NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem
Chamberlain University NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem– Step-By-Step Guide
This guide will demonstrate how to complete the Chamberlain University NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem
Whether one passes or fails an academic assignment such as the Chamberlain University NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem
The introduction for the Chamberlain University NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem
After the introduction, move into the main part of the NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem
For most people, arthritis is a health condition associated with people over the age of 65. The stiff, inflamed joints and nagging aches and pains are just seen as side effects of aging and years of wear and tear on the body. While arthritis is a health condition that results from inflammation of the joints and causes chronic pain, it is not just a health condition that affects elderly people. Arthritis can develop in children, teenagers, even adults in their twenties and thirties. As a long-term care nurse for over 15 years, my familiarity with the effects of arthritis in patients living in long-term care (LTC) facilities settings is considerable. Residents suffering from chronic arthritis find it extremely difficult to lift items, open doors, walk long distances, and perform activities of daily living (ADL): bathing, getting dressed, using the toilet, eating, transferring oneself to or from the bed or chair, or generally participating in activities that require strength and flexibility. Millions of people suffering from arthritis do not live in LTC facilities, so they do not have nursing assistance to help them with their ADLs or instrumental activities of daily living (IADLs): housework, grocery shopping, driving, caring for pets, etc. On the other hand, millions of arthritis sufferers are forced to give up their independence every year and move into long-term care facilities as they find they are no longer able to perform normal daily functions due to the pain and discomfort caused by their arthritis.
The Georgia Department of Public Health (GDPH) reports that arthritis is the predominant reason for disability in the United States and Georgia, affecting over 53 million people across the nation (Bayakly, 2015). In 2013, one in four adults in Georgia, ranging in ages from 18 to 85, were reported to have been diagnosed with arthritis by their primary care physicians (Bayakly, 2015). With the average age of onset arthritis reported to be 47 years old, cost-effective evidence-based strategies are needed to treat LTC patients suffering with arthritis (Tavakoli, Akwara, Kish, 2018). This paper will examine the prevalence of osteoarthritis (OA) and rheumatoid arthritis (RA) and describe their backgrounds. The paper will also discuss surveillance methods, provide an epidemiology analysis of OA and RA, and explain how they are diagnosed. Lastly, this paper will reflect on what actions can be taken to address OA and RA as a family nurse practitioner.
Background of arthritis
Arthritis is a degenerative joint disease that causes swelling, tenderness, and pain of the joints. Arthritis may affect one joint and cause occasional discomfort, but it often times affects multiple joints in the body and decreases mobility. People of all ages can develop arthritis; however, their chances increase as they grow older. The Centers for Disease Control and Prevention (2018) report there are over 100 types of arthritis. The most prevalent cases of arthritis are osteoarthritis and rheumatoid arthritis (CDC: Arthritis basics, 2018). Other commonly diagnosed forms of arthritis include juvenile rheumatoid arthritis, knee osteoarthritis, degenerative joint disease, fibromyalgia, and gout (CDC: Arthritis basics, 2018). OA occurs in the joints when cartilage begins to break down; this may be the result of injury, aging, or overuse of the joints (CDC: Arthritis basics, 2018). Osteoarthritis is the most common type of arthritis and affects 30 million people or 60 percent of all diagnosed cases within the U.S. (CDC: Arthritis basics, 2018) and for 70.9 percent of all cases in Georgia (Martyn, Bayakly, & Bagchi, 2013). Furthermore, OA is the reason for 79 percent of hospitalizations among Georgia patients 65 years and older (Martyn, Bayakly, & Bagchi, 2013). OA targets the neck, lower back, hands, hips, and knees and worsens over time, resulting in permanent disability (PubMed Health, 2018).
