Introduction
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 nurse case manager 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 patient’s healthcare provider to get clinical data, as well as discuss care plan. The evaluation of the patient’s plans and their adjustment in accordance with the guidelines of the American Diabetes Association (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 patient’s 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 anti-inflammatory drug use. 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 telephone case management 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 study’s 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).
Cardiac patients
Cardiac related diseases are common in the world today, and they are blamed for a significant number of deaths across the globe. A study carried out in Baltimore Maryland aimed at investigating the impact of case management in patients with coronary heart disease (CHD). In this study, patients were allowed to enrol in the program after their coronary re-visualisation for one year. In this study, the case manager was critical in setting appointments after 4-6 weeks aimed at developing lipid management plans.
The case manager also offered counselling services for lifestyle modification and adjustment of medication. The case manager also made calls to ensure that patients stuck to the health plan. Lastly, the case manager communicated blood results with the primary physician for adjustment and changes. According to the study, case management was critical in improving hypercholesterolemia among patients with CHD (Allen, et al, 2002).
Another study carried out in south California aimed at examining the efficiency of nursing case management through a phone call intervention to patients with heart problems. This study was done using software known as “At Home with Heart Failure” (Riegel, et al, 2002).
The study aimed at assessing the impact of case management in reducing the patient’s use medical services after being discharged. Among the intervention group, the case manager made calls to patients for five days to know about their conditions and ensure improvement. The frequency of succeeding calls depended on the symptoms and needs of the patients. In this study, it was found out that case management reduced hospitalisation and cost of health care services for the patients (Riegel, et al, 2002).
Benefits for Nurses and Patients
Case management has been identified to improve the nurse’s satisfaction. This module improves both the work environment and healthcare delivery. Conventional nurses have been complaining about doing extra jobs related to patient care. The case manager plays critical roles in organising patient care plan from the point of admission to when the patient is discharged. In this respect, nurses have ample time to provide to care for the patients effectively.
In this case, case management can be used to ensure satisfaction of nurses in their work performance (Cohen and Cesta, 2005). Some studies have been conducted to determine job satisfaction among nurses. Aiken, Clarke, Sloane, Sochalski and Silber (2002) noted that nurses are likely to experience job dissatisfaction in hospitals with high patient ratios.
Cohen and Cesta (2005) noted that the creation of a case manager position in a hospital had positive impacts on the part of the nurses. It was found that the number of registered nurses’ hours per patient and number of registered nurses on the unit decreased substantially. This led to an increase in the productivity of the nurses (Cohen and Cesta, 2005). Therefore, case management can be beneficial to both the patient and nurses as it facilitates healthcare delivery.
Conclusion
Case management concepts improve health service and outcomes. Collaboration between nurses and other stakeholders through the sharing of knowledge and experience to coordinate and facilitate care significantly affects health care delivery. The application of case management in nursing care for patients with highly complex needs showed great improvement. Nurses’ use of case management reduces the complication risk for patients and the need for hospitalization, thereby reducing costs.
Patients with diabetes, cardiac disease, or asthma are prone to many complications. The coordination of their care by nurse case managers can improve their quality of life. This paper showed the effectiveness of using the case management concept with diabetes, asthma, and cardiac disease. Therefore, case management is an effective strategy for providing quality and cost-effective health care service.
References
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