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Mariana Esposito (48 yo F), Health information, What is the nature of…
Mariana Esposito (48 yo F)
Chief Complaint: Right shoulder pain
(suspected rotator cuff (supraspinatus) injury) and establishing care with new PCP
Manual wheelchair: Over use of arms when using her wheel chair
Right shoulder strength weak compared to left (can't abduct more than 30º)
Pain with active movement, but passive shoulder movement present
Preliminary assessment: High suspicion of supraspinatus muscle injury in rotator cuff
treated with naproxen
what is the nature of naproxen for treating shoulder pain and what are potential SE?
Naproxen is an NSAID - reduces inflammation and decreases pain in the shoulder joint
Available over-the-counter with doses typically ranging from 220 mg to 500mg, taken every 8 - 12 hours as needed
Common side effects: GI issues, dizziness, headaches, drowsiness, GI bleeding with long-term use, HTN, kidney problems, cardiovascular risks with prolonged use, allergic reactions
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Q: policy to protect individuals with disabilities?
American Disabilities Act, the Rehabilitation Act of 1973, Affordable Care Act
ADA Title III: Public Accomodations is effective
Private entities like dr's offices fall under Title III and these places must comply with specific requirements related to architectural standards for new and altered buildings and existing barriers must be removed
Q: Overlooked barriers that exist for patients with disabilities in clinical care settings and what has been done historically to help address them?
Physical: Examples: (1) Only standing weight scales - disability rights groups have advocated for more wheelchair accessible and inpatient bed scales but more standardization is needed. (2) Poor lighting in public spaces can pose a challenge for individuals with low vision. ADA - create guidelines
Transport: ADA passed in 1990 - required public transit systems be accessible, paratransport systems be established, personnel get training in working with people with disabilities
Communication: Assumptions made about patient with disabilities can impact patient-provider relationship and lead to worse health outcomes. Assumptions about mobility, sexual activity, and mental health are common.... Disability competency training to improve provider communication and prevent assumptions is key
What can medical practices do to become adapted to be more accessible for all patients?
establishing clear protocols to address situations; training to address provider and staff bias and make sure staff know all protocols and are comfortable carrying them out
accessible equipment like exam tables, rooms, doors, scales, etc.
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Q: What is the nature of mental health stressors for patients who are disabled (wheel chair) and what ways exist to alleviate those stressor? (Incorporate info related to health disparities in this population)
Depression, anxiety, isolation, increased likelihood of obesity, pressure sores, stroke, IPV
Increase accessibility to healthcare, funding programs for patients with disabilities, have open and honest conversations
accessible scale, Hoyer lift, and automatic-opening door.
Social History
Insured via work
Insurer denied power wheel chair
Manual wheelchair ordered
Has a boyfriend
Reliance on him for transport
Diet: Eats bread, rice, and sweets regularly
Q: What is the nature of nutritional programs and/or accommodations that exist to help someone whose ADLs or IADLs (instrumental activities of daily living) are impacted?
physicians play a vital role in facilitating these accommodations by collaborating with dietitians and other healthcare professionals
Expanded Food and Nutrition Education Programs, Supplemental Nutrition Assistance Program, Adaptive Eating Utensils and Assistive Devices, Meals on Wheels, and Cook's Meals on Wheels
Many of these services can be accessed using 2-1-1
waist circumference 90cm = increased cardiovascular risk
Incorporate more fruits and vegetables into her diet and reduce consumption of high-sodium single-serve meals and processes meats
Lost 15 pounds through diet and exercise and feels well
unreliable transportation due to lack of accessibility
Exercise: minimal (Cannot find a gym that accomodates)
Q: Describe excercise program and streching routine she can take part in
weight training, resistance bands, aerobics, laps on an accessible track, aqua therapy. Shoulder strengthening exercises can involve external and internal rotation with light resistance bands (could benefit Mariana!)
social worker
Health information
No documented screening tests due to inability of physician's office to accommodate her disability
Q: What's the nature of provider bias and how can these be addressed?
Conscious/unconscious bias based on social stigma and/or past experiences
paternalism and infantilization of patients with disabuilities
Solution: Deliberative reflection & questioning and actively countering stereotypes
address via educating providers on ideal communication with patients with disabilities
Spinal cord injury in teenage years --> paraplegia with preserved use of arms and hands
FHx: older sister w breast CA dx age 55
unable to obtain accurate height and weight as office does not have sufficient equipment to accommodate the wheelchair
What is the nature of obtaining assisted living devices for patients with disabilities and mobility needs?
Funding: Medicare, medicaid, private health or disability insurance, and Worker's compensaiton may pay for some assistive technology. Funding requires statement of medical necessity and a prescription from healthcare professional.
Can only apply for new wheelchair every 5 years unless demonstrating proof of damage to chair
Patients must obtain devices from licensed durable medical equipment suppliers
