of the elderly individuals do not have access to dental benefits, the addition of dental benefits for the elderly can greatly reduce the prevalence of poor oral health and oral diseases (Griffin, et al., 2012). To evaluate these interventions, some of the outcomes to be measured include oral health literacy of health care providers, elderly, and the caregivers. The outcomes can be measured using the Rapid Estimate of Adult Literacy in Dentistry (REALD) or the Test of Functional Health Literacy in Dentistry (ToFHLiD). These health literacy tools allow recovery of data that can show the probability and levels of risk of individuals. Aside from oral health literacy, other measurable outcomes include prevalence of homebound elderly individuals with poor oral health, prevalence of elderly individuals who utilized dental benefits and other oral health care services (Dickson-Swift, 2014).
Another health concern among elderly patients include mental illnesses such as depression and dementia. To address this concern, several interventions have been developed over the years. One intervention is the provision of pharmacotherapy as well as psychotherapy among elderly patients to help them cope up with their mental conditions such as feelings of isolation, impairment, and depression. Since institutions which specializes on the provision of mental health services are generally inaccessible and costly, it is better for health care institutions to collaborate with other aging services networks when dealing with the provision of adequate and effective mental health services among homebound elderly patients. To be able to efficiently and effectively identify the mental health status of homebound elderly patients, the Patient Health Questionnaire-9 and Brief Symptom Inventory-18 were developed. This tool is an effective and efficient screening tool for the symptoms and diagnosis of depression. Upon the assessment of the mental health status of elderly patients, different psychosocial interventions must be implemented for the treatment of depression. These psychosocial interventions include therapies which focus on behavioral, problem-solving, interpersonal, reminiscence, and cognitive. Another intervention includes problem-adaptation therapy which is a program in collaboration with different agencies (Choi, et al. 2013). Some of the outcomes to be measured to evaluate the effectivity of this intervention is the prevalence of mental illness among homebound elderly before and after the implementation of the intervention, incidence of the different symptoms associated with mental illnesses, and the risk of the development of the disease among elderly individuals who participate in the intervention and those who do not (Thornicroft & Slade, 2014).
Since food insecurity is also a problem among homebound elderly patients, health interventions and programs have been established to help in the improvement of the health outcomes of elderly patients with food insecurity. To help in the reduction of elderly patients who are food insecure, the home-delivered nutrition services was developed by the older Americans Act. Included in this act are numerous nutrition services to help improve the health outcomes of elderly individuals. One of the activities included is the provision of home-delivered meals to food insecure elderly. Based on studies, home-delivered meals have been reported to have significant positive effect on the nutrition and diet of homebound elderly. It has been established that home-delivered meals helped increase food intake, improve diet quality, and reduce food insecurity along with nutritional deficiencies. For the evaluation of this intervention, the outcome measures to be considered include the nutrient and food intake of the elderly individuals. Other patient-centered interventions that can be measured to assess the intervention include death due to the disease or disability, discomfort brought about by the individual’s health condition, dissatisfaction, and dollars used for health care services. These outcomes were measured using dietary recalls and food diaries of elderly patients or caregivers, anthropometric measurements (weight, height, and body mass index), blood tests, and nutritional risk assessments. (Campbell, et al., 2015).
Lastly, the high incidence of falls among homebound elderly have also been considered for the development of interventions. Since it is one of causes of mortality among homebound elderly patients, it has been linked with compromised bodily function as well as early admission of elderly patients to long-term care facilities. One of the best interventions for this health risk is the provision of an environment which decreases the prevalence of falls among the elderly. It is also best if they are assessed bases of their activities, and physical status. Since homebound elderly limit their activities at home, it is important to make their home fall proof. Aside from this, caregivers and relatives should also be educated about the possible ways to help prevent falls. Brochures and visual aids can be utilized to ensure that the elderly, caregiver, and even their relatives are knowledgeable about the different ways to prevent fall prevention. For this intervention, the outcomes that can be measured include the physical status of the elderly such as stamina, gait, balance, muscle coordination, and cognition. These outcomes can be measured using Falls Efficacy Scale, 30-second chair stand test, Timed Up and Go, and the GEM Environmental Assessment. The prevalence of falls can also be obtained using a Fall Interview Schedule (Gardner & Snow, 2014).
The development of these interventional programs allowed me to appreciate the importance of public health interventions and programs. It also showed me the essence of prevention as an effective strategy to minimize and reduce the prevalence of health risks as well as the morbidity and mortality of patients. Along with this, I was able to realize that interventions can help in the improvement of the health outcomes of patients. By knowing these, I will be able to help in the provision of various health programs and interventions that can greatly impact the health status of a whole population.
References
Baker, B. (2016). Medicare clarifies its definition of ‘homebound’. ACP Internist. Retrieved from http://www.acpinternist.org/archives/2001/06/q&a.htm [Accessed on 22 Mar 2016].
Campbell, A.D., Godfryd, A., Buys, D.R., and Locher, J.L. (2015). Does Participation in Home-delivered Meals Programs Improve Outcomes for Older Adults?: Results of a Systematic Review. Journal of Nutritional
Choi, N.G., Sirey, J.A., and Bruce, M.L. (2013). Depression in Homebound Older Adults: Recent Advances in Screening and Psychosocial Interventions. Current Translational Geriatrics and Experimental Gerontology Reports 2(1): 15-23.
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., and Perricrew, M. (2012). Developing and evaluating complex interventions: the new Medical Research Council guidance. Commentary International Journal of Nursing Studies 50: 585-592.
Dickson-Swift, V., Kenny, A., Farmer, J., Gussy, M., and Larkins, S. (2014). Measuring oral health literacy: a scoping review of existing tools. BioMed Central Oral Health 14: 148.
Feeding America. (2015). Spotlight on Senior Health: Adverse Health Outcomes of Food Insecure Older Americans. United States: Feeding America.
Gardner, D. and Snow, L. (2014). Occupational Therapy Interventions for Homebound Older Adults. Student Perspectives in Occupational Therapy. Retrieved from http://spin-ot.com/all-articles/2014/4/28/an-occupational-therapy-intervention-for-homebound-older-adults [Accessed on 22 Mar 2016].
Griffin, S.O., Jones, J.A., Brunson, D., Griffin, P.M., and Bailey, W.D. (2012). Burden of Oral Disease among Older Adults and Implications from Public Health Priorities. American Journal of Public Health 102(3): 411-418.
Huseareau, D., Drummond, M., Petrou, S., Carswell, C., Moher, D., Greenberg, D., Augustovski, F., Briggs, A.H., Mauskopf, J., and Loder, E. (2013). Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. BioMed Central Medicine 11 (80).
Lorgelly, P.K., Lawson, K.D., Fenwick, E.A., and Briggs, A.H. (2010). Outcome Measurement in Economic Evaluations of Public Health Interventions: a Role for the Capability Approach?. International Journal of Environmental Research and Public Health 7(5): 2274-2289.
Qiu, W.Q., Dean, M., Liu, T., George, L., Gann, M., Cohen, J., and Bruce, M.L. (2013). Physical and Mental Health of the Homebound Elderly: An Overlooked Population. Journal of American Geriatric Society 58(12): 2423-2428.
Rychetnik, L. (2010). Is an ‘evaluation jigsaw’ a feasible way forward?. Journal of Public Health 32(1): 10-11.
Stanley, J.M. (2010). Advanced Practice Nursing: Emphasizing Common Roles. Philadelphia, PA: F.A. Davis Company.
Thornicroft, G. and Slade, M. (2014). New trends in assessing the outcomes of mental health interventions. World Psychiatry 13(2):118-124.
