At the federal level, one major policy impacting care coordination across all health conditions is HIPAA, or the Health Insurance Portability and Accountability Act. While HIPAA protects patient privacy, which is critical, aspects of the rules can pose challenges for coordinating care between providers (Marron, 2024). For example, HIPAA restrictions require explicit patient consent to share health information outside of the originating organization. This can inhibit coordination activities like discharge planning or referral follow-ups between hospitals and outpatient clinics. Some provisions have been relaxed during the COVID-19 public health emergency to enable better information sharing for care continuity. However, ethical questions remain around patient rights to control their data versus the benefits of information exchange to promote integrated, holistic care.
Looking beyond HIPAA at other federal policies, we see many government regulations shape prevention and treatment services relevant to cardiovascular health. For instance, CMS guidelines determine what cardiac rehab and smoking cessation counselling sessions Medicare will reimburse – which informs access for millions of Americans (American Hospital Association, 2024). FDA advertising rules attempt to limit misleading health claims on foods and supplements that could give false impressions about heart benefits (Federal Trade Commission, 2022). Agriculture policies subsidizing commodity crops indirectly influence nutritional patterns tied to risks for obesity, diabetes, and hypertension. Evaluating all the upstream policies that construct the modern food environment reveals many ethical debates about public health versus consumer choice.
Moving to state-level policies, a major one affecting access to cardiovascular services is Medicaid expansion. In states that have expanded eligibility for this public insurance program, research shows increased rates of health coverage, regular primary care, and use of medications for managing chronic conditions like high cholesterol. However, the 12 states still refusing expansion are more likely to have uninsured residents unable to afford critical preventative help or early treatment. Hospitals and clinics in non-expansion states often provide uncompensated care, leading to financial strain and closures that further reduce health access. So, state leaders blocking policies that would assist low-income individuals face ethical scrutiny for perpetuating coverage gaps and barriers to care continuity.
Local Policies and Cardiovascular Health Programs
Drilling down to the local level, we see city and county policies aiming to promote cardiovascular wellness in the community. For example, some municipalities have implemented special taxes on sugary soda purchases to curb overconsumption and raise revenues for health programs. Store zoning policies might regulate the density of fast food restaurants or restrict sales of tobacco products – though these face criticism for overreaching government control. On the other hand, policies funding public transportation, community gardens, and fitness space creation can positively influence activity levels and nutrition. Grants for preventative screenings, food pharmacies, or mobile health clinics also expand access along the continuum of care. Nonprofit hospitals have a mandate to spend a portion of their budget on community benefit programs – many target heart disease through blood pressure outreach events or CPR training open to the public.
Ethical Debates in Cardiovascular Care Delivery
Clinical cardiovascular care itself carries many ethical considerations as well. Disparities along racial, geographic, and socioeconomic lines emerge at every step, from risk assessment to rehabilitation. This raises equity issues around the standard of care and fairness for those facing systemic disadvantages (Youmans et al., 2019). Treatment decisions for advanced therapies or transplants also require balancing the probability/severity of risks versus benefits with cost burdens on families or society. Difficult judgments similarly weigh prolonging end-stage life with palliative approaches versus quality of remaining life. Ailing rural hospitals creating care deserts confront moral and economic dilemmas to stay solvent. Across prevention and disease management alike, choices surrounding resource allocation elicit complex tradeoffs under constraints.
Impact of Nursing Code of Ethics on Care Coordination
Nurses play central roles in connecting patients across phases of cardiovascular illness – from primary prevention to acute care to chronic maintenance. The Nursing Code of Ethics provides principled guidance on the delivery of caring, compassionate, ethical care. Provision 1 emphasizes patient autonomy and shared decision-making between clients and clinicians. This directive is highly relevant when advising on delicate procedures like implanted defibrillators or considering hospice discussions for elderly patients. Provision 3 underscores equitable, just resource distribution – applicable to nurses advocating for policy changes to address disparities or barrier removal. Provision 7 integrates individual, family, community, and population health interests (American Nurses Association, 2015). Determinants like education, built environments, and social support intrinsically link to cardiovascular outcomes. Nurses balancing multidimensional well-being while respecting cultures align with this Provision’s call to understand people holistically.
Health Disparities and Cardiovascular Disease
Unfortunately, significant outcome disparities exist across populations for both heart disease and stroke. Low-income individuals face higher risks for hypertension, diabetes comorbidities, smoking, and other factors – yet have lower access to regular preventative care or prescription affordability. Ethnic minorities also bear elevated cardiovascular risk, but utilization of rehab services falls below optimal levels. Rural residents report heavier disease burdens; however, specialist and emergency care access lags due to hospital closures. And relevant to the AHA’s audience – women exhibit lower awareness around female-specific symptoms like fatigue, nausea, and back pain that prompt delayed help-seeking behaviour. Compounding lifestyle and clinical divides underscore why equity-focused care coordination strategies remain so vital.
Addressing Wider Determinants of Cardiovascular Health
Caring for the whole person and whole community moves beyond just doctors’ offices into homes, schools, jobs, farms, and forests. Social and environmental inputs shape everything from inflammation and immunity to blood pressure. Nutrition programs, smoking bans, playgrounds, and resilient city planning represent just some interventions to help construct healthier contexts. Yet policy changes alone cannot eliminate health disparities without empowering affected groups through education, voice, and collective capability building to mobilize communities from within. Nurses play integral roles in decoding medical language, connecting cultural dots, and advocating alongside patients marginalized by existing systems. Amplifying lived experiences fuels ethical, equitable, activist care coordination redesign.
References
American Hospital Association. (2024, January 17). Proposals to Reduce Medicare Payments Would Jeopardize Access to Essential Care and Services for Patients | AHA. Www.aha.org. https://www.aha.org/guidesreports/2023-06-26-proposals-reduce-medicare-payments-would-jeopardize-access-essential-care-and-services-patients
American Nurses Association. (2015, January). Code of ethics for nurses. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
Federal Trade Commission. (2022, December 20). Health Products Compliance Guidance. Federal Trade Commission. https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance
Marron, J. (2024). Implementing the Health Insurance Portability and Accountability Act (HIPAA) Security Rule: https://doi.org/10.6028/nist.sp.800-66r2
Youmans, Q. R., Hastings-Spaine, L., Princewill, O., Shobayo, T., & Okwuosa, I. S. (2019). Disparities in cardiovascular care: Past, present, and solutions. Cleveland Clinic Journal of Medicine, 86(9), 621–632. https://doi.org/10.3949/ccjm.86a.18088
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