Running head: SUMTER COUNTY HEALTH ASSESSMENT 1

Sumter County Health Assessment

Corey A Ferrante Gennaro

University of South Florida

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Sumter County Health Assessment

The purpose of this paper is to assess the health of Sumter county by an analysis of data

collected and to formulate a health policy that can increase the health of it. One intended

outcome is that through telehealth, a mobile clinic, and a clinical home an increase access to

health care services for the community will be reached. Next this paper will formulate a relisted

health policy that can shape future plans in the county to meet this outcome.

Overview of Sumter County, Florida

Sumter county is an inland rural county next to Citrus county on the west, Lake county to

the east, Marion county to the north, Polk Hernando and Pasco counties to the south. The green

flat open fields engulf the entire county with about half of the population sporadically spaced

throughout (Sumter County, Fl- Offical Website, n.d.). The other half of the population is in

the heavily dense city of The Villages at the north end of the county (Sumter County, Fl- Offical

Website, n.d.). In fact, the most well-known fact of Sumter is that The Villages has aided it to

become the 3rd fastest growing county in the United States in 2015 (Fastest growing counties in

the U.S 2015, n.d.). This has strengthened the counties health however it brings its own

challenges as well.

Comparison of Local vs. State Findings

The Villages is the most urban area that can be found within Sumters borders. The other

much smaller cities in the area, such as Webster located in the south, Center Hill located to the
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east, Bushnell and Sumterville located in the middle, Lake Panasoffkee located toward the west,

and finally Coleman and Wildwood located toward the north, are a combination of rural and

urban parts. The southern end and rest of the area or completely urban. Socioeconomically The

Villages is filled with middle to a wealthy class of society and a middle to low class in the rest of

Sumter (Sumter County, Fl- Offical Website, n.d.). The three major employers are Coleman

Federal Prison with a total of 1,204 employees, Sumter District Schools with 815 employees, and

Publix with 673 employees (Sumter County, Fl- Offical Website, n.d.). The two biggest health

care services are The Villages Regional Hospital (TVRH) and American Medical Response

(AMR).

The county poverty level is 31%. Florida has 24% of families living in the poverty level

which puts the county at 7% higher than the state. With the comparison of county to state

population who are older than 25 and have a high school diploma Sumter has 79% compared to

Florida having 75%. When comparing the population that does not speak English to that of the

state percentage in a population range that is five years old or older Sumter has 1% and Florida

has 6%. Comparing the access to primary care providers Sumter has 3,570:1 ratio of person to

primary care physician compared to the state 1,390:1. Now for an analysis of the strengths and

weaknesses for Sumter. (Health Rankings, 2016).

Identified Strengths

The first strength of Sumter County is that 13% of the population reported poor or fair

health. This is in comparison to 18% in Florida overall and a National Bench marker of 12%.

Sumter County is below Floridas average by 5% which makes this a positive health outcome for
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the county. The second strength is insufficient sleep. The county has a 27% sleep insufficiency.

Floridas average is 35% and the National Bench Marker is 28%. The county is below both

Florida and the National Bench Marker by 8% and 1% making it another strength. The third

strength is HIV prevalence. The county has 209 new cases annually compared to Floridas 599

annually and the National Bench Marker of 41 annual new cases. Even though the county is well

above the National Bench Marker it is still well below Floridas average by 390. (Health

Rankings, 2016).

Identified Weaknesses

The first weakness is 31% of children are living in poverty. This is compared to Floridas

24% and National Bench Marker of only 13%. This puts the county at 7% and 18% higher than

the state and national average. The second weakness is 12% of children are uninsured. The state

has the same 12% however the National Bench Marker is 5% making this a weakness. The third

weakness is a lack of primary care physicians per person compared to the state and nation.

Sumter has 3,570:1 ratio of person to primary care physician compared to the state 1,390:1 and

nation of 1,040:1. This shows the county has a sever lack of physicians per person. (Health

Rankings, 2016).

Priority Health Issue

A priority health indicator for the county is the severe lack of primary care physicians.

According to Health Ranking, there is an extra 2,180 people per physician compared to the state

and 2,530 with the nation. The defining characteristics for primary care providers include non-

federal, practicing physicians included M.Ds and D.Os specializing in general practice
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medicine, family medicine, internal medicine, and pediatrics. All under the age of 75 years old

and younger. An important reason that this is a priority health indicator is because studies show

that having higher ratios of people to primary care physicians is essential for improved health

outcomes (Healthy People 2020, 2016). Healthy people 2020 further shows the importance of

this health indicator under the access to healthcare services AHS-4.1 topic which includes the

goal of increasing the number of practicing medical doctors. Creating an environment that will

foster increased migration of primary care providers is one step that can be taken to reach this

goal. (Health Rankings, 2016).

