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Equality vs Equity: Real time education via medication

Pictured is one medication, for the same person, but in two different forms. This example was a light bulb moment for me that is very personal. There are several examples related to patient care, patient safety, person centered care, active listening, medication reconciliation, and more that I could share, but I want to focus on the difference of equality and equity.

My son is g-tube dependent. He used to have the ability to eat by mouth but lost it over time due to the brain injury he sustained at birth (HIE).

The gastroenterologist we had been seeing for eight years, left the practice and we selected a new one based on temperament, philosophy and style. In a matter of minutes, the new provider nearly upended years worth of work from a medical and insurance perspective. Both of the medications shown are the generic of Prevacid, an anti-reflux medication. This is an over the counter medication, thus the rigorous, robust and exhausting battle with insurance to get it covered.

The two forms of the medication show a delayed release capsule and a delayed release orally disintegrating tablet. When a person who utilizes a g-tube for all nutrition which form of the medication do you think they need? If you answered the orally dissolving tablet, you are correct. Orally dissolving means it will dissolve in liquids, like saliva or water.

Equality is represented by the blue and white capsule medication that is filled with beads. It is the same medication that has a delayed release, but clogs the g-tube extension and g-tube if it makes it in there.

Equity is represented by the orally dissolvable tablet as it will disintegrate and easily flow through the g-tube extension, g-tube and ultimately into the stomach.

What stresses me out the most is not being listened to. I caught the error when I picked the medication up from the pharmacy. I brought it to their attention and was met with “that is what the doctor prescribed.” I responded, “I understand that, so do you know that it will go through a g-tube? Do the beads quickly and easily dissolve in water? Do I need to crush the beads?”. Again, I was met with “this is what the doctor prescribed, yes it should.”

Well, they don’t.

When we talk about making healthcare equitable that means we have to teach people to see and partner with individual patients. There is no policy that can be written that enforces providers to see and value my son. There are policies written that require medication reconciliation, but what good is that if the provider is writing a script as they usually would for every other patient and not writing the prescription with consideration of the patient that is in front of them? What is the benefit of a pediatric medical home when the intended benefits don’t outweigh the risks of medication errors. What is the point of having signs up all over a clinic, hospital, and pharmacy that say “Speak Up” if you’re not going to hear us when we speak up?

Equitable healthcare becomes attainable when systems are built and the people who work in, run and enforce them value the individual being seen, and create the space to engage and care for them in a way that does no harm.

Is active listening important? Is medication reconciliation necessary? Does patient and parent/family member involvement make a difference in patient outcomes? Is there really a benefit to operating in a patient and family centered way?

Yes, to all of the above.

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