Rheumatoid arthritis is an autoimmune disorder that occurs when the immune system attacks the healthy cells in the connective tissue lining of the joints, causing damage and inflammation to joints throughout the body (CDC: Arthritis basics, 2018). Rheumatoid arthritis mainly attacks the synovial membrane soft tissue that lines the joints and leads to bone damage (CDC: Arthritis basics, 2018). RA causes chronic pain in the joint tissues of the hands, wrists, and knees; as a result, the person may develop a lack of balance or a deformity of the hands. Advanced RA may affect other tissues and cause health issues in organs such as the lungs and heart (CDC: Arthritis basics, 2018). RA is the most diagnosed autoimmune inflammatory arthritis in adults, affecting about 1 percent of U.S. general population and accounting for 0.7 percent of hospitalizations among Georgia patients ages 35 – 65 and over (Martyn, Bayakly, & Bagchi, 2013). RA is often misdiagnosed or mistaken for other disorders (Martyn, Bayakly, & Bagchi, 2013). The burden that OA, RA and other forms of arthritis places on arthritis sufferers is significant as it leads to a lower quality of life. Due to physical limitations and difficulty of staying healthy, arthritis sufferers find it increasingly difficult to work or participate in social or familial activities.
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Signs and symptoms
The overall symptoms of OA are aching pain, stiffness in affected areas, decreased range of motion, and joint swelling. The general symptoms of RA include pain, stiffness, weakness, tenderness, and swelling of the joints. Accompanying systemic symptoms for RA are weight loss, fever, fatigue, eye inflammation, anemia, pleurisy, and subcutaneous nodules (PubMed Health, 2018). When RA symptoms worsen, they are called flare-ups; when symptoms do not appear, they are said to be in remission (CDC: Arthritis basics, 2018). Risk factors associated with osteoarthritis and rheumatoid arthritis are multifactorial and include familial, individual, or behavioral causes (Martyn, Bayakly, & Bagchi, 2013). Hereditary risk factors are genetic mutations that increase the risk of RA or OA; individual risk factors include aging, being female, and being White; behavioral risk factors are joint injuries sustained during an activity, repetitive motion characteristic of certain jobs, long-term infections, and obesity (Martyn, Bayakly, & Bagchi, 2013). In terms of the effect of RA and OA on patients in long-term care, the ability of these arthritic conditions to debilitate the body has adverse mental effects. Affected residents often experience feelings of fear, helplessness and anxiety, which lead to depression and increased stress levels. Many patients with RA suffer from comorbidity
Incidence/Prevalence statistics
Of the 1.7 million adult Georgians who report having been diagnosed with arthritis, 76,000 report they are disabled (Martyn, Bayakly, & Bagchi, 2013). Among racial and ethnic groups diagnosed with arthritis, the most affected group is White non-Hispanic at 69 percent (Ibid.). RA and OA are most prevalent among women at 59 percent (Ibid.). Women are 30 percent more likely to report symptoms of arthritis than men at 22 percent (Ibid.). Among racial and ethnic groups, White non-Hispanic females are most likely to report arthritis symptoms at 32 percent, followed by White non-Hispanic males at 25 percent, Black non-Hispanic females at a 26 percent, and Black non-Hispanic males at 20 percent (Ibid.). Georgians 65 years and older report arthritis symptoms at 57 percent while Georgians ages 18 to 24 years old only report at 4 percent (Ibid.). Among Georgia adults diagnosed with arthritis, 58 percent were still employed, 10 percent had retired, and 18 percent were totally disabled and unable to work (Ibid.).
On average, 24,360 Georgia residents are hospitalized every year due to arthritis complications (Martyn, Bayakly, & Bagchi, 2013). Of the Georgia adults who have health insurance, 28 seek medical attention for arthritis; 18 percent of Georgia adults without health insurance seek medical attention for arthritis symptoms (Martyn, Bayakly, & Bagchi, 2013). The rate of hospitalizations was highest among women at 58 percent , Whites at 77 percent, and patients 55 years and older at 77 percent (Ibid.). Per year, an average of 2,084 Georgians dies from arthritis or health issues linked to arthritis (Ibid.). Of these deaths, 66 percent occurred among females, 66 percent occurred among Whites, and 61 percent among people age 65 years or older (Ibid.). The prevalence of arthritis is drastically lower in metro-Atlanta county health districts: the lowest numbers reveal Clayton County at 16.7 percent, DeKalb County at 17.6 percent, and Fulton County at 20 percent (Ibid.). The prevalence of arthritis is higher outside of metro-Atlanta counties: the cities with the highest incidences are Dublin at 32.8 percent, Albany at 31.2 percent, Augusta at 31.2 percent, Waycross at 31.1 percent, and North Georgia health districts at 31.1 percent (Ibid.).
