Course Case Studies
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- Participation Instructions
- Review the course material online or in print.
- Complete the course evaluation.
- Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
We will use the following case throughout the remainder of this course. As you read, note the barriers Patient J encounters and consider which are structural versus individual.
Patient J is a 52-year-old Black man living in a mid-sized urban neighborhood. He works as a security guard, a job that requires him to be on his feet for 10-hour shifts. He has a history of hypertension, type 2 diabetes, and depression. His primary care physician recently identified worsening blood pressure control and requested a nephrology referral.
Patient J has experienced the following over the past six months:
His nephrology referral has been pending for four months. He is not sure why.
The nearest nephrology office is 18 miles away, and he does not own a car. The bus route requires two transfers and takes 90 minutes each way.
His insurance plan has a high deductible, and he has not filled his new antihypertensive prescription because he cannot afford it until after his next paycheck.
He stopped going to his previous primary care provider after he felt his pain complaints were dismissed on three separate occasions.
He has not disclosed his depression to his current provider because a friend told him that disclosing mental health conditions could affect his employment status.
Reflection
Which of Patient J’s barriers are individual? Which are structural? Make a list before reading further.
Let's return to Patient J's case. If you were his provider, his care team, or a healthcare administrator, what would equity-promoting action look like?
Conduct a social needs screening. Identify the transportation barrier and connect Patient J to Medicaid transportation benefits or community ride programs.
Have a transparent conversation about medication costs. Explore generic alternatives, manufacturer assistance programs, or in-house pharmacy options.
Create a psychologically safe environment to discuss mental health. Clarify confidentiality and address the patient's concern about employment consequences.
Acknowledge prior negative healthcare experiences without defensiveness. Ask what he needs from you to rebuild trust.
Assign a care coordinator or community health worker to track the pending nephrology referral and remove barriers to completion.
Conduct a warm handoff to behavioral health rather than providing only a referral number.
Use the care team's huddle to flag patients with complex social needs and coordinate wrap-around support.
Review referral completion rates stratified by race and insurance type. Investigate whether there are patterns of differential delay.
Assess transportation assistance programs and pharmacy affordability resources. Ensure that information about these programs reaches patients proactively.
Examine whether the clinical algorithm used to calculate Patient J's kidney function incorporated race-based corrections, and review the process for updating clinical decision support tools.
- Back to Course Home
- Participation Instructions
- Review the course material online or in print.
- Complete the course evaluation.
- Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.