Week 14: Interview and Strategies for increasing consumer participation in the policy process

Since it is the last week for the healthpolicy blog, I will finally post my interview. A couple students in our program and I interviewed Sara Marlow FNP, Public Health Nurse at the AANP Health Policy Conference in Washington DC. The reason we chose to interview her was during a conversation at lunch with Dr. Angela Golden, Immediate Past President of AANP who is from Arizona. Dr Golden suggested Sara Marlow because she was a 2015 Health Policy Fellow in Washington DC and serves on the Health Policy and Practice Committee for the California Association for Nurse Practitioners and ANA. She can be followed on twitter at @MissFNP. There were are few students who interviewed her so hopefully this interview is not repetitive for you.  We asked her the following questions:

What characteristics are essential to influence change within the healthcare sector?

Passion and subject knowledge, people will seek you out if they know you are knowledgeable in a certain area. Being objective, professional and respective and understanding that not everyone has the same views.

What is the biggest proponent for change in healthcare?

NP’s in primary care is where healthcare is going. NP’s in primary care make sense and we need to education individuals about NP’s and what we do as well as the research that shows the impact of NP’s. The increasing numbers of NPs in leadership positions in various organizations.

 Challenges when advocating for change?

Nurses face many challenges: public perception regarding what nurses in general do and the actual nurse practitioner role. The general public has a strong perception of nursing and views it as a trusting profession, but public perception still tends to view nurses as the “assistant” and cannot see us in a provider role.

Nursing organization tend to have less money than physicians (AMA) so nurses have less visibility then physicians.

Tips and tricks for being heard during healthcare/nursing advocacy?

Speak out-if you are passionate about something then take a stand. Start a healthcare policy group in your university or organization. Keep educated on current news and changes regarding NP issues

So based on Sara’s thought and this weeks topic of “Strategies for increasing consumer participation in the policy process”  I think passion is key.  Having excitement and passion about a health policy topic will help get our patients, the public, and consumers behind it.  Additionally Sara likes to use social media such as twitter for topics she is passionate about.  I think we need to use social media like Facebook, twitter, instagram to help get consumer participation.  After the health policy conference I started following my local, state and national politicians on Facebook.  I find this very helpful to see what they want and need support  for.  So for all those fellow students who don’t like social media, I think we will need to utilize it if we want a future in health policy.  Social media is  a way to get consumer participation.

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Week 13: Sustaining innovative environments

My clinical DNP project revolved around sustainability. To achieve sustainability it was through a process improvement project implementation.

According to Longest (2010):

“The consequences of policies- including consequences for those who formulate and implement the polices and for the individuals, or organization, and interest groups outside the process but affected by the policies cause people to seek modifications. This occurs continually throughout the life of a policy. At a minimum, individuals, organizations, or interest groups who benefit from a particular policy may seek modifications that increase or maintain these benefits over time.”

In order to sustain a policy, a policy must constantly go through analysis, scrutiny, and modifications. A healthcare policy can be put into effect but once that effect takes place modification need to be made to optimize the policy in a certain environment, with a specific population, or under certain legislation.

My topic to combat antibiotic resistance will have to go through analysis after the “President issued Executive Order (EO)13676: Combating Antibiotic-Resistant Bacteria, the National Strategy on Combating Antibiotic-Resistant Bacteria and addressing the policy recommendations of the President’s Council of Advisors on Science and Technology (PCAST)’s report on Combating Antibiotic Resistance; and the President as set more than $1.2 billion to go towards combating antibiotic resistance (whitehouse.gov, 2014).” This is a lot of money to waste and lives at risk if the strategy for combating antibiotic resistance is not optimized. The National Action Plan for combating antibiotic resistance will be utilized over the next five years. I believe five years is a sufficient amount of time to optimize a strategy.

 According to Burwell, Vilsack, and Carter (2015), “The NAP is a comprehensive effort that will require the coordinated and complementary efforts of individuals and groups around the world, including public- and private-sector partners, health care providers, health care leaders, veterinarians, agriculture industry leaders, manufacturers, policymakers, and patients. Working together, we can turn the tide against the rise in antibiotic resistance and make the world a healthier and safer place for the next generation. “

There are many groups that will be needed to combat this issue. It will be the leaders of these groups that according to Longest (2010), “Leaders can devise and assess possible new solutions or alternations to existing ones through the operational experience of the organization and groups they lead.” It will be the responsibility of the leaders (as mentioned above) to optimize and modify the national strategy plan once the strategy is operational.

Additionally Longest (2010) stated, “The modification phase is extremely important to the health policy making process because it provides continuing opportunities for the performance of policies and their consequences to stimulate modifications.”

