Discussion: Building A Health History

Discussion: Building A Health History

Main Discussion Post

Case Study:  EB is a 68-year-old black female who comes in for follow-up of hypertension. She has glaucoma and her vision has been

worsening during the past few years. She lives alone and is prescribed four hypertension medications (Hydralazine 50 mg PO Q8H,

Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily). She brings in her medication bottles and she has some

medication bottles from the previous year full of medications. She is missing one medication she had been prescribed and says she may

have forgotten it at home. Her BP in clinic today is 182/99 with HR of 84.

The patient’s socioeconomic status may be low as she lives alone; therefore, more than likely one income.  Since the patient did not

bring a family member or friend with her to the appointment, she may not have a strong support system.  The patient is non-compliant with

medication, this may be from her belief system, financial reasons, or not being able to properly see due to her worsening glaucoma.

I would make sure the patient felt comfortable and provide as much education about her diagnosis as possible.  African Americans

have a much higher prevalence of hypertension compared to all other racial and ethnic groups (American Heart Association, 2017).  Often,

illness is affected by the patient’s overall experience in healthcare and their belief system (Ball et al., 2018).  It is important to develop

a positive relationship, so the patient feels comfortable and develops trust.  I want to ensure she can read the labels on her medication and

offer to speak to her pharmacy about providing medication labels for the visually impaired.  The FDA Safety and Innovation Act (S.3187)

encourages pharmacies to provide drug labeling for the vision-impaired or elder population (Pharmacy Times, 2015).

Targeted Questions:

Tell me about your daily routine and diet?

Do you understand how your medications help you?

Do you have a way to check your blood pressure at home?

Do you notice a difference in the way you feel when you take your medications verses days that you do not take your medications?

Do you have any difficulty obtaining the medications from the pharmacy?

References

American Heart Association. (2017). What About African Americans and High Blood Pressure? Retrieved June 9, 2021, from /orders/www.heart.org/-/media/files/health-topics/answers-by-heart/what-about-african-americans-and-hbp.pdf?la=en

Ball, J., Dains, J., Flynn, J., Solomon, B., & Stewart, R. (2018). Seidel’s guide to physical examination: An interprofessional approach (mosby’s guide to physical examination) (9th ed.). Mosby.

Pharmacy Times. (2015, January 5). Best Practice Guidelines for Prescription Labels for the Visually Impaired. Retrieved June 9, 2021, from /orders/www.pharmacytimes.com/view/best-practice-guidelines-for-prescription-labels-for-the-visually-impaired

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POST 2

Week 2 discussion

“Culture shapes health-related values, norms, beliefs, and behaviors through people’s connection to their social and physical environments,” said Swierad et al. (2017, p.2). As a result, race, ethnicity, cultural and spiritual disparities, in addition to poverty and socioeconomic status, affect healthcare delivery in the United States (Ball et al., 2019).

The patient is a 68-year-old African American female who comes in for a follow-up of hypertension. She has glaucoma, and her vision has been worsening during the past few years. She is a widow who lives alone in an apartment building in a diverse neighborhood in the city. Her grown children are “out of town at that moment.” She brings in her medications for reconciliation. Some of the medication bottles are dated from the previous year and are full of medications. The patient says that she is missing “that pink pill” she had been prescribed and added, “maybe they are at home, but I am not sure.” The prescribed medications are for hypertension and include Hydralazine 50 mg PO Q8H, Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily). Her BP in the clinic today is 182/99 with HR of 84.

The patient appears to have low or limited healthcare literacy. For example, she does not know the names of her medications (“that pink pill”) and looks like she does not fully understand the necessity of medication adherence (bottles full of old medicines, high BP in the clinic). Patients with limited health literacy are at higher risk to obtain, process, and understand basic health information. Therefore, those risks adversely affect the health decisions and outcomes, Davis et al. emphasized (2020).

There are demographic factors associated with low or limited health literacy, including unemployment, income, education, and gender (Davis et al., 2020). For example, authors in their study showed that 43% of black American males with a high school diploma or less, who are unemployed, unable to work, or retired, with low household income (less than $25,000) did not have an annual physical exam. Additionally, Melton et al. (2014) emphasized that black Americans receive a lower quality of care and are treated differently than the white population due to injustices and racism. Consequently, they don’t trust and avoid the medical care and healthcare system.

However, the health literacy disparities not only appear because of race. The level of education, culture, and access to the healthcare system also play a fundamental role in healthcare literacy (Melton et al., 2014). Therefore, interventions that target a diverse population should be implemented. For example, patient education through community resources or materials with easy-to-understand language should be delivered to the patients.

The sensitive issues while caring for the patient are racism, stereotyping, bias, gender identity, sexuality, and language barrier. Ethnic and cultural minorities, as well as the LGBT+ population, often face discrimination and disrespect within the society. The stereotypes, biases, mistreatment, and dehumanization of patients from diverse groups increase the risk of mistrust and avoidance of medical care. Therefore, culturally competent healthcare is paramount in delivering professional patient-centered care.

Targeted questions

1. Since you live alone, tell me, who helps you in the household?

2. Tell me, who helps you manage your medications?

3. Tell me if you have a problem with filling out medical forms?

4. Tell me if you know the names of your medications?

5. Tell me if you have a problem with reading or writing?

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Davis, S. N., Wischhusen, J. W., Sutton, S. K., Christy, S. M., Chavarria, E. A., Sutter, M. E., Roy, S., Meade, C. D., & Gwede, C. K. (2020). Demographic and psychosocial factors associated with limited health literacy in a community-based sample of older Black Americans. Patient Education & Counseling, 103(2), 385–391. /orders/doi-org.ezp.waldenulibrary.org/10.1016/j.pec.2019.08.026

Melton, C., Graff, C., Holmes, G. N., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African American adults: an interpretative phenomenological analysis. The Journal of asthma: official journal of the Association for the Care of Asthma, 51(7), 703–713. /orders/doi.org/10.3109

Swierad, E. M., Vartanian, L. R., & King, M. (2017). The influence of ethnic and mainstream cultures on African Americans’ health behaviors: A qualitative study. Behavioral Sciences (2076-328X), 7(3), 49. /orders/doiorg.ezp.waldenulibrary.org/10.3390/bs7030049