Public Health Determinants and Trends

1. Abigail Gaines
Health4200
April 25, 2017
Public Health Determinants and Trends
Social Determinantsin Health:
Modernpublichealthhasrecognizedavarietyof social
determinants of health.Pickonor more,fromone of the three categories,of these social
determinantsof healthandreflectonhow it(they) mayhave influencedthe type,variety,
and/orneedforthe healthormedical servicesdeliveredatyourinternshipsite.
Availabilityofoptions for physical activity:
ThroughoutmyinternshipatHummel Physical Therapy(PT),locatedinSeneca,Iwas
able to observe avarietyof social determinantsthataffectedthe healthof numerouspatients
whoattendedthe clinicona dailybasis.While interningatHummel PT,I workedwithpatients
who’sagesrangedanywhere fromeighteenyearsoldtoeighty-fouryearsoldandeachpatient
was veryunique astowhy theywere beingreferredtophysical therapy. Eventhoughthere
were numeroussocial determinantsthatIwas able toobserve atHummel PT while interning,
the two that impactedthe practice the mostwere the availabilityof optionsforphysical activity
such as parks,sidewalks,orhealthclubs,alongwithdailyconditionsinwhichpeople live.
While workingatHummel PT,I workedamajorityof geriatricpatients.The most
commonreasonas to whythese patientsare beingreferredtophysical therapyisdue to
extreme fall riskalongwithbalance issues.Accordingtothe CentersforDisease Control,more
than one thirdof adultsagessixty-five andolderfall eachyearandtwentytothirtypercentof
those suffermoderate tosevere injuries(Gardner,2016). These injuriescanrange frombeingas
serioustoa brokenhipor arm or to somethingassmall asa bruise ora laceration.If apatient
breaksa bone,a hipfor example,itcanleadthatpatienttoexperience long-termdisabilityand

2. will therefore mightnotbe able tobe independentintheiractivitiesof daily living(ADL’s) for
much longer(Tidy,2017).
In orderto preventthe riskof fallingforelderlypatients,physical exercise isthe main
methodof preventionalongwithstrengtheningandbalancingexercises.Muscle weakness,due
to a lack of physical activity,isamajor reasonas to whyfallshappen inolderpeople.This
directlyrelatestoasocial determinantof health,inspecific,the availabilityof optionsfor
physical activity.ManypatientsthatattendHummel PTlivedinareasthatwere veryrural and
therefore theydidnothave adequate accesstofacilitieslike gymsorothertrainingplaces.
Doctors knewthatif patientwasat an increasedriskof fallingthattheyneedtoprescribe them
physical therapysothat theywouldhave aplace to go to inorder to obtainthe properamount
of physical activitydue tothe inefficientfacilitiesaroundthe community.Whenapatientbeing
seenforfall andbalance issues,the therapistswouldprescribe themmostlylegstrengthening
exercisessuchasweightedlegexercises,side-steppingalongwithotherbalance exercises,and
eitherthe stationarybike ortreadmill.If there were more facilitiesinthe community,the
patientscouldsimplygotothose placesandperformtheirexercisesata muchlowercostthan
havingto payout-of-pocketorhavingtodeal withinsurance companies.Ihave seenfirsthand
fromthe gymthat I attend,some of the same machinesthatHummel PT haslike the UBE or
Biodex machine.If all gymscouldsupplythesemachinesinadditionthe regularweighted
equipment,Ibelieve more elderlypatientscouldattendthe facilitiesinordertoimprove their
healthstatus.
The dailyconditionsin which people live:
There are manyfactors to considerwhendiscussingthe dailyconditionsthatindividuals
live in,however,Ibelieve the mostimportantfactortobe those of poor decisionmakingskills
because thisleadsmanyindividualsinneedingassistance of healthcare andmedical services.

