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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.
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.
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
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).
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
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
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.
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.
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
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
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
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
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
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
Reference
https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-
Services/objectives#3970
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
Luque, J., & Castaeda, H. (2013). Delivery of Mobile Clinic Services to Migrant and Seasonal
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Williams-Barnard, C., Sweatt, A., Harkness, G., & DiNapoli, P. (2004). The clinical home
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/