INTERDISCIPLINARY TEAM CASE

Mrs. B is a 35-year-old female who comes to the community clinic complaining of a cough for 3 months. She had come to the clinic 2 months ago with a similar complaint and was given "some pills" to take. She reported that she only took 3 of the pills because "they did not help" and they upset her stomach. She does not know what her diagnosis was or what the name of the pills was that she was given. She also was given pills for her blood pressure and she reports that she needs some more of these since she ran out two days ago. She has no other symptoms and she reports that no one else in her family is sick at this time.

She does not smoke, although her husband does. She does not drink alcohol. She does not exercise. She eats a small amount for breakfast and a big dinner at night.

Mrs. B works as a cleaning lady for a family who lives in the suburbs. She has a 3-year-old daughter and a 7-year-old son. She has lived in the United States for about 3 ½ years after immigrating to the US from Central America. She speaks very little English. She has brought her son with her this evening to interpret. He was not able to come to the last visit. Mrs. B is able to read very little in her native language and does not read any English. She earns $600 per month at her job and has no medical insurance. She traveled by bus to come to the clinic this evening. This is the clinic nearest to Mrs. B’s home. She lives in an apartment with her husband and 2 children and 3 other adults. There are no pets. Mrs. B reports that she "takes shots" that she gets from her native country to prevent pregnancy.

• There is a family history of Diabetes.
• Vital Signs at this visit as taken by the clinic nurse are: Weight 185 lb, Ht 5’ 4", BP 160/108 on the Right arm. The nurse notes that the patient appears depressed and tired.
• Mrs. B is examined by a clinic physician who is a new volunteer physician at the clinic and has not seen Mrs. B before.
• Plan of Care this visit:
  •   PPD placed. Patient to return in 2 days for reading.
  •   Patient given referral for x-ray at the nearest hospital. (Hospital is 3 buses away and she must go before 5 p m on a weekday.)
  •   A new medication for hypertension is given. (The medication she previously was given is not currently available at the clinic). Patient is to return to clinic in one month for a recheck of her blood pressure
  •   Appropriate Labs are drawn and results are pending
  •   Appointment given for follow up in 2 months
  •   Appointment given for nutrition/exercise counseling in 4 weeks. (Nutritionist available once per month)
  •   Patient advised to make an appointment for a complete physical exam including a gyn exam and PAP smear test.

Mrs. B returns to the clinic 6 weeks later with the complaint of continued coughing. She comes to clinic because her employer is concerned that she might have something contagious. She did not return for the PPD reading as scheduled. She did go to the hospital for the chest X-ray but after waiting a long while she left without being seen. She is out of her blood pressure medicine again and today her blood pressure is 180/110

A clinic community volunteer has agreed to go with Mrs. B for the chest x-ray. A new PPD is placed. A new medication is given for hypertension because the clinic does not currently have either of the previous two medicines.

The chest x ray is negative. The PPD is read as 15mm in size. The Department of Health is notified and Mrs. B is told to go to the Chest Clinic for a smear and culture. The patient’s daughter is tested and found to be PPD positive as well as one of the other adults sharing the apartment. Mrs. B’s husband has not been tested yet. Mrs. B’s employer and the other members of her family have been tested and are all negative.

Using your individual knowledge, experience and creativity as well as the information and readings presented in the module, analyze this case with consideration of the following questions.

1. Identify 3 major health problems this patient and her family were encountering. Consider health problems in a community-oriented framework. Think about her individual health problems and health risks as well as those of her family and community that are evident in this case.
2. What barriers were presented in this case that impeded her access to optimal community-oriented primary care
3. Identify the individual members of the health care team that were involved in Mrs. B’s health care at the clinic. Describe their roles. Assess their team function in the delivery of care to Mrs. B. What type of team practice model was being used?
4. What additional team members could have been utilized to facilitate optimal health care for Mrs. B and her family and community, why? What type of team model/s would improve the care given to Mrs. B, her family and the community?
5. How would you modify the plan of care given to Mrs. B using the concepts of Interdisciplinary team health care described in this module