Case Management
Case management denotes cases where medical case managers create liaison between patients having a long-term health condition, with their medical practitioners and the patient’s friends and family. Case managers do not offer treatment or diagnosis. Instead, they only monitor the patient’s treatment plan so as to make sure that all people responsible for implementing the plan are doing their respective duties as required. As such, the case manager works for the interests of the patient (William, 2003).
Case management highlighted below is a management plan to oversee the treatment of an elderly patient with chronic obstructive pulmonary disease (COPD). COPD is a condition that makes breathing difficult, and progressively worsens breathing as the condition progresses. The condition is characterized by chest tightness, shortness of breath, wheezing, production of mucus as well as other symptoms (Juvelekian & James, 2013). The condition is caused by prolonged smoking and/or exposure to lung irritants such as dust, chemical fumes and other irritants commonly designated as air pollutants (Young et al. 2009).
Case
A 50 year old industrial worker that smokes at least a pack of cigarettes in day has been smoking for over 30 years, and now he has been diagnosed with COPD. The patient is released after prolonged treatment that was necessitated by an exacerbation of the condition while at work. The exacerbation was a result of continued exposure to environmental pollutants at the patient’s workplace. After successful control of the exacerbation the patient has been released to outpatient care, where he will be receiving care from his primary care physician. The discharge plan offered upon release recommends that the patient should stop working at the factory because it exposes him to chemical irritants and pollutants that possibly trigger exacerbations and worsening of the condition. In the discharge plan the practitioner in charge of the patient recommends a lung transplant as a long-term solution based on the worsening condition of the patient’s status. This is due to the poor prognosis as determined by the worsening condition of the patient.
The lung transplant may offer better results, but it carries with it a greater risk for COPD patients, and may result in high risks of morbidity and mortality. However, the plan is promising because lung transplantation may improve exercise capacity and pulmonary function (Juvelekian & James, 2013). The patient is worried about leaving his job so as to avoid exposure of pollutants that could exacerbate the condition. Additionally, he is worried about receiving a lung transplant because of the risks associated with transplant of key organs such as lungs. Additionally, the patient is faced with challenge of stopping cigarette smoking because he is already addicted. The patient spends his few weeks after discharge adapting to the home care situation where he uses portable oxygen equipment. The patient has problems coming to terms with the fact that he may have to drop from his work at the local factory where he works as a way to minimize the risk of exacerbating the condition. He frequently receives visits from the primary care physician that closely monitors his drug regimen and daily exercise.
As a case manager assigned to the patient, I collect all information pertaining to the drugs that the patient is using as well as any other health related engagements that he is undertaking. I establish that the patient is adhering to the drug regime prescribed before his discharge. However, I note that he has relapsed into his smoking habits because of the urge to smoke, which bears negatively on the improvement of his health (Young et al. 2009). The patient reports that he cannot overcome the urge to smoke because he was deeply addicted to cigarette smoking.
A review of the current situation shows that cessation of smoking and quitting his job at the factory are the most important things necessary to avert any further exacerbation of the condition. In relation to this fact, I develop short-term goals to first tackle the addiction problem and the reduction of occupational exposure. In order to handle the smoking issue counseling sessions and hypnosis is scheduled so as to help the patient overcome the urge to smoke. The counseling sessions are designated to take a group form where the patient would meet other people with smoking problems so as to learn from their experiences (Juvelekian & James, 2013).
In addition to this, family counseling sessions at home are organized for both the patient and his family. The family sessions are geared towards garnering support or buy in from the family, which plays a significant role in overseeing the recovery of the patient (Ferguson & Cherniack, 1993). It is anticipated that the family’s engagement will be important in convincing the patient to abandon his job. If family members can understand the risk of occupational exposure, then it will be easier for the patient too because he is the breadwinner (Hurst et al. 2010). The family has therefore to be convinced about the need to stop the patient from working so as to avert the worsening of the condition. A contingent plan is also in order just in case the hypnosis and counseling fail in relation to combating the smoking problem. This plan may include the use of nicotine replacement to help cut back on smoking.
Apart from these short-term plans, the implementation plan shall also entail creating an exercise regime to which the patient shall abide to as a daily routine. This is aimed at helping improve lung exchange capacity and prevent possible disease progression in the patient (Juvelekian & James, 2013). The patient shall also be expected to stay away from any sources of environmental pollutants, lest they worsen the condition again.
Finally, the ultimate goal will also include training the family members and friends on how to detect possible exacerbation of the condition so as to always monitor the patient (Ferguson & Cherniack, 1993). Inclusion of the family in such training is an important component because they will learn what to do or how to assist the patient whenever symptoms worsen or health seems to deteriorate. Therefore, the family will be educated to look out for general signs of worsening such as insomnia, malaise, breathlessness, chest tightness, wheezing, depression, fatigue and confusion. As the case manager it will also be appropriate to link the patient and family to a health outreach programs concerned with COPD information dissemination so as to keep them always informed about new developments in relation to the condition. This will be significant because it will help in keeping both the patient and the family updated about any care information that may help improve the status of the patient. The finally expected outcomes should include adherence to the set up exercise regime, strict adherence to medical regime and overall quitting of the smoking habit.
Reference
Ferguson, G. T. & Cherniack, R. M 91993). Management of chronic obstructive pulmonary disease. New England Journal of Medicine; 328 (1), pp. 1017-1022.
Hurst JR, Vestbo J, Anzueto A, et al. (2010). Susceptibility to exacerbation in chronic obstructive pulmonary disease. New England Journal of Medicine, 363 (1), pp. 1128-38.
Juvelekian, G. & James, K. S. (2013).Chronic Obstructive Pulmonary Disease. Retrieved from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/chronic-obstructive-pulmonary-disease/
William F. B. (2003). Group Insurance: Fourth Edition. Winsted, CT: Actex Publications, Incorporation
Young RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD (2009). COPD prevalence is increased in lung cancer, independent of age, sex and smoking history. Eur. Respir. J. 34 (2): 380–6
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