Recently the NY Times had an article commenting on the unforeseen consequences of cost-sharing among patients with chronic illnesses like diabetes, hypertension, and heart disease. This is based on a recent study from The National Bureau of Economic Research that observed patients with higher cost-sharing for medications tend to cut back on them which can have deleterious consequences – more ER visits, hospitalizations, and complications from their chronic illnesses. This would then lead to more healthcare spending which is what cost-sharing was meant to decrease. Check out the article below and click on the link above to the study!
A 19 yo white male with no past medical history presents with hand tremors, slurred speech, and severe anxiety, all of which have progressed over the last 3 months. Present both at rest and with activity. Also notes a change in personality, characterized as “extremely anxious.” Initiated on anxiety medication without improvement. This has progressed to the point that anxiety has caused him to drop out of school. He comes in now with slurred speech, excess drooling, and difficulty walking. Denies visual changes, HA, Sz. No obvious wt loss. No fevers, chills, night sweats. No unusual travel or exposures.
Past medical/surgical history: none
Family history: grandfather with liver problem
Social history: no tobacco, alcohol, or drugs. Not sexually active. Lives at home. No pets.
Current Medications: alprazolam 1.75 mg at bedtime, citalopram 20mg daily
Vital Signs: T 37.1, P 80, BP 140/75, RR 16, O2 sat 98% RA
Awake and oriented x3
Tongue protruding; speech is slightly dysarthric; cranial nerves otherwise intact
Strength 5/5 in all extremities; tone increased in bilateral lower extremities