Discussion and Application of Community Health Models

The Determinants-of-Health Model focuses on different factors and reasons why some

people are healthy and others are not. The use of this model aides in developing interventions to

improve the health of a population by looking at personal, social, economic, and environmental

factors that influence health status. This community health model will help to eliminate the

barriers to accessing healthcare services, the priority health indicator for Sumter county, which

includes a lack of availability, high cost, and no insurance to name a few. These factors lead to

unmet health needs, delays in receiving appropriate care, not being able to participate in

preventative services, and hospitalizations that could have been forgone. Since Sumter county

only has one hospital prevention of this cascade can take off unneeded pressure not only for the

hospital but for other healthcare services in addition. Creating a policy that will foster an

environment that will remove these barriers is what is needed.

Population Diagnosis
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Families of low income in Sumter county are at risk for overall poor health due to the

lack of access to healthcare services as evidence by not being able to see a primary provider on a

regular basis, lack in health literacy, and difficulty in the ability to drive to a health care facility.

Primary Level of Prevention

The community of Sumter county as a whole can overcome the lack of access to

healthcare services through a primary intervention of clinical homes. These clinical homes

would serve as another access to healthcare services to those who need it and prevent the start of

disease. It gives community member access to risk factor modification and health promotion

services. This will help people manage their complex health problems preventing unnecessary

hospital admissions. For example, at a clinical home education on controlling hypertension and

smoking sensation, which are cardiovascular disease risk factors, can be taught. This would

prevent these patients from ending up in the hospital because they have modified their life in

order to stay healthier. Setting up clinical homes with a focus specifically in cardiac, stroke, and

diabetes will maximize community health and prevent these patients from burdening the health

system. A study at a University in New England showed that through a clinical home

community model where nursing students used health promotion it decreased the healthcare cost

of the individuals in the community going to these clinical homes on a regular basis significantly

(Williams, Sweatt, Harkness, & DiNapoli, 2004). Funding concerns for this intervention would

be the cost of the facility including utilities and renting space, the pay salary of the nurse at this

clinical home, and the ability to find where founding sources would come from. The role of the

community nurse in this intervention would be to coordinate where these clinical homes would
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be located within the areas of most need, setting up meeting times, topics being discussed,

reminder notifications to those signed up, and providing the educational material. The

stakeholder would include the individuals signed up for these homes and the healthcare providers

within the community because this would be another access to healthcare services that people

can tap into instead of the traditional acute care services when diseases go unnoticed.

Secondary Level of Prevention

A mobile health clinic is another evidence based interventions that helps detect and

provide early treatment for patients who are showing signs and symptoms of a disease. This

intervention would provide another means of access to healthcare services because it can be used

for screening, diagnosis, and treatment of individuals in the community who are not able visit a

provider. Bringing the health professionals to the individuals that are underserved or have the

lowest levels of access to providers can prevent these people from suffering greater health

problems in the future. Another study on the effects of a mobile clinic showed that it can

increase the number of patient visits to an extra 3,400 visits a year (Luque & Castaeda, 2013).

Here community members can get blood sugar and blood pressure screenings, TB testing,

immunizations, contraception, and general healthcare advice to name a few health services. This

intervention is geared toward community members as the stakeholder because they will directly

benefit from this easy access to healthcare. Other stakeholders would be healthcare providers at

TVRH and AMR because it would prevent these patients from having to access their acute

services which are much costlier and burdensome. Funding concerns include the mobile clinic

medical supplies, gas, maintenance, breakdowns, insurance, and other upkeep. The public health
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nurse could be the coordinator. The duties would include advertising these mobile clinics,

researching the best locations and times, and serving on the clinic with direct patient care in

screening, treatment, and education.

