The writer will have to read each of this articles and react to them by
commenting, analyzing and supporting with relevant articles. The writer will
have to read carefully before giving constructive comments on the article. The
writer should write a one paragraph of at least 150 words. APA and in text
citation must be use as each respond to the two articles must have in text
citations. The writer will have to use an article to supports his comments in
each of the article. Address the content of each article below in a one
paragraph each, analysis and evaluation of the topic, as well as the integration
of relevant resources.
What is the feasibility of implementing the practice change in your clinical setting?
I personally believe that the feasibility of implementing the practice change within my clinical
setting would be highly likely. There is great teamwork and accountability among the
practitioners and other primary care providers that I have met. There is already great
documenting concerning chronic conditions and mental illness. So, this is exciting.
What are the potential barriers to making the change?
Potential barriers to initiating the change within my clinical setting would have to be
communicating the implementation of my proposal among other specialists that are involved in
the patient’s care. If it is not being assessed and/or documented that the patient is beginning to
show or is showing signs and symptoms of depression…the other parties will not be abreast on
how effective the treatment plan is. The key to this proposal is ignition on a very strong, solid
built foundation that pertains to education, proper treatment, and proper communications. You
will have to communicate effectively with specialists and/or psychiatrist to have the most
effective outcome. Another barrier that I have noted is that we are in a rural area, this is a benefit
because the community is small and everybody knows everybody. Additionally, located is 2
mental health facilities, but none that focus specifically on depression and chronic conditions.
There is also limited amount of research that is strictly aimed at depression and chronic
Sawyer, Gale, and Lambert (2006) lists the same barriers that I mentioned above and also
mentioned insurance coverage as being a barrier. It is simply unrealistic within a rural area to
expect every individual to have insurance coverage. Those that do are on a fix or limited
income. It is true that we strive to meet the basic needs within life, however, when you don’t
have money to buy food…..you are sure not going to spend it on medications. This is driven to
review the general age of these suffers. This will help me focus in on the cost of providing care
and address and education how the caregivers feel about the diagnosis and implementation.
What risks are involved in making the practice change?
Risks that are involved in making the practice change is that the change will not be received
well, therefore, will not initiate well, and then we are back to square one. We have to take out on
a strong note to get stronger as we grow in our knowledge of the risks and benefit related to my
proposal discussion. Additional risk is lack of support, follow-up, and follow through.
What are the benefits of making the practice change?
The benefits of making the practice change would be that more individuals are getting their
needs met and more providers are working together in a productive manner. I am praying that
this proposal will show the benefits of further research into the matter and bring further
awareness of the importance of addressing this matter. This could potentially save us millions of
dollars that are currently associated with treating depression. We must note that along with the
physical chronic conditions that depression is a chronic mental condition.
Does time and cost justify change toward improving clinical outcomes?
Yes, time and cost justify change toward improving clinical outcomes, however, their should be
emphasis placed on the ethical considerations associated with fair and effective treatment for all.
Though, there is a potential to save a lot of money, it is more important to ensure that we as
consumers and as primary providers continue to advocate and strive for growth. If not, all the
efforts would be in vain and the implementation of the proposed changes would cease before we
could even get started.
Which governing entities will need to grant permission for you to make a practice change? Will
your work need to be approved by an Institutional Review Board (IRB)?
Governing entities that would need to grant permission for approved to try my proposal would be
the health care administration, practicing physicians, the ethics committee, and affiliated mental
health specialists. Additionally, the patients must be willing to comply and report as they are
instructed by their primary care provider. Yes, I my work would need to be approved by a IRB.
I would love for it to be approved so that it would have some validation and be accepted among
other health care professional and entities. Stanford Medicine (2016) supports my argument
about having governing entities on board and also touch base on a previous argument concerning
the effective use of nurse practitioners to their full scope of practice. Another barrier is that there
is a lack of primary care providers within rural areas to provide the care that the patient needs.
The United States Department of Health and Human Services (2016) explains that IRBs must
approve proposed non-exempt research before involvement of human subjects may begin,
therefore, we must respect the ethical considerations involved while at the same time providing
I look forward to your responses. I am eager to have your input. I have continued to build upon
my resource materials for my proposal. I think that I will more than enough informaiton to make
my argument. We will see how it turns out.
Sawyer, D., Gale, J., Lambert, D. (2009). Rural and frontier mental and behavior health care:
Barriers, effective policy strategies, best practices.
Stafford Medicine. (2016). Healthcare disparities and barriers to healthcare.
Unites States Department of Health and Human Services. (2016). Institution review boards.
Include the one paragraph comments hear using a pear review article to support your
comments. Also include in text citations in APA.
- What is the feasibility of implementing the practice change in your clinical setting?
I think this practice change is highly feasible. The research and ground work has been done with
the project and there would be minimal work for the other providers to do. Data collection can be
gathered on the current EHR. There wouldn’t be a need for extra personnel or overtime work.
Space is available to do group sessions at the current clinic.
- What are potential barriers to making the change?
I think potential barriers include attendance and lack of provider referral. Currently, with a lack
of a regular educator, we don’t refer many people because it is very difficult to get the educator
to come and more than one patient to show up all at the same time. There is also the barrier of
getting patients to attend because of the rural location of most patients and sometimes a lack of
transportation. Potential solutions to this is to have our patients do the education at the time of
their office visit and let them know their office visit will be expanded; also by recommending it
as part of their treatment and pushing a little harder to have them do it will make them more
likely to do it.
Potential risks include implementing the program and unable to get attendance for the program.
- Benefits are twofold. Benefit to the office includes increased income from billing. Medicare
reimbursement for the first hour is 48.46-68.11 per 30 minutes; then reimbursement rate goes to
12.05-18.43 per 30 minutes for a maximum of 9 more hours. (DNCC, 2013). If 10 patient are
enrolled in the program, this averages to 3128.20-4679.60 of reimbursement for the office.
Its known that DSME can help reduce patient expenses on medications, acute complications, and
chronic complications. A 1% reduction in mean A1C levels is associated with a risk reduction of
21% for death related to diabetes; 14% for MI; and 37$ for microvascular complications (Center
for Health Law & Policy Information, 2015). With the evidence showing that DSME will help
improve patient education and decrease A1C levels, this is a great benefit for our patients.
- Does the time and cost justify change toward improving clinical outcomes?
One study showed an average savings of $135/month among benefeciaries that did DSME
(DNCC, 2013). There will be a cost of $800.00 for AADE certification and hourly wage of an
educator although this would not be overtime for anybody that did this because of the amount of
hours regularly worked. In 2012, diabetes cost $245 billion with $176 billion in direct medical
cost and $69 billion in indirect costs related to unemployment. Medical expenditures for
diabetics is also 2.3 times higher than nondiabetics; $13,741 versus $5,853 (Center for Health
Law and Policy Information, 2015). With the potential to achieve better outcomes for patients
and increased revenue for the clinic, the cost and time are justified towards improving clinical
- Which governing entities?
There are no particular entities at this clinic. This paper and the evidence presented would be
submitted to the administrator who would present it to the providers at the clinic. If they would
be interested in pursuing the project, I would be able to present the project to the providers in the
Center for Health Law and Policy Information. (2015). Reconsidering cost-sharing for diabetes
self-management education: recommendation for policy reform.
DNCC (2013). Diabetes Self Management Education/Training Reimbursement Toolkit.
Include the one paragraph comments hear using an a pear review article to support your
comments. Also include in text citations in APA.