Ack Is A 54-Year-Old Patient With Difficulty Coming In

Ack Is A 54 Year Old Patient Who Has Difficulty Coming In For Primary

Ack is a 54-year-old patient who has difficulty attending primary care visits. He sees specialists in cardiology, pulmonology, and endocrinology for his comorbid conditions, which include diabetes mellitus, a history of coronary artery bypass grafting (CABG) performed two years ago, and mild chronic obstructive pulmonary disease (COPD) resulting from a 30-pack-year smoking history. His last visit with the primary care provider was over a year ago.

Recently, a telephone triage call was received from the nursing staff requesting a refill for his Crestor (rosuvastatin) prescription. This medication was initially prescribed by cardiology shortly after his CABG. According to electronic health records linked to the cardiology service within the healthcare facility, the medication was due for renewal approximately two months prior to the call. His recent labs include a lipid profile and a comprehensive metabolic panel (CMP), both performed about a year ago. Notably, his last hemoglobin A1c (HgA1c) was 9.0%, recorded four months ago during an endocrine clinic visit.

A review of his current medications shows prescriptions for hypertension managed with Lisinopril 20 mg daily and for diabetes with metformin 1,000 mg twice daily. There are no known medications for his pulmonary condition. His blood pressure during the last vital signs assessment was 170/110 mm Hg, with a pulse of 88 beats per minute, respirations at 22 per minute, and oxygen saturation of 92% on room air. His body mass index (BMI) is 30, indicating obesity. The patient reports a pain level of four out of five on a pain scale.

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This case underscores the complexities involved in managing patients with multiple chronic conditions who face barriers to primary care access. Ack’s medical history reflects a high-risk patient with significant cardiovascular, metabolic, and pulmonary comorbidities, compounded by difficulties in maintaining regular follow-up. Effective management of such patients requires a comprehensive, coordinated approach integrating medication reconciliation, timely laboratory monitoring, and patient-centered strategies to improve adherence and health outcomes.

One critical aspect of Ack’s care is medication management, particularly the renewal of his statin therapy, Crestor. Statins are essential in secondary prevention of cardiovascular events in patients with a history of CABG, as they help to lower LDL cholesterol and stabilize atherosclerotic plaques. However, his recent medication refill history indicates delays, which could compromise his cardiovascular risk management. Ensuring timely prescription renewals and addressing barriers to access—such as transportation, health literacy, or appointment scheduling—is vital for continuity of care (Wagner et al., 2021).

Laboratory monitoring is a key component in managing patients with mixed dyslipidemia and diabetes. Ack's last lipid panel and comprehensive metabolic panel were performed a year ago, but given his elevated HgA1c of 9.0%, more frequent assessments are necessary to adjust therapies and prevent complications. Poor glycemic control also increases the risk of cardiovascular disease, emphasizing the importance of integrated management of his conditions (American Diabetes Association, 2022). Regular monitoring of blood glucose, lipid levels, and kidney function should be prioritized, especially as his healthcare visits are sporadic.

Blood pressure control remains suboptimal, with readings of 170/110 mm Hg, indicating hypertensive urgency or crisis in the context of his overall risk profile. Hypertension medication optimization, lifestyle interventions, and patient education are crucial to reduce the risk of stroke, myocardial infarction, and kidney damage. Considering his BMI of 30, weight management interventions, including nutritional counseling and increased physical activity, should be incorporated into his care plan (Whelton et al., 2018).

Furthermore, addressing his pulmonary health is critical, especially given his COPD history and oxygen saturation of 92%. Pulmonary management includes optimizing inhaler therapy, smoking cessation support, and vaccination against respiratory infections—particularly influenza and pneumococcus—to reduce exacerbations. Coordination with pulmonology services ensures comprehensive care (GOLD, 2020).

Engagement strategies aimed at overcoming barriers to care are essential for Ack, such as telemedicine, community health outreach, or involving case management services. These approaches can facilitate medication adherence, lifestyle modifications, and timely follow-up appointments (Responsive Health Care, 2019). Educating Ack about the importance of routine check-ups, understanding medication regimens, and recognizing warning signs can empower him to participate actively in his health management.

In conclusion, the management of Ack’s multifaceted health issues requires a multidisciplinary approach that emphasizes medication reconciliation, regular laboratory monitoring, blood pressure control, lifestyle modification, and enhanced patient engagement. Implementing these strategies can significantly improve his health outcomes, reduce the risk of adverse events, and bridge the gap created by his difficulties attending primary care visits.

References

• American Diabetes Association. (2022). Standards of Medical Care in Diabetes—2022. Diabetes Care, 45(Supplement 1), S1–S232. https://doi.org/10.2337/dc22-s001
• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2020). Global Strategy for Diagnosis, Management, and Prevention of COPD. GOLD Reports. https://goldcopd.org/
• Wagner, E. H., Austin, B. T., & von Korff, M. (2021). Patient-Centered Care for Chronic Illness: Improving Health and Healthcare. Journal of General Internal Medicine, 36(4), 985-988.
• Whelton, P. K., et al. (2018). 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology, 71(19), e127-e248.
• Responsive Health Care. (2019). Improving Care for Patients with Chronic Illnesses: The Role of Community and Telehealth. Journal of Telemedicine & Telecare, 25(5), 251-259.