Applied assessment

Same scenario as the sparring section — now apply the module's concepts directly. Four multiple-choice questions followed by a short reflection.

SCENARIO REMINDER

A 52-year-old woman is living in temporary shelter accommodation. She presents with:

• Poorly controlled type 2 diabetes

• Chronic obstructive pulmonary disease (COPD)

• Hepatitis C

• History of injection drug use

• Major depressive disorder

She has visited the emergency department five times in the last six months for hyperglycaemia and respiratory exacerbations. She has missed multiple outpatient appointments with endocrinology and hepatology. Shelter staff report increasing withdrawal and irregular medication use.

She reports feeling “tired of repeating her story.”

Part I – Applied Knowledge

1. Which of the following best describes her clinical profile?

A. Single chronic disease with poor compliance

B. Acute episodic illness

C. Multimorbidity with trimorbidity features

D. Primarily psychiatric case

2. Which factor most directly increases her risk of emergency department dependence?

A. Personal irresponsibility

B. Lack of health knowledge

C. Fragmented continuity of care

D. Shelter overcrowding alone

3. Which condition increases her vulnerability to infectious complications?

A. COPD only

B. Diabetes and substance use history

C. Age alone

D. Temporary housing status

4. Which barrier category is most visible in this case?

A. Financial only

B. Administrative only

C. Logistical and structural combined

D. Cultural misunderstanding

Part II – Integrated Reasoning

Write 4–6 sentences addressing:

If you were part of an integrated team, what would be your first coordinated intervention priority, and why?

Guidance:

Your answer should reference: Housing stability, Chronic disease management, Mental health, Care coordination

An integrated response would prioritise:

Immediate housing stabilisation (housing-led approach)

Coordinated primary care follow-up

Integrated mental health and addiction support

Medication management support within housing context

Case management to reduce fragmentation

The primary shift is from episodic emergency treatment to structural stabilisation.

Part III – Evaluation of Service Models

Which innovative model would most effectively reduce her emergency admissions?

A. Standard outpatient referral system

B. Strict abstinence-based programme

C. Multidisciplinary outreach team integrated with housing support

D. Emergency-only intervention

Part IV – Ethical Reflection

Briefly reflect:

Is it ethically sufficient to treat her acute episodes without addressing housing instability?

Does equity require additional resource allocation in this case?