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Health Promotion Final Paper: Clients in Sussex County at Bayhealth Total Care

The Bayhealth Total Care Center in Milton, DE, is an emergency department and urgent

care center under one roof. This allows the community of Sussex County or anywhere in the

Delaware a more flexible means to health care without the confines for a week schedule. Most

doctor’s offices are only open Monday through Friday from 0800 to 1600 whereas, the urgent

care center is open 24/7. This allows community members who are unable to take off of work to

be able to be seen by a provider. An urgent care is also generally less expensive than a hospital

visit to an emergency room. The total care center has everything that would be needed for a

patient such as lab work, diagnostic testing, screenings, educational classes, and providers. The

Bayhealth Total Care Center is not only an urgent care center but also an emergency department

that provides medical care for many different types of minor health problems. The goal is to

diagnose the underlying cause of a condition and formulate an effective course of treatment.

Using different data systems healthcare providers are able to see what various needs the

community needs and work toward those goals. For the clients in the state of Delaware some of

those medical concerns cancer screenings, diabetes management, and obesity. The Bayhealth

Total Care Center tries to help with some of these health concerns.

Review of Data

Cancer screenings

According to the 2022 Bayhealth Sussex County CHNA, Bayhealth has collaborated with

the community service partners to develop strategies to address the needs for the state of

Delaware (2022). These include partnering with Penn Medicine’s Abramson Cancer Center

Teleogenetic Program to provide genetic testing and counseling, implementing colorectal and
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lung navigator programs to reduce barriers to screening, and targeting at-risk groups for outreach

(Bayhealth, 2022). Routine screenings such as pap smears and colorectal exams has declined

cancer incidences in the last few decades by 45 and 55 percent (Pinsky, 2022).

Obesity

According to the Center for Disease Control and Prevention, in 2021 33.9 percent of the

state of Delaware suffer from obesity (2023). Obesity is defined as a body mass index of over 30

and Delaware has the highest ranking of obesity for people over the age of 65 out of all 50 states

(Bayhealth, 2022). People who are obese are at greater risk of developing chronic conditions

such as heart disease, cancer, and stroke but can help be prevented with physical activity and

nutrition (Bayhealth, 2022). According to the Bayhealth Sussex County CHNA, Delaware also

ranks higher than the national average (47 th) for adults with obesity who also have three or more

chronic conditions (2022).

Disparities and Barriers

Three needs or problems that affect my community are lack of primary care provider,

social determinants, and preventable emergency department visits. According to the Bayhealth

Community Health Needs Assessment, approximately 151 million people visit the emergency

department annually and of those, 27 percent could have been managed with a primary care

provider (2022). Some conditions that are preventable emergency department visits include

mental health, substance abuse, dental, asthma, and diabetes (Bayhealth, 2022). According to the

Bayhealth CHNA, Delaware ranks 17th in the list of highest rate of emergency room visits and

37th of preventable hospitalizations (2022).

According to the County Health Rankings in 2020 the state of Delaware had 1,1330

people per provider but has trended down since in the last ten years (2023). Although there may
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be a lot of health care providers in the state of Delaware, many of them do not have

appointments readily available for patients (Bayhealth, 2022). Delaware is also known as a

retirement state so each year more and more people move here and do not get a new primary care

provider.

There is also a social determinants of health problem in the state of Delaware. Factors

that are included in this are income, education, employment, and housing quality. According to

the Bayhealth CHNA, Sussex County’s deprivation index was a 6 out of 10 and a higher level of

index has been associated with an increased risk of adverse health outcomes (2022). According

to the Bayhealth CHNA, some of the rates include: unemployment (5.45%), families with at least

one employed parent (92%), family poverty rate (14.02%), and the rent burden (29.6%). Many

people who need health care cannot afford to seek in out because that could mean not having

groceries for the week.

SMART Goal #1: Clients in Sussex County will have 25 percent less preventable emergency

room visits by the end of 2024.

SMART Goal #2: Clients in Sussex County will be able to have 15 percent more access to a

primary care provider by the end of 2024.

SMART Goal #3: Clients in Sussex County will have 20 percent more access to healthcare by

the end of 2024.

Role of the Nurse

Public health nursing is a specialty within nursing that focuses on the community as a

whole instead of an individual person. Public health is about prevention and education with

interests being in immunizations, infection, environmental health, and others (Savage, 2020).

Public health focuses on eight principles: 1) client is the population, 2) primary obligation is to
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achieve the greater good for the maximum number of people, 3) clients are equal partners, 4)

primary prevention is priority, 5) focuses on strategies that create healthy environments, 6)

obligated to reach out to those who would benefit more, 7) available resources must be optimal

for overall improvement, and 8) collaboration with other professions (Savage, 2020). Public

health nurses work in a variety of settings to include schools, extended care facilities, and

community clinics.

The nurses role in an urgent care center is to evaluate the patient, assess what they are being seen

for, implement a plan to get the patient to a common goal, and then discharge them. In my

opinion it works the same as a doctor’s office without having to be sent elsewhere to get certain

tests done. A patient can come in, get the tests they need completed, have the results read, and

then have a provided put a plan in place to help them get better. The nurses role in this is to

ensure the patients are receiving the best care possible and collaborating with the

interdisciplinary team to meet the patient’s needs.

Interventions and Resources

There are many resources to be utilized in the Delaware to help meet the needs of the

community. The resources that could help mitigate preventable emergency room visits would be

the Bayhealth Total Care Center and the Mobile Unit. Both of these resources need to be

advertised more to members of the community, so they know they are available. Putting the

places and times of the mobile unit on an easily accessible platform would allow clients to seek

minor things such as prevention methods and immunizations. Community members should reach

out to their representatives to establish more 24/7 urgent care centers in the state of Delaware to

mitigate how many people are going to the emergency department unnecessarily.
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La Red Health Center is a 24/7 telephone hotline for individuals in the community who

speak little to no English and who are uninsured. This resource should be advertised on multiple

platforms so that it is able to reach more individuals that need it. Business cards should be placed

at well-known establishments so that individuals who are afraid to go to the doctor are able to

seek help. Another resource is the Health Care Connection and Voluntary Initiative Program. It is

a way to help uninsured Delawareans to be screened for financial eligibility to ensure access to

primary care. As of now individuals can call 2-1-1 or email the program but, this needs to be

advertised more so individuals know it exists.

Delaware 2-1-1 is a partnership between United Way and the State of Delaware. It is a

hotline individuals can call for different resources in the community such as housing, food,

healthcare, and rent assistance. Health care staff should ensure they tell their clients about this

resource especially for the individuals who are too afraid to speak out about help. This resource

needs to be advertised on multiple platforms to ensure it reaches as many individuals as possible.

Evaluation

At the end of 2024 another Community Health Assessment Needs survey should be done

to see if the numbers have changed since the last year. After implementing these resources and

interventions I would hope the numbers would change for the better. I would also put out another

survey to see where individuals see the most advertisement for resources so I would know where

my resources would get the most attention.

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References

Bayhealth. (2022). (rep.). 2022 Bayhealth SUSSEX County CHNA. Dover, DE.

Health Outcomes. County Health Rankings & Roadmaps. (2023).

https://www.countyhealthrankings.org/explore-health-rankings/delaware?year=2023

Savage, C. L. (2020a). Public/Community Health and Nursing Practice: Caring for populations.

F.A. Davis Company.