Categories of ‘Patients’ in one Clinical Group

During a review session on diabetes melltius, the students learnt that while there’s an ideal level of care to aim towards, most patients lie within one of four categories:
1. Premium Independent Care
2. Independent Care
3. Basic Care
4. Don’t Care

Heh. The last category is a bit of an attempt to inject humour into this classification system. This is not based solely on financial circumstances (e.g. insulin pumps are very expensive) but also social circumstances (e.g. it’s difficult for a taxi driver to have regular mealtimes). Anyhow, J. was amused when he discovered that there was a similar categorisation within his clinical group!

It is for allergic rhinitis.

Allergic rhinitis is a very common condition and it is estimated that close to 40% of the population have a “sensitive nose”.

For acute treatment of AR symptoms, one could use anti-histamines. For long-term control, intra-nasal steroids (such as budesonide) are recommended for prevention of symptoms. And for really severe AR, certain forms of immunomodulation are available (but expensive). AR symptoms include runny nose, itchiness, sneezing, dark rings under eyes, cough (due to post-nasal drip), dry mouth on wakening (oral breathing at night).

Under the Don’t Care category, one friend, a real tough guy, feels that AR is not a life-threatening conditiion and that it’s easy to live with the symptoms of AR.

Under the Basic Care category, another friend who feels that nasal sprays are expensive (e.g. $30 for Rhinocort Aqua, though cheaper generic steroids are available), occasionally uses steroids and anti-histamines to control exacerbations of AR.

Under the Independent Care category lies J., who is very compliant with his regular intra-nasal steroids because he feels the comfort is worth the money and that intranasal steroids have few practically no systemic side effects. He does not use anti-histamines because his AR is well-controlled.

It’s interesting to have a tiny, tiny, tiny population model regarding patient care and compliance, eh?

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One response to this post.

  1. Posted by Lee Hurren on October 31, 2012 at 4:23 pm

    Anthistamines are really necessary if you have perenial rhinitis and urticaria. .

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