Burwell, M. S., Vilsack, T., & Carter, A. (2015, March). Our plan to combat and prevent antibiotic-resitant bacteria. Retrieved from https://www.whitehouse.gov/blog/2015/03/27/our-plan-combat-and-prevent-antibiotic-resistant-bacteria

Longest, B.B. Jr. (2010). Health Policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

The White House. (2014). National strategy for combating antibiotic resistant bacteria. Retrieved from http://www.whitehouse.gov/sites/default/files/docs/carb_national_strategy.pdf

Week 12: Healthcare financing

The US federal government is the number one supporter for combating antibiotic resistance. President Obama makes this issue a priority in the 2016 Budget.   Antibiotic resistance and antibiotic resistant infections are a health crisis and with this “crisis” comes federal money.

According to the the CDC (2015) reports “antibiotic-resistant infections account for at least $20 billion in excess direct health care costs and up to $35 billion in lost productivity due to hospitalizations and sick days each year.” These extremely high cost of antibiotic resistant infections have contributed to the President’s proposal to combat antibiotic resistance in the 2016 budget.

President Obama 2016 Budget calls for more than 1.2 billion Federal dollars to help combat antibiotic resistance.   According to The White House (2015), “the funding will improve antibiotic stewardship; strengthen antibiotic resistance risk assessment, surveillance, and reporting capabilities; and drive research innovation in the human health and agricultural sectors.” Additionally the 2016 budget for combating antibiotic resistance will be twice as much money as compared to the 2015 budget.

The Federal dollars to go towards combating antibiotic resistance is broken down as follow according to The White House (2016):

o   More than $650 million across the National Institutes of Health (NIH) and the Biomedical Advanced Research and Development Authority (BARDA) to significantly expand America’s investments in development of antibacterial and new rapid diagnostics, and to launch a large scale effort to characterize drug resistance.  Earlier this year, NIH-supported scientists developed a novel technique for extracting powerful antibiotics from soil, including teixobactin: the first new antibiotic to be discovered in more than 25 years.  The FY 2016 investment increases support for this kind of innovative research and discovery.

o   More than $280 million at the CDC to support antibiotic stewardship, outbreak surveillance, antibiotic use and resistance monitoring, and research and development related to combating antibiotic resistance.

o   $47 million at the Food and Drug Administration (FDA) to support evaluation of new antibacterial drugs for patient treatments and antibiotic stewardship in animal agriculture

  • Nearly quadruples antibiotic research and surveillance funding at the Department of Agriculture (USDA) to $77 million.

Increases funding at the Departments of Veterans Affairs (VA) and Defense (DoD) to $85 and $75 million, respectively, to address issues related to antibiotic resistance in healthcare settings.

It seems the more an issue is a crisis or pressing matter the more likely this issue will get more federal money. This is what would make sense. However I was in the scientific cancer research field when Clinton and Bush were both in office and I saw the huge cuts in grant money for research after Clinton was out of the office. Even though the research we were working on wasn’t a crisis as Ebola it would potentially save more lives than all the people who died from Ebola. So just because an issue isn’t immediately pressing it doesn’t mean that it shouldn’t be a priority for funding.  I think we will see today more and more how those cuts from the Bush administration will have an effect on scientific discovery.

Center for Disease Control (2014, March 4). Core Elements of Hospital Antibiotic Stewardship Programs . Retrieved from http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html

The White House. (2015, January). FACT SHEET: President’s 2016 Budget Proposes Historic Investment to Combat Antibiotic-Resistant Bacteria to Protect Public Health.  Retrieve from https://www.whitehouse.gov/the-press-office/2015/01/27/fact-sheet-president-s-2016-budget-proposes-historic-investment-combat-a

Center for Disease Control (2014, March 4). Core Elements of Hospital Antibiotic Stewardship Programs . Retrieved from http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html

Week 11: Characteristics of innovators and change agents in the healthcare sector.

Currently I am at the AANP conference in Washington DC and this conference is filled with innovators and change agents. It is a very exciting time to becoming a DNP. This health policy class is making a lot more sense now. For example, we are specifically lobbying for these specific bills which include: “Ensure Veterans Have Access to High Quality Healthcare (H.R. 1247) and (S.297)”, “(H.R.2) the Medicare Access and CHIP Reauthorization Act of 2015 to repeal the failed Medicare Sustainable Growth Rate (SGR) formula and reauthorize the Children’s Health Insure Program, and “Home Health Care Planning Improvement Act (S. 578/H.R.1342)” and “Remove Barriers to Nurse Practitioners’ Ability to Practice”. It is pretty exciting that the SGR/CHIP bill got repealed overwhelmingly in the House, now it has to go to the Senate, and fingers crossed that it gets repealed. This could mean a lot for us NPs and providers taking care of Medicare patients in which we will be able to give a greater level of care to these complex patients and be properly reimbursement for it, because we will now have the time to devote to these patients. Which ultimately will improve patient outcomes.

