Question

Mr. S is a 62-year-old man with multiple chronic illnesses, including severe chronic obstructive pulmonary disease (COPD). He is chronically ill and frequently hospitalized for his COPD exacerbation. Mr. S was once a jubilant and productive member of society. He was a circus clown and traveled all over the world with a world-renowned circus company. As he became more ill, his circus company “let him go.” Mr. S has no family members and is marginally housed. After multiple ICU admissions, he exhausted his private insurance and now receives his medical care at the county’s public hospital.

He is now homeless and on public assistance for his medical care. As he nears his end-stage COPD care, he will require long-term oxygen therapy. However, he is unable to obtain an oxygen tank for use outside the hospital because he is homeless. Potential surgical interventions such as lung volume reduction surgery and an experimental lung transplant are being considered.

Mr. S is now stable and requires a portable oxygen tank for use upon discharge.

Intersectionality Theory was developed as a means to actually study and address non-medical disease factors as potential pieces of the process in a medically defined illness. This allows health and disease to be studied at different intersections of identity, social position, oppression or privilege, and policies or institutional practices.

• Using this as a framework to start you discussion, address how understanding this theory can inform your practice in healthcare as a primary care provider.

• Discuss basic measures of health and health services utilization.
• Cite at least 1 peer-reviewed journal article

Answer 1

Very nearly 16 million Americans have incessant obstructive aspiratory ailment (COPD). For a considerable lot of these people, straightforward exercises, for example, strolling or climbing steps, spellbinds them, making their lives an every day struggle.Primary care suppliers are the central matter of contact for COPD patients, giving about 80% of their consideration. The greater part of the patients they treat present with suggestive malady the most well-known manifestations being brevity of breath, beneficial hack, weakness, and restricted exercise tolerance.Primary care suppliers' primary center is to give treatment to decrease patients' side effects and improve their personal satisfaction.

In rewarding COPD, it is significant for essential consideration suppliers to get a handle on the intricacy of the illness. No 2 COPD cases are indistinguishable; both the side effects and the illness course change by patient.Therefore, clinicians should tailor treatment to address singular patients' manifestations, instead of dealing with all COPD patients the equivalent. Clinicians likewise should perceive other key boundaries to viable administration of COPD. Coming up next are probably the most widely recognized difficulties in essential consideration: accurately distinguishing/diagnosing COPD; improving patient adherence to treatment; and decreasing the danger of intense intensifications. By meeting these difficulties head-on, essential consideration specialists have a chance to lessen the potential for superfluous or problematic consideration while improving patient results.

Distinguishing and Diagnosing COPD

A significant test confronting essential consideration suppliers is symptomatic disarray among COPD and asthma.Both are mind boggling, interminable conditions that cause deterred wind stream, and both offer a large number of similar side effects, for example, brevity of breath and constant hack. Spirometry testing is generally utilized in essential consideration to assist clinicians with diagnosing either condition. In any case, an analysis dependent on spirometry might be wrong, as halfway reversibility of wind stream hindrance with bronchodilator treatment is regularly observed in COPD and doesn't dependably recognize COPD and asthma. For an increasingly precise determination, spirometry results ought to be joined with physical test discoveries and a cautious clinical history that thinks about the patient's age, beginning and movement of side effects and social and word related hazard factors. For instance, a portion of the essential highlights of COPD incorporate beginning after age 40, industrious manifestations, and overwhelming presentation to hazard factors, for example, tobacco smoke or biomass powers.

Improving Patient Adherence and Treatment Outcomes

Breathed in bronchodilators are key to COPD treatment. It is turning out to be apparent that specific patients may battle to arrive at ideal pinnacle inspiratory stream (PIF) with certain inhalers. Therefore, both the method of conveyance and the kind of inhaler gadget are significant contemplations in COPD treatment.Device choice ought to be educated by the patient's needs, inclinations, and capacities. For example, patients who think that its difficult to arrive at ideal PIF may profit by an inhaler that requires less inspiratory exertion to actuate. Essential consideration practices should utilize different instructive and preparing strategies (eg, verbal, visual, exhibition) to train patients on appropriate inhaler strategy. Guidance and audit ought to be rehashed at each office visit to guarantee viable inward breath and medication conveyance to enhance restorative results.