3. Accordingto Golubic,poorlifestylechoices,suchassmoking,poordiet,andphysical inactivity
are justa fewexamplesof keycontributorsinthe developmentandprogressionof preventable
chronicdiseases(Golubic,2013).
While workingatHummel PT,manyof the youngerpatientsthatwere beingseenwere
there because of bothpreventableillnessesand injuries.Everyone knowsthatthe correctway
to liftsomethingheavyiswithyourlegsandnotyour upperbody,therefore thisisapreventable
injury.There were manymalesthatcame intophysical therapyinordertoreceive treatment
due to lowback painand whenaskedtheirmechanismof injuryitwasusuallythattheylifted
somethingheavy.The patientsknew whattheywere supposedtodo,butyetmade a poor
healthdecisionintryingtoliftwiththeirupperbodyandtheirdecisionhaditsrepercussions.
An individual’sdailyconditionsalongwithpoordecisionmakingaboutone’shealthwill
continue toimpactindividual’slives.People will continue tomake the wrongorharmful choice
due to it beingeasierthanmakingthe rightdecisionandforthe most part,those harmful
decisionswill have majorrepercussionssuchasmajor illnessesandinjuries.Educationforthese
individualsmaybe the keyinreducingthe numberof preventable illnessesandinjuries.
Organizational Behaviorand Governance:
Our healthcare systemisan interface of multiple structuresforthe organization,financing,
management,deliveryandevaluationof awide varietyof health-realtedservices.Basedonyour
classworkandyour experience inyourinternship,(a) identifyastructure,role orfuctionthat
youbelieve iscrucial tothe services(availability,quality,costeffectivenessetc.) providedat
your internshipsite.(b) howisthatstructure,role orfunctionfacilitatedby(orimpededby)
thingslike organizational culture,organizationalfunctioning,policyorlaw?(c) if you could
change the law,policy,ororganizational practicestomake the systemmore effective/efficient,
whatwouldyouchange?(d) explainwhy.
From myexperience inmyinternshipatHummel Physical Therapy,Ihave seenhow
insurance hassuch a large impacton everypatientandtheir individualized healthoutcomes.
Medicare Part B was the primaryinsurerof a majorityof the elderlypatientsbeingseenat
Hummel PT.For those whodidnot qualifyforMedicare,theyeitherhadprivate insurance or

4. paidfor visitsout-of-pocket.However,Medicare onlyhelpspayforoutpatientphysical therapy
that ismedicallynecessary.SowhenMedicare believesthata patienthasreachedanoptimal
level of functioning,theywillnolongerpayfortheirtreatmentsbecause treatmentisnot
medicallynecessary(YourMedicare Coverage).Inaddition,there are limitsonservicesreceived
fromphysical therapists,andthenare knownas“therapycaps.” For all rehabilitativeservicesin
2017, the “therapycaps” are hitwhenMedicare paysfor $1980.00 worthof treatments(Your
Medicare Coverage).There are exceptionsforindividualstoexceedthe cap,buta patienthasto
establishaneedformedicallyreasonable andnecessaryservicesintheirmedical recordalong
withhavingtoindicate ontheirMedicare claimforservicesabove the therapycapthat services
are medicallyreasonableandneeded.Forthese exceptions,the limitthatMedicare iswillingto
pay increasesto $3700.00 forrehabilitative services.Andforthe mostpart,Medicare will
continue topay itsportionabove the regularcap if twothingsare provided;the firstisthe
patient’sphysical therapisthastoprovide properdocumentationtoshow thatthe services
receivedwere medicallyreasonableandnecessary,andthe secondisthatthe physical therapist
providesserviceswere necessaryonthe patient’sclaim.
Anotherfeature of dealingwithMedicare isthe lengthyprocessthatittakesfor
Hummel physical therapytoreceive Medicare approvalsforpatientsbeingcoveredunderthis
insurance.Mostof the patientswill receivetenapprovalstostartout theirvisitswith,butthis
numberisquicklyreacheddue tothe patient’scomingintwotothree timesa weekfortheir
condition.Thisprocesshinderspatientsfrombeingable toattendphysical therapyonaregular
basisdue to themnot havingmore approvalsandwantingtopay out-of-pocket.
If I were able tochange the policiesregardinginsurance,Iwouldallow all servicestobe
coveredunderMedicare alongwithdisregardingthe needforpatientapprovals.If approvals
were notregulated,itwouldallow the office manageratHummel PTto participate inother