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Figure 2: Georgia public health district arthritis comparison.
| Prevalence of Doctor-Diagnosed Arthritis
Top 5 Georgia Public Health District |
|
| Waycross | 36.5 % |
| Rome | 32.6 % |
| Albany | 32 % |
| Dublin | 30.8 % |
| Valdosta | 30.6 % |
On a national scale 22.7 percent (54.4 million people) of the population has been diagnosed with arthritis, and 21 million of these sufferers complain they are disabled due to their arthritis (CDC: Arthritis related statistics, 2018). 7.1 percent of people between the ages of 18 to 44 report they have been diagnosed with arthritis; 29.3 percent of people between the ages of 45 to 64 report arthritis; 49.6 percent of people age 65 and older have reported doctor-diagnosed arthritis (Ibid.). 26 percent of the women and 19.1 percent of men in the U.S. report doctor-diagnosed arthritis (Ibid.). Out of the 54.4 million people to be diagnosed with arthritis, 4.4 million are Hispanics, 41.3 million are non-Hispanic Whites, 6.1 are non-Hispanic Blacks, and 1.5 are non-Hispanic Asians (Ibid.). By 2040, 78 million or 26 percent of the adult U.S. population is projected to be diagnosed with some form of arthritis (Ibid.).
Current surveillance methods
The CDC (2018) suggests the Behavioral Risk Factor Surveillance System (BRFSS) is the most reliable resource for accessing state-specific arthritis prevalence statistics. The BRFSS survey system is based in every state, the District of Columbia, and three U.S. territories (CDC: State statistics, 2018). The system randomly dials individuals aged 18 years or older who have a registered phone number (CDC: State statistics, 2018). The BRFSS system has been collecting arthritis data from since 1996 (Ibid). The Morbidity and Mortality Weekly Report (MMWR) provides an arthritis surveillance summary that explains the differences between each type of arthritis and the impact arthritis has at the state and local levels (Ibid.). The CDC (2018) also recommends self-reporting methods to estimate the prevalence of doctor-diagnosed arthritis. Researchers should consider individuals to have self-reported, if they ever responded “yes” to the following question found in the National Health Interview Survey (NHIS) and the state-based Behavioral Risk Factor Surveillance System (BRFSS): “Have you been informed by a physician or other healthcare professional that you have some form of arthritis?” (Ibid.). For public health surveillance, the CDC has coordinated with the National Arthritis Data Workgroup to administer the National Health Interview Survey (NHIS) to identify people in every U.S. state and territory with at least one of the 100 diseases that fall under arthritis conditions (Ibid.). The Georgia Department of Public Health relies on the information collected by the CDC, BRFSS, and minimum data set (MDS) nurses in public and private healthcare facilities to compile its state numbers on arthritis (Martyn, Bayakly, & Bagchi, 2013).
Epidemiology analysis
Nationwide, approximately 54 million people report having been diagnosed with arthritis.. Risk factors are multifactorial, with old age, being White and female as the main factors. OA affects over 30 million adults; research suggests wear and tear plays a large role in its diagnosis. RA affects a little over one percent of the national population; research suggests that behavioral and genetic factors play a role in its diagnosis. Women develop arthritis more than men, especially after age 50 with a significantly higher age-adjusted prevalence in women at 23.5 percent than in men at 18.1 percent. Inactive adults have a higher prevalence of arthritis conditions at 23.6 percent than adults who report they are active at 18.1 percent. In Georgia, 26 percent of the population suffers from some form of arthritis. White non-Hispanics report doctor-diagnosed arthritis at 29 percent, which is more than any other racial/ethnic group in the state. Georgians 65 years are more prone to doctor-diagnosed arthritis. Cobb-Douglas County has reported to date the lowest prevalence of arthritis at 18.4 percent. The population most affected is White women over the age of 65.
