Assessing a patient begins by developing a relationship through effective communication. Gathering details for an accurate history and chief complaint further aids the practitioner in aiding a plan of care. To address the needs of a 54-year-old Caucasian male, that is referred to establish primary care after a recent hospitalization after a seizure related to alcohol withdrawal requires accurate history taking. Additional information includes hypertension with medication use, history of alcohol and cocaine abuse with current abstinence, and homelessness. This male patient reports lack of medication to treat his hypertension and active cigarette smoking.
Some issues that the practitioner would need to be sensitive to when interacting with this patient would be his homelessness and drug and alcohol abuse history. By using cross-cultural communication that is open with respect, the RESPECT Model can help practitioners to remain effective and patient centered during communication with patients. The components of RESPECT are rapport, empathy, support, partnership, explanations, cultural competence, and trust (Ball, Dains, Flynn, Solomon, & Stewart, 2019, p.31). This patient has age and socioeconomical barriers that are affected by his homelessness. Ball, Dains, Flynn, Solomon, & Stewart 2019 note that those in poverty and poorly educated die at higher rates that those who are educated and economically stable. This male patient’s high-risk factors of being homeless and coupled further with smoking and hypertension increase his susceptibility to mortality. It is the responsibility of the practitioner to use appropriate screening tools when assessing a patient with these characteristics. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based practice to identify, reduce and prevent alcohol and drug use which is one tool (Acquavita, Van Loon, Smith, Brehm, Diers,…Baker, 2019).
Once the practitioner completes an accurate intact or past medical history (PMH), the chief complaint (CC) is identified to establish care. The patient reports only one medication, amlodipine 10 mg’s, and other medications must be researched and documented. A social history (SH) is gathered to assess all risk factors and specifically for this patient would include the number of cigarettes smoked per day, and length of time smoking. Alcohol and drug abuse are also two risks that patient reports as prior use and knowing when the patient last drank. It is also the responsibility of the practitioner to counsel this patient on risk factors associated with smoking and his hypertension, because if is the practitioner’s responsibility to provide patient education and counseling. The practitioner knows that 70 to 80% that are homeless smoke and are at high risk to smoke because they are exposed to smoking around shelters and feel pressured to smoke which makes it hard to quit (Pratt, Pernat, Kerandi, Kmiecik, Strovel-Ayres, Joseph,…Okuyemi, 2019).
Questions the Practitioner might ask include:
What has contributed to your homelessness and are you engaged in changing your situation?
Whom was treating your hypertension and how long have you had hypertension where you have required medication?
Do you take any other medications?
When is the last time you drank alcohol or used cocaine or any other types of drugs?
Have you participated in any programs to help you not drink alcohol, avoid drug use, or quit smoking?
Do you understand the risk factors of hypertension and smoking?
Developing a plan would be for regular blood pressure monitoring, appropriate medication management, referral to an alcohol and drug treatment program, obtain lab work to evaluate for dyslipidemia, smoking cessation program referral and options for quitting, and the next follow up appointment. Goals to support this patient would be to identify any mental health issues as there is a correlation with mental illness and homelessness. Currently the major reason for homelessness is affordable housing and the reduction in programs to assist (National Homelessness, 2019). Engaging the patient in programs to support his history of alcohol, drug use, and current situation with smoking. Managing his known health condition of hypertension and other associated risk factors with his reported history.