What are the recommended discharge instructions for a 64-year-old male patient with a history of arthritis, hypertension, and type 2 diabetes after a Medicare wellness exam?

From the Guidelines

For a 64-year-old male patient with arthritis, hypertension, and type 2 diabetes following a Medicare wellness exam, discharge instructions should prioritize comprehensive disease management and preventive care, focusing on medication reconciliation, clear communication with outpatient healthcare professionals, and scheduling follow-up appointments as recommended by the most recent guidelines 1.

Key Recommendations

• The patient should continue all current medications as prescribed, including antihypertensives, diabetes medications, and anti-inflammatory medications for arthritis.
• Blood pressure monitoring should be performed at home 2-3 times weekly, with a target below 130/80 mmHg.
• For diabetes management, the patient should check blood glucose levels daily, aiming for fasting levels between 80-130 mg/dL and post-meal levels below 180 mg/dL.
• A balanced diet low in sodium, refined carbohydrates, and saturated fats is essential for managing all three conditions.
• Regular physical activity, such as walking 30 minutes daily five days per week or water exercises that are gentle on joints, will help control blood pressure, improve glucose metabolism, and maintain joint mobility.

Discharge Planning

• Discharge planning should include a structured plan tailored to the individual patient, considering diabetes type and severity, effects of the patient’s illness on blood glucose levels, and the patient’s capacities and preferences 1.
• An outpatient follow-up visit with the primary care provider, endocrinologist, or diabetes educator within 1 month of discharge is advised, with earlier appointments preferred if glycemic medications are changed or glucose control is not optimal at discharge 1.
• Clear communication with outpatient healthcare professionals is crucial, including transmission of discharge summaries and information on medication changes, pending tests and studies, and follow-up needs 1.

Follow-up Care

• The patient should schedule follow-up appointments with their primary care physician within 3 months and annual specialist visits with an endocrinologist for diabetes management and potentially a rheumatologist for arthritis care.
• These comprehensive measures address the interconnected nature of these chronic conditions, as controlling blood pressure and blood sugar levels can reduce inflammation and joint stress, while appropriate exercise and diet benefit all three conditions simultaneously.

From the Research

Discharge Instructions for a 64-year-old Male Patient with Arthritis, Hypertension, and Type 2 Diabetes

The patient's history of arthritis, hypertension, and type 2 diabetes requires careful consideration when providing discharge instructions after a Medicare wellness exam.

• Medication Management: The patient should be advised to continue taking their prescribed medications as directed, including antihypertensive medications and diabetes management medications. According to 2, ACE inhibitors and certain calcium antagonists have emerged as the preferred first-line drugs in the treatment of hypertensive diabetic patients.
• Blood Pressure Monitoring: The patient should be instructed to monitor their blood pressure regularly and report any changes to their healthcare provider. As noted in 3, the renin-angiotensin-aldosterone system (RAS) is overactivated in both hypertension and diabetes, and drugs that inhibit this system, such as ACE inhibitors, have proven beneficial effects on micro- and macrovascular complications of diabetes.
• Diabetes Management: The patient should be advised to continue to manage their diabetes through diet, exercise, and medication as prescribed. As stated in 4, ACE inhibitors have a pre-eminent place in controlling the complications of diabetes mellitus, and their use should be considered early in patients with diabetes.
• Vaccination: The patient should be advised to stay up-to-date on recommended vaccinations, including pneumococcal and influenza vaccines. According to 5, patients with rheumatoid arthritis receiving abatacept can mount an appropriate immune response to pneumococcal and influenza vaccines.
• Follow-up Care: The patient should be scheduled for follow-up appointments with their healthcare provider to monitor their condition and adjust their treatment plan as needed. As noted in 6, about two-thirds of patients hospitalized with acute ischemic cerebrovascular events are discharged from the hospital on ≥1 antihypertensive medication, highlighting the importance of ongoing care and management.