5. aspectsof her jobrather thansittingona phone withMedicare servicesinordertoobtain
approvalsforpatients.Ialsobelievethatapprovalsshouldbe disregardedbecause each
individualhasthe rightto attendphysical therapyinordertobettertheirhealthandnothave a
delayintheirexercisesortreatment.Ibelieve thatthe decisionsof apatient’shealthshouldbe
inthe handsof the physical therapistorproviderof healthcare andnotleftupto an insurance
companythat can not physicallysee the healthof the patientbeingtreated.If the barriers
mentionedabove were eliminated,patientswill benefitfrommore physicaltherapyvisitsand
will alsoincrease theirhealthstatus.
Concentration-SpecificQuestion:
Describe asituationorindividual thatyouencounteredduringyourinternshipthat
exemplifiesprofessionalism,andexplainhow/whythisistrue.Whatdidyoulearnfromyour
internshipthatcanhelpyouimprove yourownprofessionalism?
Throughoutmy experienceinterningatHummel PT,Iworkedwithtwophysical
therapists,Jeff Hummel andKristi Haley.Itisvital,inanyhealthcare setting,tomaintainahigh
level of professionalism, responsibility,andrespectforothersinvarioussituations,andbothJeff
and Kristi representedthese characteristics.Iworkedcloselywith Kristi, asshe wasmy
preceptorformy internship.Kristi isthe image of someonewhoportraysprofessionalism
regardlessof the circumstance.Wheneveradifficultpatientwasbeingtreated,she wouldbe
mindful of herwordsandhave a positive attitude inordertogive the patientthe greatestcare
she was able to.
Kristi alsodemonstratedhow importantitwasto getto know each andeveryone of her
patients.Evenif she wasbeingpushedfortime,she alwaysmade itapointto sitdownand have
a fewminutestotalkto the patientabouthis/herconditionorevenjustasimplyquestionabout
the patient’sfamilyorhobbies.There wasone instance inwhichKristi toldme aboutandit
registeredwithme howimportantitwastotake the time,evenif itisa few minutestotalkto

6. the patient.There wasa patientwhohad knee surgeryandshe had beencomingintophysical
therapyfora fewmonths.Once daythe physical therapistassistantcalledKristi overandtold
herthat the patienthadbeenhavingpainthe backof her knee.Kristi saidshe wasswamped
that theydaywithtons of patientsbutshe wentto the patientanyway.She thenexaminedthe
patientandcalledthe physicianandthenproceededtotell the patienttogothe emergency
room.The nextday,that patientcalledbackandtoldKristi thatthe doctorhad found a blood
clot inherknee andthat was whatwas causingherpain. Thiswill foreverstickwithme because
if Kristi hadnot takenjusta fewminutestocheckonthe patient,the patientcouldhave had
seriouscomplicationsfromthe bloodclotnotbeingremovedassoonaspossible. Sinceeach
patientwasdifferent,Kristi hadtotailorhisor herexercise regimentoeachpatient.Inorderto
do this,she hadto spendtime witheachpatientandwatcheach exercise tosee if the patient
was improvingorif theywere still havingdifficultieswithanyexercise.
My internshiptaughtme a greatdeal aboutwhat islike toact withprofessionalism.By
beingaroundrespectful,professional,andresponsibleindividuals,Ilearnedjusthow important
isto representall of these characteristics.BywatchingbothKristi andJeff interactwithpatients
indifficultsituations,Ilearnednotonlyhow tointeractbut alsohow to communicate to
patientseffectively.Italsotaughtme that no matterhow busyI may be in the future,thatI
needtotake the time tocheck eachpatientmyself inordertoavoidfuture complications.Itis
alsoextremelyimportanttobuildpersonalrelationshipswitheachpatientinordertobuilda
sense of non-judgmentalcommunicationbetweenpatientandprovider.Ihope topossessall of
these keyqualitieswhenIbecome aphysical therapistinthe nearfuture toprovide mypatients
withthe upmostqualityof care that I am able to.

7. References
Gardner,Kelly.“Balance andFalls.” APTA. N.p.,9Sept.2016. Web.23 Apr.2017.
http://www.apta.org/BalanceFalls/.
Golubic,Malden,Dr.“Lifestyle Choices:RootCausesof ChronicDisease.” Cleveland Clinic. N.p.,
14 Jan. 2013. Web.23 Apr.2017.
https://my.clevelandclinic.org/health/transcripts/1444_lifestyle-choices-root-causes-of-
chronic-disease.
Tidy,Colin,Dr.“Preventionof Fallsinthe Elderly.InformationonElderlyFals.” Prevention of
Falls in the Elderly. Information on Elderly Falls | Patient. Patient.Info,24Mar. 2017.
Web.23 Apr. 2017. https://patient.info/health/prevention-of-falls-in-the-elderly-leaflet.
“Your Medicare Coverage.”Medicare.gov –The OfficialU.S.GovernmentSiftforMedicare. N.p.,
n.d.Web.24 Apr. 2017. https://www.medicare.gov/coverage/pt-and-ot-and-speech-
language-pathology.html.