Question

Case study:

Mark, age 38, and his wife, Cathy, and age 34, have two children: Sam age 5 and Alex is 3. They decided that Cathy would stay home with the boys until they reach age 6 and were ready to attend first grade. Kathy's educational background is in early childhood education, so she feels comfortable staying home with the children. Mark is self-employed as an accountant, so he has a small office and two assistants. In addition, Gretchen, Cathy's mother, a 72, lives with the family. Gretchen has been battling breast cancer for several years and has received multiple chemotherapy treatments, causing her immune system to be weak. As for health insurance, Gretchen has Medicare and the recommended supplemental policies for cancer treatment and prescriptions. Mark, Cathy, and their churches are enrolled in insurance they bought from the insurance exchange that was created through the federal Affordable Care Act. Generally, Mark and They do not use their health insurance because they save money by only going to the doctor when it is necessary. They used health insurance mainly for the children for annual physical examinations, vaccinations, and visits related to mild childhood illnesses, such as ear infections, and vomiting, and sore throats. Mark and Cathy report that their children play outside daily, so the children remain healthy and active.

The family is involved in their faith-based community, and the children play soccer on the youth team sponsored by the community recreation center. Mark and Cathy are not opposed to having their children receive all of the recommended vaccinations for childhood illness, but they are opposed to receiving vaccines from themselves. For example, they have never received the flu vaccine. They believe that because they do not work in large corporate offices are travel on public transportation, they are not exposed to routine viruses. They also report that they have not had an upper respiratory infection or the flu in many years. As a result, Gretchen follows the belief of Mark and Cathy and does not receive prevention vaccinations, even though her oncology physician recommends that she obtain the vaccines.

Over the past year, life in the household was stable and moving in a positive direction. Mark's accounting business increased profits, and he was able to hire another accountant to join the practice. This started offering part-time daycare to two young children in their neighborhood. Gretchen was in remission from breast cancer, but still suffering from a weak immune system.

After the holidays, things began to change for the family. Cathy got sick with flu symptoms and upper respiratory infection. After two weeks, she went to the neighborhood urgent care clinic. The doctor told her that she had bronchitis and possible pneumonia and gave her a prescription for antibiotics and cough medication. She recommended that Cathy get a chest x-ray to verify her diagnosis. Although the urgent care offered chest x-ray services, Cathy refused the extra services. She filled the prescription, but once she started feeling a little better she stopped taking the medication and did not take the whole prescription. Within a week, Gretchen developed a severe cough and was submitted to the hospital for pneumonia. Cathy was unable to continue the daycare services. Mark shortened his work hours to care for their children, while Cathy went to the hospital to care for her mother for about 2 weeks. When Gretchen was discharged, her physician reminded her to rest, avoid stress, and eat healthy food because her immune system remained weak. After a few days later, she developed a painful rash and was diagnosed with shingles. Gretchen died 1 week later from a secondary infection caused by the shingles rash.

1. As a health navigation professional, how would you assist this family?

Answer 1

As a health navigation professional, my job includes understanding Mark and Cathy’s problems, illness and their plans to mitigate their problems and further suggesting improvements to their plan on a healthcare basis as well as personal level, if required.

I will first explain Mark and Cathy that the major fault from their end, which possibly resulted in the present situation, was the disinterest towards vaccination of adult members of their family that they had shown recently. The flu of Gretchen and Cathy could have been avoided had they been vaccinated. Hence, the first thing they need to do is to get them vaccinated for shingles and flu.

I will further caution them and point out that, given the recent problems and disturbances faced by them; they should not forget or miss any vaccination for both of their children.

As the financial position of the family has been improving recently, I will suggest then to go for yearly health check-up for their family. This will help them to be proactive on the health front.

I will arrange for a dietician and get a proper diet plan and routine for the family. So that they lead a healthy lifestyle.

Lastly, on the personal front, I will take the liberty, if given, to suggest them a plan for future. I will suggest them if Cathy extends her daycare with more children, they could earn more with little more effort.

My discussion with them will be frank, open and clear. It will include firm healthcare instructions as well as friendly and logical discussion of their plans.