Tertiary Level of Prevention

Another way the community of Sumter County can overcome the lack of access to health

services is a tertiary prevention of telehealth. Patients in rural Australia have reported benefits

from the use of telehealth because it provides an easy access to health services, and it also gave

the patients specialized health professionals that are difficult to afford and locate (Moffatt &

Eley, 2010). Monitoring compliance, monitoring treatment effect, and reporting consequences

are three benefits telehealth brings to those patients who are not able to access healthcare in the

traditional way. This would also prevent further negative impacts on health to an individual

because it would decrease the time that would normally be spent traveling to a location. The

stakeholders would be the community member and the healthcare provider. The health provider

will also benefit because telehealth has shown to increase recruitment and retention for rural

health workers (Moffatt & Eley, 2010). Funding concerns would include paying for this advance

technology, software updates and crashes, and the individuals financial concerns with being able

to afford a computer or smartphone where telehealth would be accessed. The community health

nurse would have the primary role in carrying out this intervention by making community rounds

in various parts of the county providing teaching on the use and services telehealth brings to the

individual. Other duties would include initial patient visits to set up the software and an

orientation to its use.

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Development of Health Policy

Health policy on healthcare has effects on where people live, where they get an

education, how far or close a health care facility is in relation to a community, and the

environment where people must live and work. Health policy can decrease or increase the

workload on the general healthcare system. The health policy proposal for this county would be

to develop clinical homes in key locations within the community. This health policy is a primary

level of prevention because it is concerned with preventing the onset of disease. This would be

another access for healthcare services for individuals who will be able receive free health

promotion and risk factor modification health services through this clinical home. The

community nurse will need to focus on educational areas on cardiac, stroke, and diabetic

teaching.

The stakeholders would include the individuals signed up for these homes and the

healthcare providers within the community because this would be another access to healthcare

services that people can tap into instead of the traditional acute care services that are already

overloaded. The supporters would be the public health sector and community members who do

not have access to healthcare services. Opposing forces to this policy could be any health care
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service provider because this policy would take patients away from them and move them into a

clinical home where free healthcare disease prevention would be provided.

The plan to put this policy in action is to approach the local health department, AMR, and

TVRH personal. Next the community nurse would coordinate where these clinical homes would

be located within the areas of most need, setting up meeting times, topics being discussed,

reminder notifications to those signed up, and providing the educational seminars and materials.

This policy would affect the county by meeting the goals and outcomes of when the county EMS

provider AMR notices a decrease in the volume of calls going out for unnecessary preventable

problems. It would also be met when TVRH has a lower number of patients who are being

diagnosed with cardiac, strokes, or diabetic problems. And lastly it will foster a greater

community health literacy leading to greater health for all because the acute care services will

have less stress and the access for health services for those in poor and underserved areas will

have a clinical home to take advantage of for services.

Conclusion

Key areas of this paper include that Sumter county has a large metropolitan population in

the north and mostly rural population spread throughout the rest of the area. It has strengths of

sleep quality, HIV prevalence, and overall reports of good health. Its weaknesses when

compared to the state and national bench markers are poverty, children being uninsured, and a

lack of access to health services. Primary, secondary, and tertiary prevention techniques to

increase health care services include clinical homes, mobile clinics, and telehealth. The health

policy of setting up clinical homes targets patients who do not have access to healthcare services
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and it increases their access by giving them a place to migrate to and receive disease prevention

through risk factor modification and health promotion.

This paper has had a huge impact on my nursing career because it is opening my eyes to

health disparities, the greater cause of poor health. It has also shown me all the ways that can be

used to better the health of people. I use to think that hands on clinical nursing was the best way

to help people, however as a result of this paper I am now more capable to help people in

possible greater ways.

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Reference

Healthy People 2020. (2016). Retrieved September 29, 2016 from

https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-

Services/objectives#3970

Health Rankings. (2016). Retrieved September 18, 2016, from

http://www.countyhealthrankings.org/app/florida/2016/measure/factors/24/description.

Moffatt, J. J., & Eley, D. S. (2010). The reported benefits of telehealth for rural

Australians. Australian Health Review, 34(3), 276-281. doi:10.1071/AH09794

Luque, J., & Castaeda, H. (2013). Delivery of Mobile Clinic Services to Migrant and Seasonal

Farmworkers: A Review of Practice Models for Community-Academic

Partnerships. Journal Of Community Health, 38(2), 397-407. doi:10.1007/s10900-012-

9622-4

Williams-Barnard, C., Sweatt, A., Harkness, G., & DiNapoli, P. (2004). The clinical home

community: a model for community-based education. International Nursing

Review, 51(2), 104-112.

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Fastest growing counties in the U.S. 2015 | Statistic. (n.d.). Retrieved November 20, 2016, from

https://www.statista.com/statistics/241711/fastest-growing-counties-in-the-us/

Sumter County, FL - Official Website | Official Website. (n.d.). Retrieved November 19, 2016,

from http://sumtercountyfl.gov/