Incidence of RA in women is lower among women who take oral contraceptives compared with women who have never taken oral contraceptives or those who have stopped taking oral contraceptives (Tavakoli, Akwara, & Kish, 2018). Research shows that female subfertility increases RA in women (Tavakoli, Akwara, & Kish, 2018). Women who breastfeed and women who go through a postpartum period after a first pregnancy are at greater risk of RA (Ibid.). Environmental factors such as viral and bacterial infections increase the chance of RA in men and women (Ibid.). Men and women who smoke cigarettes increase their risk of RA (Ibid.). Over 15 percent of female in-home nursing assistance insurance claims are due to arthritis (Ibid.). The numbers show that 10 percent of nursing home residents receiving benefits for arthritis or arthritis related conditions are women over age 50 diagnosed with arthritis (Ibid.).
In 2013, the national arthritis medical care costs and earnings losses totaled $303.5 billion; attributable lost wages amounted to $164 billion (CDC: Cost statistics, 2018). The direct total cost per adult in national arthritis medical amounted to $2,117 (CDC: Cost statistics, 2018). OA is the second most costly hospitalized health conditions among U.S. residents, accounting for $16.5 billion of the combined costs for hospitalizations and $6.2 billion in hospital costs for privately insured patients (CDC: Cost statistics, 2018). Adults with arthritis bring home $4,040 less pay compared to adults without arthritis due to taking days off to recuperate from symptoms (CDC: Cost statistics, 2018). The State of Georgia estimates it loses over $2.4 billion in direct costs and $1.5 billion in indirect costs treating patients with arthritis conditions (Martyn, Bayakly, & Bagchi, 2013).
Diagnosis and Screening and Prevention
To diagnose arthritis, a doctor will ask about symptoms then perform a physical examination to detect swollen joints or loss of range of motion (Martyn, Bayakly, & Bagchi, 2013). To distinguish the type of arthritis the doctor will order blood tests and X-rays (Ibid.). Doctors’ evaluations may include questions about symptoms, current and past health issues, health habits, and family medical history (Martyn, Bayakly, & Bagchi, 2013). Doctors will conduct a hands-on joint evaluation; depending on the findings, the doctor may order lab or imaging tests (CDC: Arthritis basics, 2018). The primary care doctor may refer the patient to a rheumatologist for a more comprehensive assessment (CDC: Arthritis basics, 2018). If necessary, the rheumatologist may make a referral for an orthopaedist who will determine if surgery is needed (CDC: Arthritis basics, 2018). To date there are no specific screening tests for arthritis (Ibid.). Early diagnosis has been determined to be the best screening method to detect arthritis (Ibid.). The National Arthritis Action Plan is a public health strategy headed by the CDC and the Arthritis Foundation to combine efforts with other health organization to educate the public about arthritis and self-management goals (Ibid.).
Since there is a lack of data about the sensitivity, specificity, and costs factor of tests used to diagnose arthritis, more specifically rheumatoid arthritis, a five-year study was conducted to compare the following tests: B-cell gene expression, MRI, IL-6 serum level, and genetic assay (Busiman et al., 2016). The results of the study revealed, the B-cell exam was the overall best test when doctors used it as an additional test to confirm early diagnosis and as an overall diagnostic replacement in at-risk patients (Busiman et al., 2016). The following numbers show the B-cell test has better health outcomes, one of the lowest cost values, and high prevention value: B-cell gene expression test sensitivity reads 0.60, specificity reads 0.90, costs on average is $170—which means the test is not that sensitive to false positive results, it’s about 90 percent accurate, and is affordable without insurance (Busiman et al., 2016).
