UHC Case Study
 (1500 words; 3 pages single spaced)
 
The purpose of this assignment is to familiarize yourself with the road to UHC and the ‘guts’ of monitoring indicators and data for UHC in a selected country.
The page limits given in parentheses after each question are guides.  Use tables and bullet points in your responses.
Select an LMIC country from the list of countries by income level used by the World Bank (http://data.worldbank.org/about/country-and-lending-groups). The country that you are going to work on is?

1. Describe the path that the country has taken to UHC. (1 pages)
   1. What health systems reforms efforts have taken place in the country over a relevant time frame. The time frame will differ by country. For example, for a country that gained its independence in the 1960s, that date might be the logical starting point.   For one of the countries that emerged from the former Soviet Union, the time frame might be at the point of independence in the 1990s.  Draw a timeline with the key milestones and dates.
   2. Justify why you chose the starting date for your analysis.
2. Summarize and assess data provided for the country in the official SDG Indicators Global database https://unstats.un.org/sdgs/indicators/database/ for Goal 3.8 and in the WHO global Health Observatory database http://apps.who.int/gho/portal/uhc-overview.jsp (1 ½ pages)
   1. Examine any inconsistencies or differences in reported data.
   2. Assess the quality and availability of reported UHC data.
   3. Identify country specific databases on UHC and summarize the data.
   4. Compare your selected country to a country that has a similar profile – either one in the same region, same historical trajectory, same income level, etc. Justify why you selected the comparator country.  How do the indicators differ?  What might explain differences?
3. Select one additional tracer indicator that you think the country should monitor. (1/2 page)
   1. What is the specific indicator?
   2. Why is this indicator key for the country’s progress toward UHC?
   3. What data are required to monitor the new indicator?

This website may help:
http://apps.who.int/gho/portal/uhc-overview.jsp

Congestive Heart Failure Assignment
Case Study
Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.
HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH: Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies: Penicillin
Vaccination History:  Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111,  R 22 and non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.
Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
A:
Primary Diagnosis: Congestive Heart Failure (CHF)
Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)
Differential Diagnosis: Peripheral Vascular Disease (PVD)
Plan:
Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain
Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.
Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %
BNP – not available.
As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).
Questions:

1. According to the ACC/AHA guidelines, what medications should this patient be prescribed?
2. Does he need medication(s) given his history of MI?
3.    Must be supported by at least 2 peer reviewed references and all paragraphs must be cited.