SCHIZOPHRENIA, CROHN’S DISEASE, COLOSTOMY, AND POOR SOCIAL AND FAMILY SPUPORT: HOW AN INTEGRATED IBD TEAM MADE CARE POSSIBLE DESPITE HEALTHCARE DISPARITIES

Abstract While many Inflammatory Bowel Disease (IBD) providers understand the importance of family and community support for patients with health disparities, only those that have a patient-centered Medical Home can fully support these fragile patients. This case study presents a patient with Schizophrenia, Developmental Delay, Crohn’s Disease, permanent Colostomy, family distancing and housing insecurity cared for at the Medical University of South Carolina IBD Medical Home. “Sam” presented to our IBD team through Colorectal surgery for his first ostomy at the age of 18. Social worker (MSW) noted he had no visitors, a diagnosis of Schizophrenia, and listed family was great grandmother (GGM). Fast forward 8 years, Sam and GGM arrive at IBD clinic after a year of missed appointments as he desperately needed a prescription for ostomy supplies. After multiple attempts to contact GGM, MSW learns she had died. Sam continues to live in her home with extended family, but none provide the patience and oversight GGM did. This case study presents the next 4 years of Sam’s life challenges, and how the IBD team approach re-engaged Sam in care, despite his careless fire which destroyed the family home and subsequent family estrangement, several psychiatric hospitalizations, state boarding home rules disallowing ostomies, a knife attack by boarding home resident, a bed bug infestation and kidney injury while preparing for colon reconnection, and Sam’s intermittent cooperativeness with care plans. Due to the strong communication between IBD providers and the colorectal surgeon, and the ability of MSW to float between clinics and support staff, a strategy was developed to optimize Sam’s health for the colon re-anastomosis he desired so deeply and would impact his qualifications for a more responsible boarding home. Our infusion nurse provided weekly IV hydration since Sam would not drink enough for kidney health; our Specialty Pharmacy team arranged for Sam to come to clinic for medication injections to ensure he was receiving them, and once he was in a more responsible boarding home, coordinated with the caretaker to ship medications. The MSW coordinated with the Mental Health Center, social security check representative payee, ostomy supply provider, and transportation to medical care. IBD providers, the colorectal surgeon, the nephrologist and their support staff coordinated with MSW to arrange appointments Sam would agree to. Grandmother became more involved in supporting him. Sam still occasionally misses appointments, but he successfully underwent colonic re-anastomosis, gets his IBD medication on time, and developed trust in our team to more frequently adhere to his care plan. Integrated IBD care through a patient-centered medical home often achieves higher levels of care than fragmented service provision within a healthcare system.