Nurse practitioner implementation plan and conclusion
Arthritis is the leading cause of disability in the U.S. and Georgia. There are 100 different types of arthritis that affect people of all ages and backgrounds. OA and RA are the most common types of arthritis, and women are affected more than men. After I graduate, I will use my knowledge of arthritis and its management to develop a fall prevention strategy for LTC patients. My program will involve a risk assessment for patients who walk with gaits or who have been noted to have balance difficulties or a history of falling. The assessment will involve muscle evaluation for weakness, an orthostatic hypotension check, a full examination of the feet, and a replacement of inefficient and unsafe footwear. The assessment will evaluate the patient’s ADL capabilities and use of mobility aids. I will also give patients a questionnaire about fears, falling, exercise, medication, and health goals. This information will make a difference in how interventions and treatment plans are executed.
Since arthritis is characterized by pain, stiffness and inflammation in affected joints, nurse practitioners play a pivotal role in both the early detection of arthritis symptoms in at risk patients and the pain management of patients with chronic arthritis. The first action I will take is getting involved in arthritis community programs that educate the general public about non-pharmaceutical pain management methods. Addiction to pain medication has become a national concern, and arthritis patients who become addicted to pain medications will only make their health conditions worse. Next, I will address the physical, psychological and social needs of the patient by asking questions during patient check-ups about each of these areas then by providing resources to help resolve any concerns. My goal is to improve the patient’s quality of life, so I will focus on a holistic approach to alleviating arthritis symptoms that involves a manageable diet and exercise regimen, participation in a social or spiritual activity, and shared decision making about treatment options.
References
Bayakly, A. R. (2015). Burden of Chronic Disease in Georgia. Retrieved from Georgia Department of Public Health website: https://dph.georgia.gov/sites/dph.georgia.gov/files/Chronic%20Disease%20Burden_Rana_8.13.15.pdf
Buisman, L. R., Luime, J. J., Oppe, M., Hazes, J. M. W., & Rutten-van Mölken, M. P. M. H.
(2016). A five-year model to assess the early cost-effectiveness of new diagnostic tests in the early diagnosis of rheumatoid arthritis. Arthritis Research & Therapy, 18, 135. http://doi.org/10.1186/s13075-016-1020-3
Centers for Disease Control and Prevention (CDC). (2018, February 21). Arthritis basics. Retrieved from https://www.cdc.gov/arthritis/basics/index.html
Centers for Disease Control and Prevention (CDC). (2018, August 1). Arthritis-related statistics. Retrieved from https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm
Centers for Disease Control and Prevention (CDC). (2018, July 18). Arthritis: State statistics. Retrieved from https://www.cdc.gov/arthritis/data_statistics/state-data-current.htm
Centers for Disease Control and Prevention (CDC). (2018, July 18). State statistics. Retrieved from https://www.cdc.gov/arthritis/data_statistics/state-data-current.htm
Martyn, A., Bayakly, A. R., & Bagchi, S. (2013). Georgia Arthritis Burden Report. Retrieved from Georgia Department of Public Health (Epidemiology Program) website: https://dph.georgia.gov/sites/dph.georgia.gov/files/related_files/site_page/Arthritis%20Burden%20Report_2013.pdf
PubMed Health. (2018). Arthritis. Retrieved from NIH – National Institute of Arthritis and Musculoskeletal and Skin Diseases website: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024677/
Tavakoli, N., Akwara, C., & Kish, P. (2018). Considerations in the management of rheumatoid arthritis among older adults in long-term care. Annals of Long Term Care, 26(4), 18-23. Retrieved from DOI: 10.25270/altc.2018.08.00035
Sample Answer for NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem
Chronic health problems are a concern to the healthcare system, at the individual, population, and national management levels owing to their impacts on care cost, access, safety, and thus, quality. Understanding the natural process of these diseases, their diagnosis, treatment, and epidemiological characteristics is important in preventive and curative care. The burden of the disease reflects its impact on the social, cultural, economic, and political underpinnings behind the disease’s impact on healthcare costs and disability (Leung et al.,2020). Asthma is a chronic disease that involves the respiratory system with a huge burden on the health system in my state, California, and nationally. The purpose of this paper is to describe the background and significance of asthma, its surveillance and reporting system, epidemiology, screening, and plan of care.