I got to see on the frontline how we as NPs can make changes, influence politicians, and be a sounding board and and educator for politicians. We are able to affect the health care industry from a health policy perspective and make real changes in our government. Which can ultimately improve patient outcomes and our health care system.
There was a slight amount of talk about my topic of antibiotic resistance specifically whose from Shannon Brownlee who gave a presentation on, “Overtreated: Why Too Much Medicine was Making Us Sicker and Poorer”. Shannon Brownlee is not a NP or even a RN, she is a writer and essayist. So during this talk I think a lot of our colleagues were cringing a little, because she came at this topic from a journalist perspective almost a Michael Moore type way, rather than an NP or scientific perceptive. I asked her thought’s about the overuse of antibiotics, she stated, “why are we still doing it”? Good question, and I thought to myself. Why are we still doing it…. Lack of education, patients not wanting to leave the office empty handed, not having a rapid point of detection device to diagnose an illness, whether it be bacteria, viral, or fungus. So many aspects go into that answer, it’s just not that simple. Somehow journalist are able to make the solutions so simple, and I think it is important to keep that in mind when reading magazine, online, or newspaper essays.

AANP (2015). Current government affairs update. Retrieved from http://www.aanp.org/legislation-regulation/health-policy-office-e-newsletter

Brownlee, Shannon (200*). Overtreated: Why Too Much Medicine Is Making US Sicker and Poorer. Bloomsbury, USA.

Wk 10 – Change Theory

The Rosswurm and Larrabee’s evidence based practice (EBP) model can help conceptualize the researcher’s evidence into practice with an organized approach. The Rosswurm and Larrabee model is a 6-step model to guide practitioners for an evidence based practice change into a care delivery system (Rosswurm & Larrabee, 1999).

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The Obama Administration, Center of Disease Control (CDC), and the World Health Organization have all assessed the need for change and try to combat the rise of antibiotic resistance. Currently it seems that the US government has proposed a design change in practice from the Obama Administration with initiating an Executive Order, a National Strategy on Combating Antibiotic-Resistant Bacteria, and report launched by the President’s Council of Advisors on Science, and Technology (PCAST) with recommendations for addressing the antibiotic-resistance crisis. The CDC has initiated a plan to preventing infections, preventing the spread of resistance, tracking resistance patterns, improving use of today’s antibiotics, and developing new antibiotics and diagnostic test. The WHO is tackling this issue by bringing all stakeholders together to agree on and work towards a coordinated response, strengthening national stewardship and plans to tackle AMR, generating policy guidance and providing technical support for Member States, and actively encouraging innovation, research and development (WHO, 2014).   The WHO had also synthesized the evidence to help develop a change strategy by publishing a first global report on surveillance of antimicrobial resistance, with data provided by 114 countries (WHO, 2014). Additionally the WHO (2014) has listed these key facts which assessed the need for change:

Key facts – (from WHO, 2014)

  • Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.

  • It is an increasingly serious threat to global public health that requires action across all government sectors and society.

  • AMR is present in all parts of the world. New resistance mechanisms emerge and spread globally.

  • In 2012, there were about 450 000 new cases of multidrug-resistant tuberculosis (MDR-TB). Extensively drug-resistant tuberculosis (XDR-TB) has been identified in 92 countries. MDR-TB requires treatment courses that are much longer and less effective than those for non-resistant TB.

I’m just using my topic of antibiotic resistance and applying the Rosswurm and Larabee model for change using the steps (for example) that the US government, CDC, and WHO are taking to combat antibiotic resistance. There are other models for change, however I appreciate the easy to follow step by step process of the Rosswurm and Larabee model. To me this approach just makes sense in order to create health policy change.

Rosswurm, M. A. & Larrabee, J. H. (1999) A model for change to evidence-based practice. Journal of Nursing Scholarship, 31(4), pp. 315-322

World Health Organization (2014, April). Antimicrobial resistance. Received from http://www.who.int/mediacentre/factsheets/fs194/en/

Week 9: Policy governing access to data and privacy protection in an electronic and genomic age.

My first thought in trying to combat antibiotic resistance was to develop an electronic database were the government would monitor the type and quantity of antibiotics prescribed by each provider. There will be no patient data affiliated with the database. This will be more of tracking of data to help combat antibiotic resistance. The only personnel to be privy to this information will be government officials who were properly trained with this information. This tracking system would be similar to DEA’s prescription drug monitoring program. Researchers would be able to potentially develop stricter guidelines for antibiotic prescribing to help combat resistance. Also more provider education on prescribing antibiotics could be developed.

