Clinical Case Studies

Among minorities such as Asians, Hispanics, Indians, Native Americans, and Middle Easterners, the African American race has been affected tremendously by the health disparities in the United States. Currently, African Americans have significantly higher mortality rates from cardiovascular and cerebrovascular disease, cancer, diabetes, HIV, unintentional injuries, pregnancy, sudden infant death syndrome, and homicide than do whites Americans (Fiscella & Williams, 2004). While African Americans may lead in these categories, other minorities are not far behind in experiencing health disparities.

Barriers in health care can lead to disparities in meeting health needs and receiving appropriate care, including preventive services and the prevention of unnecessary hospitalizations (HealthyPeople.gov, 2012). In their 2008 annual report, the Agency for Healthcare Research and Quality lists several disparities’ in health care. They report that racial and ethnic minorities in the United States

Healthy People 2020 discusses a number of special population’s that have barriers to care including; race, age sex, sexual identity, age, disability, socioeconomic, and location; this post will discuss race (ethnic) group.  There are a number of races mentioned in healthy people 2020, such as, Asian, American Indian, Alaskan, Latino and African American (Healthy People 2020, n.d.). Access to health care in an ethnic group is multifaceted from the lack of trust, lack of health care education, discrimination and cost of care including health insurance. According to Howard, Peace, & Howard (2014), African Americans have a greater risk of three preventable diseases, hypertension, renal failure and bacterial infections stating; “no other disease

According to the Centers for Disease Control and Prevention, “health disparities are preventable differences in the burden of disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups, and communities” (CDC, 2017).  It  is easy to believe that control on overall health relies solely on making  a firm decision (the “right” decision" to lead a healthy lifestyle— by being active and eating a balanced-diet. There are other factors to be considered in evaluating and understanding health disparities: why people seem to be noncompliant? Or why people aren’t seeking medical attention in a timely manner?  In reading

In today’s society, there are many different factors that can contribute to one’s overall health and well-being. Since there are so many different factors that can affect one’s health, there are inequalities that exist among people and this is knows as health disparity. "Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States” (Nhlbi.nih.gov, 2015). Health disparities can be associated with factors such as: socioeconomic status, education, gender, race, ethnicity, age, mental health, and religion. There are certain health problems that can affect different groups more than others, such as diabetes, obesity, heart disease, and HIV/AIDS (Surgeongeneral.gov, 2015). One example of a specific population in the United States that is affected by health disparities is the African American Population. While African Americans are affected by various health disparities, one that affects this population more prominently is heart disease.

Health disparities endure tenacious issues in the United States of America, setting certain groups at higher risk of being uninsured, limited access to care, facing a poorer quality of care, and overall negative health outcomes. The high incidence of health disparities reflects the range of individual, social, economic, racial/ethnic and environmental magnitudes. Among the minority groups, African-Americans disproportionately access health care and the health disparities clearly glow in the nationwide.

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

The Ethnic minority populations, such as the African Americans, are more likely to be physically inert and experience higher levels of obesity and other sustained conditions than the other ethnic majority counterparts. This disparity may be connected in part to socio-economic status, lack of access to healthful foods and exercise facilities, and varying access to and utilization of health care services .The African Americans are likely impacted by both numerous factors such as self efficacy, and unsafe environments . Becoming more physically active demand cost and safety due to poor access and utilization of health services (de Oliveira et al., 2016).

According to the Census Bureau approximately 49 million Americans didn’t have coverage in 2011. The Patient Protection Affordable Care Act has only been extended to cover 32 million uninsured individuals mandates. The main issue of access to affordable care will be to exacerbated by limited community- based resources that provide preventive services, primary care access and the continuum care for patients with chronic conditions. There is a need to increase capacity to serve more patients, while improving outcomes and reducing cost. Health disparities in the U.S. range from HIV/ Aids to obesity. The minority population typically has a disproportional burden of the HIV/ Aids epidemic ( Wetle & Scanlan 2013). Disparities in healthcare are among the lines of access to care, treatment, preventive measures, and medicine. Several research projects were used to examine how ones race, neighborhood, or social classes affect their quality of care, and health outcomes ( Wetle & Scanlan , 2013). It was found that people who lived in lower income urban areas were found to have a lower quality of care. The study also found that these people were also prescribed stronger more dangerous medicine, and also paid higher co- pays. The Affordable Care Act was created to target, and eliminate health disparities (Adepoju , Gonzales , and Preston 2015). The ACA planned to improve health disparities by increasing access to care for minorities. In addition to improving access to care the ACA

On Tuesday 06/27/2017, veteran Mr. Saenz walked very angrily in my office with his wife about 11:00 AM. I greeted them and offered to sit down; Mr. Saenz and Mrs. Saenz were very upset and asked me where they need to go as they have VA examination, they both said “nobody tells them anything; they have been sitting in waiting room”. They told me that the lady on the desk told them to come to me.

Some African American, especially those in low resource communities, do not know how routine visit to the doctor and taking their medication on a regular basis can be beneficial to their health. Missing appointment are often time associated with increased risk of hospitalization. By missing appointment, doctor are not able to provide the proper care to their patient, which is often time result in poor control of chronic illness, hospitalization and sometime death if proper medical care is not given in time. Often time African American in low resource community have a hard achieving normal blood pressure as appose to other ethnic group. Even though several intervention programs are set in place to improve appointment adherence, many individual still missed schedule appointment, which remain a problem because proper healthcare and treatment is not given. Many individual does not know about the importance of appointment adherence, but despite its importance, not much information or data exist about the risk factors associated with non-adherence among hypertensive African American. “Therefore, to fill this gap, this study examined factors associated with patient-reported appointment adherence among African-Americans with severe, poorly controlled hypertension, using data from the Inner City Hypertension and Body Organ Damage (ICHABOD) - a cross-sectional survey of urban African-Americans hospitalized with severe, poorly controlled

Nearly 50,000 African- American women are killed by cardiovascular diseases (CVD)annually.3 Sedentary lifestyle/physical inactivity and overweight/obesity are two significant risk factors for CVD in African-American women.2 Prevention is possible by reversing community acquired behavioral risks, especially in African-American women, such as diet, exercise, and blood pressure control. However, minority women have limited access to health care resources. This disparity is even more evident in Southern African-American women.2 It is reported that 57% of these women lack leisure time activity, and 43% are either overweight or obese.2

Bennie has been experiencing many feelings of depression. One symptom that is listed with major depression disorder is Bennie’s feelings of depression for over the past two months. Bennie has been having these feelings of depression almost everyday. Another symptom Bennie is experiencing is insomnia every night and feelings of exhaustion the next day. Bennie is having trouble concentrating and diminish in pleasure in everyday tasks. Other symptoms of depression are low appetite and feelings of worthlessness. One major symptom that needs to be explored more is Bennie’s thoughts and feelings about suicide. There is definitely a correlation between Bennie’s depression and his substance abuse. Without more information about Bennie’s past it cannot be said whether Bennie’s feelings of depression came first or his substance abuse. However, it is quite clear that his substance abuse is not helping his feelings of depression. Bennie has been using alcohol to try to make his life manageable and ease his feelings of depression.

Diet encompasses heart-healthy eating that includes the Dietary Approaches to Stop Hypertension (DASH diet) which aims at reducing the blood pressure and the bad cholesterol (LDL). This requires the fat rich hamburgers to be replaced with legumes, vegetables, fruits, whole grains, vegetable

Client reported that she decided to compete in that NYC marathon after some encouragement by friends she met while in Odyssey house's in-patient treatment. Client sites her friends as being a motivational component of her life, but doesn't have many real ones.