Background and Significance of Asthma
Asthma is a reversible inflammatory disease affecting the small and medium airways. It leads to hyperresponsiveness of these airways as well their acute smooth muscle contraction that results in limitation of breathing efficiency. The inflammatory hyperresponsiveness and airway smooth muscle contraction leading to the narrowing of the airway lumen due to mucosal edema and disruption (Leung et al., 2020). Chronic asthma is characterized by repeated bouts of inflammation that lead to remodeling of the airway due to proliferation and matrix deposition
Signs and Symptoms
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines asthma as a chronic airway inflammation that causes fluctuating expiratory airflow limitation and respiratory symptoms over time (Roman-Rodriguez & Kaplan, 2021). As opposed to chronic obstructive pulmonary disorder (COPD), asthma symptoms are reversible and fluctuating. The 2019 report of the global initiative for asthma (GINA) specifies two key features of asthma: variable respiratory symptoms and variable expiratory flow limitations (Global Initiative for Asthma, 2019). Asthma patients can present with a history of shortness of breath, wheezing, cough, or chest tightness. The national institute for health and care excellence (NICE) latest guidelines on asthma assessment, diagnosis, and chronic management published in 2017, emphasize the presence of seasonality of these symptoms, triggers for exacerbations, and family history of atopy in the clinical assessment of chronic asthma.
On examination, the presence of expiatory polyphonic wheeze is a key sign of asthma but not a pathognomonic of asthma. Therefore, a combination of symptoms from history, physical examination findings, and objective test findings is required to distinguish asthma from other chronic lower repository diseases. Sometimes, chronic cough can be the chief complaint in asthma patients and thus can be confused with other chronic lower respiratory diseases. This cough variant is common in pediatric patients who usually report asthma sooner after showing cough as the only symptom.
Incidence and Prevalence
According to the United Health Foundation, the current prevalence of asthma in the United States is 7.5% per 2019-2020 survey data from the National Survey of Children’s Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), and Maternal and Child Health Bureau (MCHB) (United Health Foundation, n.d.). The least prevalence was reported in North Dakota (4%) while the highest prevalence was reported in Connecticut (11%). The prevalence of asthma in California in 2020 was 6.4%, which is 1.1% below the national estimates during that year. California ranked 14th in terms of health regarding the prevalence of asthma.
California Department of Public Health reported California asthma prevalence data in 2020 in terms of lifetime prevalence and current prevalence. In the general Californian population, the figure is about 15.1% (California Department of Public Health, n.d.). This includes the proportion of those who had been diagnosed with asthma in their lifetime and currently report not having it. As shown in Table 1, compared to national estimates during 2020, this prevalence is still lower than the highest reported value, 18.4% (Farzan et al., 2019). This value represents a 1.3% increase in the 2014 average prevalence of asthma among adults and children in California according to the California Air Resources Board (n.d.). Therefore, the prevalence of asthma has been rising in California in the past decade.
Table 1
California state and National Asthma prevalence
| Parameter | California | National | Source intext |
| Current Prevalence 2020 | 6.4% | 7.5% | United Health Foundation, n.d. |
| Lifetime prevalence 2020 | 15.1% | 18.4% | California Department of Public Health, n.d.; Farzan et al., 2019 |
| Lifetime prevalence of children 2020 | 11.9% | Comparative Data not found | California Department of Public Health, n.d. |
| Lifetime prevalence of adults in 2020 | 16.2% | Comparative Data not found | California Department of Public Health, n.d. |
Surveillance and Reporting
Disease surveillance involves the systematic and periodic collection, analysis, and interpretation of health data of a given disease condition from various primary sources (CDC, 2022). Disease surveillance and reporting are important in providing warning about trends, identifying emergencies, informing health policies and planning, and guiding disease monitoring at the public health level. Asthma surveillance and reporting in the United States is done at the state and national levels (California Department of Public Health, n.d.). Surveillance and reporting are, therefore, important for quality improvement purposes and ensuring health safety through health prevention based on health data.
