Utilizing Case Management While Caring for Patients
The world has embraced the concept of privatisation in all aspects of life including the health care services. In this case, consumers have the freedom to choose the best health care services from the market. Privatisation has introduced competitiveness in the health sector and service providers are engaged in the provision of quality care at reasonable prices.
The advent of case management has had a great impact on the provision of healthcare services. Case management can be described as a care delivery model designed to coordinate and manage patient care across the continuum of health care system (White and Hall, 2006, p. 100). Case management is usually performed by nurses within or outside the hospital setting. The coordinates and facilitates the various aspects associated with patient care.
This paper focuses on how nurses can utilise case management while caring for patients with complex conditions. In particular, the paper shall focus on patients with diabetes, cardiac disease, and asthma and how case management is beneficial to both patients and nurses.
Diabetes patients
Diabetes can be classified as one of the most chronic condition affecting human beings. In particular, diabetes mellitus has no cure. However, this condition can be managed and controlled to alleviate patient suffering (Middleton, 2003). A significant number of individuals have been diagnosed with diabetes mellitus.
In the U.S., about twenty million individuals are living with the condition. These patients are predisposed to health complications such as renal failure and cardiovascular disease (Hogan, Dall and Nikolov, 2003). It is the duty of healthcare professionals to ensure that complications associated with diabetes are well managed to alleviate patient suffering. The government spends a substantial amount of money in addressing the complications associated with diabetes. In the year 2002, over $130 billion were spent on efforts aimed at managing complications associated with diabetes (Norris, et al, 2003).
Nurse case managers are critical in enhancing the health condition of the diabetic patients (Gabbay, et al, 2006). Case management presents the best way of dealing with patients suffering from complex conditions (Krein, et al, 2004; Taylor, et al, 2003). There is also a study by Pettitt and his associates entitled Decreasing the Risk of Diabetic Retinopathy in a Study of Case Management.
The study aimed to test whether enhanced diabetes case management was essential in preventing or delaying diabetic retinopathy among patients suffering from type 2 diabetes. The study was conducted in counties found within the southern part of California. The study focussed on low income ethnic minority populations. The subjects were categorised into two groups including the intervention and the control groups. Among the intervention group, diabetes case management was applied whereas the control group was subjected to the conventional diabetes treatment.
The results of the study indicated that progression of retinopathy among the intervention group was not considerably less than that of the control group. Nonetheless, the subjects in the intervention group who did not show signs of retinopathy in the first place were less likely to develop diabetic retinal changes than those in the control group. In this case, case management that begins before the commencement of clinically identifiable retinopathy reduces the danger of retinopathy development among patients with type II diabetes (Pettitt, et al, 2005).
Another study was done in New York aimed at demonstrating the benefits associated with the use of case management in controlling glycaemia among patients suffering from type II diabetes (Middleton, 2003). Those who participated in the study had been diagnosed with primary or secondary type 2 diabetes.
During the study, the baseline haemoglobin levels were taken, and this was measured after every 120 days (Middleton, 2003). In the study, the baseline value was regarded as group A; whereas the measurements that followed were regarded as group B. the measurements in group B included haemoglobin values after the patients were enrolled in the case management program (Middleton, 2003).
Case management in this study was critical. The nurse case manager was responsible for conducting the initial interview assessment through the phone. Also, the nurse manager contacted every patients healthcare provider to get clinical data, as well as discuss care plan. The evaluation of the patients plans and their adjustment in accordance with the guidelines of the (ADA) was also done by the nurse case manager. Lastly, the nurse case manager was responsible for identifying short and long term objectives, and the development of an action plan (Middleton, 2003).
This study indicated that there was a reduction in haemoglobin values for about seventy per cent of the participants. It was also noted that the participants who did not show any improvements in the haemoglobin values had failed to follow their care plan. This shows that care management is critical in controlling glycaemia among patients suffering from type II diabetes (Middleton, 2003).
Asthma patients
Asthma can be identified as a chronic disease that is characterised by difficulties in inhalation process. This condition affects a significant number of people. In the United States, the condition affects about fourteen million people, and the government spends about $6 billion every year for the treatment of the condition. Case management helps patients by increasing accessibility to the healthcare services, enhancing the patients quality of life, and decreasing the need for patient hospitalisation. Also, case management helps cut on the costs of treating asthma (Patel, Welsh and Foggs, 2004).
A cohort study was conducted among 48 asthma patients in an American military hospital using the National Institutes of Health (NIH) guidelines and asthma case management program. This study showed a reduction in clinic visits and . In this study, case management was critical in various ways. The case manager in the study offered an asthma education course for the patient or parents to the patients. The case manager also instructed patients on the NIH guidelines.
The case manager played a critical role in teaching patients how to use their peak flow meter. The case manager was also responsible for the provision of a home treatment plan based on the NIH guidelines. Lastly, the case manager contacted patients through phone calls every week after the first visit, and afterwards, once in three months (Darin and Dinelli, 2002).
Another study was conducted to establish the importance of case management among diversified paediatric population. The study focussed on the implementation of a program to children suffering from asthma. This program was used in place of home visits that are critical in case management. In this study, children suffering from asthma and their caregivers formed the study population. In this study, it was been discovered that the scheduled visits to a comprehensive asthma clinic were poor.
However, there was a significant improvement in the visits of the sick individuals to the clinic after the case management was implemented. It was concluded that telephone case management was efficient in supplementing an inclusive asthma care among diverse paediatric population in an urban setting (Fisher-Owens, Boddupalli and Thyne, 2011).
Another study in Memphis was meant to review the effectiveness of asthma case management among students in elementary schools. The study involved two groups including the intervention and the control groups. The intervention group had an asthma case manager while the control group had conventional nursing services.
Among the intervention group, the case manager provided education to students as a group. Also, the case manager was instrumental in monitoring the health statuses of the students. The other role of the case manager was the coordination of care where he contacted the family and medical providers in facilitating the provision of care.
Lastly, the case manager conducted in-service sessions for staff in the school at the start of the academic year. The studys findings were measured in terms of absenteeism and use of healthcare services. In this study, it was discovered that the intervention group recorded an improved attendance and a limited use of medical services compared to those students in the control group (Levy, Heffner, Stewart and Beeman, 2006).