Decreasing COPD Exacerbation Risk

Essential consideration suppliers' primary center is to lessen their COPD patients' manifestation trouble and related comorbidities. Intensifications – an unexpected declining, or erupt, of symptoms – place an enormous weight on certain patients, as entanglements from these intense occasions can cause dynamic wind current check and lead to extensive hospitalizations or even death.However, it is critical to take note of that "visit exacerbators" (ie, patients with at least 2 intensifications requiring extra treatment or potentially one hospitalization in the past a year) are a little subset of COPD patients in essential care.In certainty, the most extreme and difficult to-treat COPD patients – ie, the individuals who will in general experience visit intensifications and hospitalizations – for the most part get pro consideration from pulmonologists.

All things considered, essential consideration suppliers ought to evaluate their patients' compounding status at each visit by checking the recurrence with which patients require clinical mediation for expanded COPD side effects. In the event that a patient meets the measures for visit worsening, care suppliers ought to deliberately survey both the patient's adherence rehearses and the adequacy of current treatment, and recommend extra treatment or allude to pro mind as showed.

Best Practices in COPD Management

At last, the treatment of COPD is a common obligation between the patient and the essential consideration supplier – from the purpose of analysis and all through the treatment venture. The accompanying essential consideration best practices may encourage a fruitful specialist quiet association and improve COPD treatment results:

Bolster patients in their endeavors to self-oversee COPD by empowering smoking end and sound way of life practices

Give routine patient observing, including spirometry, to distinguish and address any adjustment in manifestations, deal with the danger of intense intensifications, and evaluate continuous treatment objectives

Advance prescription adherence by exhibiting and preparing on right inhaler method

The utilization of normalized, proof based pointers is basic for the appraisal of hazard factors for ceaseless respiratory sicknesses (CRDs) and their general weight, just as the assessment of clinical and general wellbeing intercessions across nations . The assortment and detailing of exact and opportune wellbeing data, including infection explicit proportions of dreariness and mortality, assists with coordinating the assignment of medicinal services assets and upgrades dynamic in wellbeing strategy. Global examinations of CRD trouble are fundamentally drawn from existing populace based investigations. For instance, the International Study of Asthma and Allergy in Childhood (ISAAC) has given data on the pervasiveness of asthma indications in kids utilizing tests from 56 nations . The European Community Respiratory Health Survey is another case of the normalized assortment of data from numerous nations, giving inexhaustible data on grimness, chance elements and the expense of CRDs . There are likewise the PLATINO contemplates and the BOLD examinations , which have analyzed the weight of ceaseless obstructive aspiratory sickness (COPD) across Latin America and different landmasses, individually. Existing CRD work by the World Health Organization (WHO) incorporates a report of discoveries from the World Health Survey , emphasess of the Global Burden of Diseases reports, and the GARD Basket.

The utilization of normal measures for the appraisal of modifiable hazard variables and wellbeing results in research and practice considers the correlation of the adequacy of various intercessions. Lamentably, the accessibility, relevance, understanding and helpfulness of certain markers have not been generally evaluated or illustrated, recommending a pressing requirement for a typical/uniform methodology to survey the effect of wellbeing activities and to quantify the general worldwide weight of CRDs.

Along these lines, the goal of this paper is to prescribe a system to help GARD nations to direct effect appraisals and gauge the weight of CRDs utilizing prove based, approved CRD markers and a smoothed out procedure to factual announcing. Our suggested technique will shape a supporting evaluation instrument to GARD nations that are actualizing individual and network based intercessions that help the Action Plan of GARD and the 2013−2020 Action Plan of The Global Strategy for Prevention and Control of Non-transferable Diseases. It ought to be noticed that, while CRDs are a general classification enveloping numerous conditions, suggesting a technique that joins all CRDs is past the extent of this paper. Along these lines, starting now and into the foreseeable future we center all the more explicitly around asthma and COPD, regular respiratory conditions for which there are existing assessment systems on the side of this work. The proposed technique introduced in this is intended to delineate the assessment procedure and may fill in as a format that can be changed, as suitable, for the assessment of different CRDs later on.