Asthma is part of many chronic conditions for which surveillance is done at the state and national levels. At the national level, various programs are used to collect, analyze and disseminate surveillance data and inform the national government for planning, policy-making, and implementations. These programs collect data through various methods such as surveys, prevalence reports, physician visits, self-management education, mortality reports, and electronic health records (California Air Resources Board, n.d.). At the national level, National Center for Health Statistics (NCHS) surveys and the Vital Statistics System provide access to national data on various chronic diseases including asthma (CDC, 2022). Other programs include but are not limited to National Health Interview Survey, National Hospital Discharge Survey, Behavioral Risk Factor Survey, and Center for Disease Control Asthma Surveillance Data.
Doctor’s office visits, health insurance information, personal household interviews, discharge information from the hospital records, and medication use records are some of the key sources of the surveillance data for these programs (California Air Resources Board, n.d.). The Behavioral Risk Factor Survey collects its data through regular surveys regarding many chronic conditions. At the state level, the California Environmental Health Tracking Program, California Health Interview Survey, Office of Statewide Health Planning and Development, CDPH California Breathing County Level Asthma Data, and California Asthma Public Health Initiative are involved in the asthma data surveillance and reporting. Adult and child asthma prevalence at the state level in many states is reported by the Behavioral Risk Factor Surveillance System (BRFSS) (CDC, 2022). Asthma is, therefore, a chronic disease that is mandated for reporting and forms part of the annual national epidemiological reports. The last available data on asthma surveillance and reporting is for 2020 at the national level. This calls for improved coordination with state-level surveillance systems to harmonize and update these reports for local consumption and progress comparison.
Descriptive Epidemiological Analysis of Asthma
Asthma epidemiology varies with various populations, regions, periods, risks, and outcomes. Worldwide, asthma affects up to 18% of the general population (Global Initiative for Asthma, 2019). This prevalence rate varies among different countries and regions. In the United States, asthma prevalence among children varies with race and state. The prevalence data in 2015 showed an average prevalence rate of 8.4% but this value could rise to 13.4% in some races and socioeconomic settings (Farzan et al., 2019). Farzan et al. in 2019 conducted a prevalence study about asthma and its presentation in Imperial Valley, one of the agricultural regions of California. This study found a prevalence rate of 22.4 percent with wheezing as the most commonly reported symptom. This finding suggests a possibility of underdiagnosis of asthma in remote regions.
The current national prevalence of asthma among adults and children in the United States according to the national and state surveillance systems administered by the Centers for Disease Control and Prevention (CDC) per the 2020 data is 7.8%. This translates to about 5 million people with asthma currently. Despite this disease being mostly diagnosed during childhood, it is more common in adults than children in the US. About 21 million adults against 4 million children have asthma currently. Females are more affected than males in most age groups. Asthma is also common among people who live below the federal poverty threshold (California Air Resources Board, n.d.). Non-Hispanic whites and blacks have higher prevalence rates than Hispanics and persons of Asian descent (Centers for Disease Control and Prevention, 2022).
In California, hospitalizations due to asthma are more common in children and African Americans. Certain triggers cause asthma attack episodes. Some of the commonest asthma triggers include but are not limited to exercise, cold, pollen, cat dander, tobacco smoke, air pollution, dust mites, and acute infections (Dharmage et al., 2019). According to a recent study by Pate et al. (2021), mortality related to asthma is higher among blacks, adults, and females. By regions, death due to asthma was higher in the northwest and Midwest regions of the US. The disparities in asthma indicators in the above descriptive epidemiology can be attributed to unequal access to care, different geographical locations, demographic characteristics, lower socioeconomic levels, and general poverty levels.
