Introduction
The featured managed care company’s decision to deny inpatient care to a 76-year-old patient is inappropriate because it does not consider her situation and health risk. The patient presents to the medical institution with a warm, swollen, tender left leg and a fever, suggesting she might have cellulitis. In addition, she has a history of diabetes, hypertension, and coronary artery disease, which puts her at risk of adverse health outcomes.
Although she positively responded to antibiotics, the treatment does not assure the complete resolution of her comorbidities. Thus, the managed care company’s choice to withdraw financial support after she shows a slight improvement is ill-suited, as it does not acknowledge the patient’s age, living condition, pain management, wound care, and ongoing therapy.
Medical History and Current Complications
The patient’s age, medical history, and clinical presentation require careful and comprehensive management to prevent sentinel events. Patients with chronic conditions such as diabetes and coronary heart disease are at risk of several health complications, especially when exposed to infections (Mannan et al., 2022). The patient in the case has a warm, swollen, and tender left leg accompanied by a fever, which is a common manifestation of cellulitis.
If left untreated, the condition can result in systemic infections like sepsis (Guo et al., 2021). Subsequently, the medical practitioners’ resolution to administer antibiotics to the patient indicates the severity of her case. Therefore, it would be unwise to discharge her prematurely and deny her additional care because her condition could worsen and result in more severe complications.
Living Conditions
The woman in the case is unfit for discharge because she requires specialized assistance from trained medical personnel or a caregiver to treat her wound. Cellulitis requires ongoing wound management to prevent its spread, expedite healing, and prevent recurrence (Rrapi et al., 2021). However, the woman in the case lives alone and cannot regularly assess the wound, perform dressing changes, and monitor her vital signs.
Inpatient care is imperative in her case because she needs to be close to health professionals who can evaluate her progress, identify signs of improvement or worsening, and alter her care plan if necessary (Maun et al., 2023). Hence, the managed care organizations overlook these factors by denying her inpatient care.
Ongoing Treatment and Therapies
The patient requires pain management and physical therapies to aid her recovery and improve her comfort because of the state of her left leg. The leg is described as markedly tender and warm. In addition, the practitioners observed mild weeping serosanguinous fluid from the inferior aspect of the patient’s leg. Therefore, it is likely that the patient suffers from high levels of discomfort (Guo et al., 2021).
The case study reveals that the patient works with a physical therapist to improve. Pain management and physical therapy are unique treatment solutions aimed at preventing muscle weakness and joint stiffness due to prolonged immobility. Therefore, refusing to provide the patient with ongoing pain management solutions and physical therapy does not acknowledge her critical needs.
Conclusion
Managed care organizations administer health financing and insurance to minimize costs while ensuring high-quality service delivery. However, they should not compromise a patient’s well-being to reduce medical costs. Given the patient’s medical history, living conditions, age, comorbidities, and ongoing treatments, it would be unwise to discharge and leave her with all healthcare obligations.
Therefore, the managed care company’s decision to halt further inpatient care is unsuitable for her case because it puts her at risk of complications and adverse health outcomes. Inpatient care services enable regular assessment, wound and pain management, antibiotic treatments, and physical therapy support. Hence, the company should consider these factors when deciding whether to deny or accept inpatient treatment requests.
References
Guo, W., Zhu, C., Stevens, G., & Silverstein, D. (2021). Analyzing the efficacy of isotretinoin in treating dissecting cellulitis: a literature review and meta-analysis. Drugs in R&D, 21, 29-37. Web.
Mannan, A., Akter, K. M., Akter, F., Chy, N. U. H. A., Alam, N., Pinky, S. D.,… & Rana, M. M. (2022). Association between comorbidity and health-related quality of life in a hypertensive population: A hospital-based study in Bangladesh. BMC Public Health, 22(1), 1-12. Web.
Maun, A., Björkelund, C., Wessman, C., & Arvidsson, E. (2023). Primary care utilisation, adherence to guideline-based pharmacotherapy and continuity and in primary care patients with chronic diseases and comorbidities. A registry study. Web.
Rrapi, R., Chand, S., & Kroshinsky, D. (2021). Cellulitis: A review of pathogenesis, diagnosis, and management. Medical Clinics, 105(4), 723-735. Web.