As it relates to drug resistance I found the development of a tool called Comprehensive Antibiotic Research Database (CARD) which is a bioinformatics tool to sequence the genomics of a pathogen. According to McArthur et al. (2013):

“the CARD integrates disparate molecular and sequence data, provides a unique organizing principle in the form of the Antibiotic Resistance Ontology (ARO), and can quickly identify putative antibiotic resistance genes in new unannotated genome sequences. This unique platform provides an informatics’ tool that bridges antibiotic resistance concerns in health care, agriculture, and the environment.”

Dr. Fauci and Collins from the National Institute of Health (2014) stated, “Enhanced surveillance of antimicrobial resistance will draw on cutting-edge genetic sequencing technologies, developed and deployed by the NIH and our colleagues at the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).” Older technology is currently used to detect resistant microbes, however with newer technology and genetic sequencing, researchers will be able to detect outbreaks sooner and determine outbreak linkage and spread.  Additionally the US government will like to put the microbe’s sequence in a database called National Database of Resistant Pathogens.

All these databases whether it is how many antibiotics a certain provider prescribes or a database of the genetic sequencing of microbes will have to have ethical implications associated with them. Patient information should not be associated with the databases. Additionally employees and researchers privy to this information should undergo proper training such as Collaborative IRB Training initiative (CITI) if indicated.

Fauci, A. S. & Collins, F. S. (2014). New strategies in battle against antibiotic resistance. National Institutes of Health. Retrieved from http://directorsblog.nih.gov/2014/09/18/new-strategies-in-battle-against-antibiotic-resistance/

McArthur, A. G. …& Wright, G. D. (2013). The comprehensive antibiotic resistance database. Antimicrobial Agents Chemotherapy 57(7). 3348-57

McArthur, A. G. …& Wright, G. D. (2013). The comprehensive antibiotic resistance database. Antimicrobial Agents Chemotherapy 57(7). 3348-57.

Week 8 Private sector innovation and policy advancement

One of the national strategies in the executive summary for combating antibiotic resistant bacteria as cited in the The White House (2014):

Accelerate Basic and Applied Research and Development for New Antibiotics, Other Therapeutics, and Vaccines. Antibiotics that lose their effectiveness for treating human disease through antibiotic resistance must be replaced with new drugs. Alternatives to antibiotics are also needed in agriculture and veterinary medicine. The advancement of drug development requires intensified efforts to boost basic scientific research, facilitate clinical trials of new antibiotics, attract greater private investment, and increase the number of antibiotic drug candidates in the drug-development pipeline. We must also promote the development of other tools to combat resistance, including new and next-generation antibiotics, vaccines, additional therapeutics, and diagnostics.

For this strategy the government is looking for pharmaceutical companies and biotechnology companies to invest in alternatives to antibiotics, and newer non-resistant antibiotics. According to the White House (2014), “interventions are necessary to accelerate private sector investment in the development of therapeutics to treat bacterial infections because current private sector interest in antibiotic development is limited.” This is not currently where pharmaceutical companies are making their money, however with the push from the federal government hopefully they will spur more development in this area from the private sector.

Another national strategy on the issue of antibiotic resistance in which the government is asking for help from the private sector is according to The White House (2014):

 “Advance Development and Use of Rapid and Innovative Diagnostic Tests for Identification and Characterization of Resistant Bacteria. Today, researchers are taking advantage of new technologies to develop rapid “point-of-need” tests that can be used during a healthcare visit to distinguish between viral and bacterial infections and identify bacterial drug susceptibilities—an innovation that could significantly reduce unnecessary antibiotic use. The availability of new rapid diagnostic tests, combined with ongoing use of culture-based assays to identify new resistance mechanisms, will advance the detection and control of resistant bacteria, including the priority pathogens listed in Table 1. “

Here the government is calling for a biotechnology, research institution, or pharmaceutical company to develop an innovative device to help combat this issue. According to The White House (2014), “There are opportunities to use innovations and new technologies—including whole- genome sequencing, metagenomics, and bioinformatic approaches—to develop next- generation tools to strengthen human and animal health, including: Point-of-need diagnostic tests to distinguish rapidly between bacterial and viral infections as well as identify bacterial drug susceptibilities and New antibiotics and other therapies that provide much needed treatment options for those infected with resistant bacterial strains”

There are many opportunities for the private sector to invest time and money in this field. Additionally with this executive order from the federal government, grant money in this research and innovative technology area will probably be more readily funded.

The White House. (2014). National strategy for combating antibiotic resistant bacteria. Retrieved from http://www.whitehouse.gov/sites/default/files/docs/carb_national_strategy.pdf