Screening, Diagnosis, Guidelines
Various guidelines are used in different practice jurisdictions to screen diagnose and treat asthma among children and adults. Some of the most used guidelines for screening, diagnosis, and treatment of asthma are the Global Initiative for Asthma (GINA) and the National Institute for Health and Care Excellence (NICE) guidelines. Among children under 5 years old, screening is done through clinical judgment using patient history and physical exams. Based on this clinical judgment, treatment is intimated, and the patient is monitored for improvement until five years old when reassessment for objective tests is done. The GINA guidelines recommend no use of tests for children but emphasize assessment of symptoms, and risk factors and through clinical evaluation to screen for asthma in children. Children above five years and adults can be screened or diagnosed using tests such as spirometry according to NICE guidelines. In the case of normal spirometry despite a high clinical suspicion index of asthma, the clinical can consider Fractional exhaled nitric oxide (FeNO) to make the diagnosis.
Currently, there is no gold standard test for screening or diagnosis of asthma. However, spirometry with bronchodilator response remains the main and most widely used screening and diagnostic test for asthma in older children and adults. Methacholine testing is a provocation test that assesses airway hyperresponsiveness among asthma patients (Cockcroft, 2020). Selvanathan et al. (2020) conducted a study to assess the performance of spirometry with bronchodilator response in asthma diagnosis involving 500 subjects. This study reported a negative predictive value of 57 for use of spirometry in asthma diagnosis. Sensitivity studies on spirometry in asthma diagnosis have reported mixed outcomes but insist on the use of clinical judgment and other tests such as methacholine test for diagnosis. The reliability of the various tests depends on the patient population among other factors.
Plan of Action
Upon graduation, a nurse practitioner is expected to educate, protect, advocate for, and promote the patient’s health regarding asthma and related outcomes. Specific goals will be to increase the number of patients at risk of asthma who are diagnosed in time, reduce the number of emergency room visits, and reduce the number of exacerbations. The knowledge of risk factors and treatment of asthma will be important. One of the interventions to achieve these goals will be patient education on risk factor avoidance and the use of medication and inhalers to promote adherence. This will reduce the risk of exacerbation and readmissions (Scullion, 2018). The second intervention is the coordination of care and referral to appropriate community resources that will promote and complement their care such as community pharmacies and reduce the risk of exacerbation and readmission. The third intervention is to conduct early rereferral of cases where the diagnosis of cancer is nonconclusive so that early diagnosis can be made by a specialist such as pulmonologists (Mowbray et al., 2020). These interventions’ goals are measurable and align well with the healthy people 2030 goals on asthma that aim at improving detection, prevention, and treatment.
Conclusion
Asthma is a reversible chronic inflammatory condition of the lower airway that is characterized by airway hyperresponsiveness and airway reversibility. This disease contributes to significant mortality and morbidity among children and adults. In my state, California, the current prevalence is slightly lower than national estimates, but the burden of the disease is still a problem for the state healthcare system. California ranks 14th in terms of asthma burden but there is still a need to do more to prevent, treat, and promote population health. The disease’s key symptoms include wheezing, dry cough, and shortness of breath which are a threat to the health safety of the patients. Therefore, a timely diagnosis is required. The current guidelines, NICE and GINA recommend reliance on the clinical history and physical examination for diagnosis. The use of spirometry is reserved for patients above 5 years. Methacholine testing, although not mentioned in current guidelines has been used to assess airway hyperresponsiveness. Spirometry is the most widely used but has varied viability and reliability scores in asthma diagnosis. As a nurse practitioner, my obligation will be to prevent asthma, ensure early detection, and prevent readmission and exacerbations. My key intervention will be patient education, care coordination, and early patient referral to strive to achieve the healthy people 2030 goals.
References
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