Every day millions of Americans with complex medical problems struggle with the rising cost of healthcare, the complicated health insurance market, and the shrinking pool of medical professionals. These at-risk populations across the country — the working poor, elderly, homeless, racial and ethnic minorities, and uninsured – are at an increased risk of developing severe medical problems due to substandard healthcare, poor health literacy, and a higher rate of communicable diseases.
Despite nationwide efforts to provide services to offset health disparities, healthcare providers, medical researchers and government agencies are continuing to search for solutions. At the forefront of leading changes to assist the medically vulnerable are Doctors of Nursing Practice (DNPs), nursing specialists who focus on improving outcomes for patient care and population health.
DNPs are advanced practice registered nurses (APRNs) who utilize clinical expertise, data-driven decision making, and inter-professional collaboration for leadership and policy changes. Through Duquesne University’s online DNP degree program, graduates learn the skills to transform clinical research into real-world practice and make a difference as healthcare-policy leaders.
Vulnerable Populations Across the United States
At-risk populations live in both urban and rural areas, often in impoverished communities with neighbors facing similar situations. They do not have access to stable healthcare because it is not available or too expensive.
In some cases, they have untreated chronic medical conditions, such as diabetes or high blood pressure, or untreated infectious and communicable diseases, such as the human immunodeficiency virus (HIV) that causes AIDS. In other cases, they have unaddressed mental health conditions, such as bipolar disorder or major depression, that have a negative trickle-down effect on themselves and their families.
They have trouble maintaining independence, a lack of reliable transportation, and poor communication skills. Their health problems intersect with social problems, such as illiteracy, homelessness, and poverty.
Steps to Reducing Risks to Vulnerable Populations
In 2010, the U.S. Department of Health and Human Services launched its Healthy People 2020 initiative, a 10-year project aimed at improving health outcomes. Among the goals is to boost access to quality healthcare services across the nation. At the same time, an American Hospital Association (AHA) task force explored the ways hospitals, often used as healthcare access points, can further assist patients. The two organizations found strategies to accomplish policy-level changes for the goal of health equality, as follows:
1. Improve social determinates to promote healthy living
Healthy living depends on factors that happen throughout a lifetime. The most common health-related social challenges include lack of employment, food and housing insecurity, poor social support, and illiteracy. Healthcare providers must address these social determinates of health through a series of steps that include screening patients and providing proactive services, the AHA found.
2. Utilize a global budgeting national healthcare system
The AHA said replacing the current fee-for-service healthcare system with a global budget system would allow the federal government to determine the total sum that is available to reimburse all medical facilities over a fixed period. Proponents of a global budgeting system said it would control healthcare spending.
3. Provide access to virtual healthcare
Virtual healthcare provides immediate, around-the-clock access to medical advice and treatment. Providers can examine and diagnose patients and perform high-tech monitoring. Proponents said virtual healthcare could be used to improve the management of chronic diseases, treat minor illnesses, support primary care access, and provide improved referrals to specialists for more effective treatment.
4. Match hospitalization needs to surrounding communities
As outpatient medical services become more common, medical facilities must look to ways to reduce inpatient bed capacity. Fewer hospital beds could drive down medical costs in local communities, the AHA said.
5. Support community-appropriate healthcare access
Rural hospital health clinics, frontier-area health services, and partnerships with Indian Health Services (IHS) offer targeted medical assistance. For rural communities, targeted services mean integrating care between rural hospitals and local health centers for medical, behavioral, and oral health. Frontier-area health services must address healthcare access challenges for those living in extreme geographic isolation. IHS strategies include developing partnerships with non-IHS providers for specialized services to Native Americans and Alaska Natives.
Barriers to Serving Vulnerable Populations
The leading barrier to healthcare is the high cost of medical services and medical insurance. Despite regulations aimed at reducing healthcare costs, insurance coverage remains financially out of reach for many people. In the first quarter of 2017, the percentage of U.S. adults without health insurance was 11.3 percent, up from 10.9 percent in the previous quarter, a Gallup poll found.
The federal Office of Disease Prevention and Health Promotion also found a lack of medical services nationwide and factors such as age, race, gender, and ethnicity negatively impact access to health services. The lack of health literacy, or the capability to understand and follow through on basic healthcare information, has also crippled vulnerable populations.
Further exacerbating the problem is the forecasted nationwide shortage of more than one million nurses by 2022 and some 43,000 primary-care physicians by 2030, mainly due to retirement.
DNP Role in Serving Vulnerable Populations
A Doctor of Nursing Practice degree prepares APRNs with the necessary skills to implement evidence-based interventions and improve health outcomes for at-risk populations. DNP coursework includes healthcare policy, changes in healthcare framework, social justice, and global health perspectives. The DNP program at Duquesne University focuses on creating leaders who will improve healthcare for the general population through policy changes and clinical practice.
DNPs work with communities to focus on prevention and health promotion. They “are prepared to design, influence, and implement health care policies that frame healthcare financing, practice regulation, access, safety, quality, and efficacy,” the American Association of Colleges of Nursing (AACN) said.
“Moreover, the DNP graduate is able to design, implement, and advocate for a healthcare policy that addresses issues of social justice and equity in healthcare. The powerful practice experiences of the DNP graduate can become potent influencers in policy formation,” the AACN said.
The AACN designated the DNP degree to be a terminal degree, meaning it is the highest academic track for clinical nursing. The DNP program of study was created as a way to guide APRNs to administrative and leadership positions.
About Duquesne University’s Online Doctor of Nursing Practice Degree Program
Duquesne University’s Online Doctor of Nursing Practice program allows APRNs with master’s degrees to complete coursework while continuing to their careers. Students working toward a DNP degree are trained to manage the evolving and emerging roles in nursing. The programs build on skills to prepare graduates for a comprehensive understanding of the field and strong leadership and clinical skills.
Public Health Emergency, “At-Risk Individuals, Behavioral Health & Community Resilience (ABC)”
HealthyPeople.gov, “Access to Health Services
American Hospital Association, Task Force on Ensuring Access in Vulnerable Communities Report”
HealthyPeople.gov, “Social Determinants of Health”
Harvard Business Review, “One Hospital’s Experiments in Virtual Health Care”
GALLUP.com, “U.S. Uninsured Rate Edges Up Slightly”
The American Association of Colleges of Nursing