Case Description: You are working as a health professional (practitioner or student) at Cincinnati Children’s Hospital Medical Center (CCHMC) providing care or consultation to patients seen in the Emergency Department.
Today you are assigned to provide care for a nine-year-old Hispanic male who was diagnosed with a seizure disorder/epilepsy at the age of six. He is being raised by a single mother who worked at a nursing home as a dishwasher. She has been recently let go due to too many absences due to her son’s illness. The family does not have any medical insurance. They have been evicted from their home in the past and have had to rely on friends and family to bring them in. However, their family and friends are no longer willing to help. They are currently living in a family homeless shelter. At the shelter, breakfast, dinner and a bed are provided to them. The shelter van takes the mother to the day center daily where she receives help trying to find a job. The son attends Mt. Airy Elementary.
The boy is followed by neurology at CCHMC; however, he has missed his last three scheduled appointments. He has also not been able to adhere to his prescribed medication regimen, which consists of carbamazepine TID by mouth. Over the last week, he has had an increase in seizure activity so his mom brought him to the ED for evaluation. When the patient is examined and blood is drawn, his carbamazepine level is zero. (A therapeutic carbamazepine level is four to twelve.) The mom begins to cry and tells the RN that she cannot afford his medicine and she does not know what to do. She states, “I am overwhelmed with everything!” She cannot find a job, her son is failing 3rd grade, and her family and friends have written her off.
Posting 1: Initial student response to questions:
- Lack of health insurance limits this patient’s access to quality seizure care. But barriers to quality care exist even for those who are insured. What are some of those barriers?
- Are there differences in seizure disorder prevalence by race and income? (Please base your response on a review of appropriate websites as well as the attached article.) Are there differences in how children in minority groups access medical care? How do these differences affect epilepsy care?
- As a health professional in your area of focus, how could you be an advocate for this child? How could you help to ensure improved epilepsy care (or other chronic illness, i.e. diabetes, mental illness, renal disease, etc.) for vulnerable individuals (and populations)?
Sample Solution