UW BS q

[MudPhud20XX]

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Could we discuss this q?

A 72 yr old man is hospitalized for congestive heart failure. His medical problems include hypertension, coronary artery disease, peripheral vascular disease, hypercholesterolemia, prostate cancer, and mild neurocognitive disorder. The patient is stabilized medically and discharged home to live with his daughter, who has supervised his medications in the past. A week later, he is rehospitalized with recurrent heart failure. The patient thinks he took his medications daily since being discharged, but a pill count shows that he did not take the majority of his prescribed drugs. Which of the following interventions would likely have prevented this outcome?

A. Discharge checklist
B. Involvement of a social worker in discharge planning
C. Mini-mental state examination
D. Patient education
E. Simplification of medication dosing schedule

 

[IndiaInk567]

Medication non-compliance is one of the most common reasons for heart failure hospitalization. They are asking for techniques to improve compliance. Problem with this question is checklists, social workers, and patient/family education can all be helpful. It would also help to simplify the dosing schedule (people taking once a day meds better than twice or three times a day). Bottom line: BS question with too many potentially correct answers. FYI: I have been a chart abstractor for a hospital QA program.

 

[MudPhud20XX]

I chose C thinking that this pt may have started losing his memory.... : )

 

[TheNsg300]

Tuff choices,,wud go with B,,only becuz the patient waz already diagnosed wit mild neurocognitive impairment nd waz already expected to take his meds under his daughter's supervision,,simplifying the schedule, patient education I think wud ve helped provided he had normal level of cognition,,I'm guessing involving a social worker wud be able to assist nd ensure level of support from daughter iz adequate,,

 

[Silverish]

I remember this question.
The correct answer is B. Involvement of a social worker.
There's a good chance that this person has Alzheimer's at this age. His daughter hasn't been very useful in dictating medications daily, and if he had a nurse assistant or a homecare worker working in his home (or even have him start living in the nursing home), this would have prevented the outcome.
I know this because my grandmother is going through the exact same thing. My family just paid for a healthcare worker to stay with her, because my aunts and mom are all busy with life.
If you're wondering how much it costs, its about 40k a year to have a social worker come help your elderly family member. Its much cheaper to send them to the nursing home, but a lot of old people want to die in their own homes - which makes sense of the social worker.

 

[MudPhud20XX]

Guys thanks a lot!! yeah the fact that the stem already mentioned that he has "mild neurocognitive disorder" is the reason that I should have NOT chosen C. Dang, it's true that every words matter. I think I lack this kind of skills as English is my 2nd language. thanks everyone!

 

[runner1234]

Would have guessed a since daughter was handling meds instructions would have made it clear guess I was wrong

 

[Phloston]

B is the odd one out because A, D and E all put the responsibility ultimately back on the patient, whereas B someone else takes responsibility. And C just better reaffirms the Dx but doesn't change anything.

If you do a rotation in geriatrics at some stage it'll reinforce in you how integral all components of the aged care team are (i.e., social work, OT, PT, dietetics, etc.).

 

[worldbeater]

Yeah I agree with the above posters. It's "B". He's of an older age, his health is declining, and he needs a person to help him keep track of the the various medications he is prescribed during discharge.

 

[DrPicard]

Haven't read behav sciences yet, but doesn't the question make it clear that the problem lies with the daughter? They clearly mention his neurodegenerative disorder + the fact that his daughter has supervised his medication in the past + he's been discharged to live with his daughter. Seems like we already know that patient isn't going to be compliant; the problem lies with his daughter not being vigilant enough about his medication either. So the only solution would be to involve someone else.

 

[worldbeater]

Yup, correct. It's a relatively new question in UWorld.