Introduction
According to De Regge et al. (2017), chronic illnesses account for more than half of all deaths globally. The disease under review is Chronic Obstructive Pulmonary Disease (COPD). COPD entails a range of disorders that obstruct airflow and lead to breathing difficulties (CDC, 2019). Lung inflammation and thickness define this condition, leading to the death of the tissues responsible for oxygen exchange (Ritchie & Wedzicha, 2020). This illness encompasses a spectrum of lung conditions, from emphysema to chronic bronchitis. COPD is a chronic condition since it requires continuous management. Individuals with COPD bear a disproportionate share of the illness adversity, hospitalizations, and readmissions caused by chronic disease exacerbations (Ritchie & Wedzicha, 2020). Existing health approaches are inadequate for chronic illness treatment, as shown by the high re-hospitalization rate for patients with COPD. This paper will talk about how care management helps those who have been diagnosed with COPD. Those at risk for developing COPD and the categories of people who already suffer from the disease will be discussed in depth. The advantages of case management for COPD patients will be discussed, as the role of nurses in COPD management and the care team members who should work with these patients.
The Population with the Disease and Evaluation
Although men and women experience COPD at similar rates worldwide, women have a higher COPD incidence and mortality rate in the USA (Ritchie & Wedzicha, 2020). Despite having comparable numbers of tobacco use to males, women tend to be associated with an increased risk at younger ages and later stages, leading some researchers to speculate that the consequences of tobacco may be more pronounced in women than in men (Ritchie & Wedzicha, 2020). The risk of developing COPD increases with age. Those diagnosed with this illness often are between the ages of 65 and 74, with many patients being 75 or older (Ritchie & Wedzicha, 2020). Greater cases of repeated childhood respiratory illnesses increased occupational and environmental dangers, and longer durations of cigarette use all contribute to increased prevalence in the elderly population.
Compared to big cities, rural regions had approximately double the number of reported COPD patients (Ritchie & Wedzicha, 2020). Hospitalization and mortality rates for COPD patients in rural settings have also been higher than in urban areas. American Indians, Alaskan Natives, and those of mixed racial or ethnic backgrounds have the highest infection rates (Ritchie & Wedzicha, 2020). Compared to whites, more Alaskan Natives and American Indians reside in rural locations, which may explain why they have higher COPD cases. Greater COPD prevalence is also seen among the elderly, retirees, and those incapable of working (Ritchie & Wedzicha, 2020).
Patients in rural areas have distinct challenges in COPD care from those in urban areas. The prevalence of smoking and passive smoking is higher in rural regions. In rural areas, getting medical treatment is difficult for many people. Greater rates of uninsured individuals, greater poverty, and reduced access to physicians and treatment are reported among this demographic (Ritchie & Wedzicha, 2020). Tobacco cessation initiatives, primary care physicians, and pulmonologists all play an important role in preventing and treating COPD. These programs or experts may only be accessible in densely populated locations, making extensive trips necessary for people to get the treatment they need.
De Regge et al. (2017) reveal that smoking is the leading cause of COPD. One of the causes of chronic obstructive pulmonary disease is exposure to toxic air pollutants. Any environment, from the house to the office, is a potential hotspot for this kind of exposure. COPD risk is higher in those with low levels of alpha-1 antitrypsin. Diseases of the lungs and liver are possible results of this genetic condition (De Regge et al., 2017). A significant risk factor for COPD is a history of recurrent lower respiratory tract infections, particularly in infancy. Pneumonia, flu, chest infections, bronchiolitis, and bronchitis are all respiratory illnesses (Ritchie & Wedzicha, 2020). A prior asthma history may also increase COPD risk.
Assessment of the Need for Formal Case Management
The illness process of COPD is complicated, making it challenging to treat people with it. For the greatest treatment results, fewer relapses, and higher quality of life, patients need to be followed up with by more than one healthcare professional (De Regge et al., 2017). Other chronic diseases, or co-morbidities, in these individuals might increase the difficulty of care and highlight the need for tailored treatment.
There is a higher incidence of poor health outcomes among people with the most difficulty accessing the treatment they need for chronic obstructive pulmonary disease. Compliance with medical advice is often low because people may not comprehend healthcare procedures and get dissatisfied or overwhelmed while treating a chronic condition (Summers, 2015). Transportation, medical cover and financial issues, mental discomfort, and physical ailments are all potential roadblocks to receiving treatment.
Many people needing medical treatment may not know how to find the relevant programs that might aid them. Patients with COPD often get readmitted to hospitals after receiving subpar ambulatory treatment (Riley & Sciurba, 2019). Hospital readmission rates for COPD patients need to be reduced; hence it is important to work on these issues. When providing treatment, a case management strategy looks at the full patient rather than the illness itself and adapts its methods to each individual’s requirements.
Benefits of Implementing Case Management
Care coordination, patient education, addressing psychological issues, provision of resources, and medication management are just a few of the many tasks that fall within the purview of a case manager. Disease self-management is enhanced by these approaches (Summers, 2015). After a case manager was implemented, the number of hospital readmissions due to COPD improved by 56%, according to the study’s authors (De Regge, 2017). As governments attempt to rein in rising healthcare costs, one key component of health policy is reducing the need for hospitalization among those with chronic illnesses.
CMS uses hospital readmission rates within 30 days for pneumonia, acute myocardial infarction, and heart failure as a reimbursement metric (Wadhera et al., 2019). This policy change was made to ensure that healthcare providers would be held responsible for the quality and expense of their services. Higher quality of life and less discomfort are reported by patients who are educated about their condition, its causes, the causes of acute exacerbations, treatment options, and local services (Summers, 2015).
A care manager is there to help patients through the educational process, field any questions they may have, and provide further reinforcement as necessary. The patient and care manager develop a therapeutic rapport, and the patient eventually comes to appreciate the care manager. When a care manager has earned the patient’s confidence, the patient is more inclined to follow advice, ask questions, and share concerns (De Regge, 2017).
Why Nursing Should Be a Part of this Plan
Any qualified healthcare professional, such as a medical social worker (MSW), an RN, or a community health worker, can serve in the case manager position. The training that registered nurses receive is one reason for their taking on case management roles. The RN has finished a rigorous academic program and a bachelor’s degree in science (Tai-Seale et al., 2019). Advantages in disease pathogenesis comprehension, medical treatment, and patient education possibilities result from this. To aid in care coordination, the RN has in-depth knowledge of the healthcare system, its procedures, and the best ways to network with other care providers (Wadhera et al., 2019). Finally, it is worth noting that nurses have been named the most transparent and ethical professionals. This helps immensely in developing a strong therapeutic bond with patients.
Other Members of a Case Management Team
As indicated throughout this paper, treating a COPD patient is interdisciplinary. General practitioners, pulmonologists, thoracic surgeons, and radiologists are examples of healthcare professionals who aid in the management of COPD. The MSW, ambulatory RNs, MA staff, case managers, dieticians, and financial advisors are among the other specialties participating in treatment (Riley & Sciurba, 2019). Staff at community resource centers may be engaged in care delivery as well. Patients must work closely with their primary care practitioner to manage their COPD and any other illnesses they may also have. The primary care physician will recommend specialists as required, and the senior specialists associated with a COPD patient are the pulmonologist and, if appropriate, the thoracic surgeon. The pulmonologist will support the primary care physician in managing and treating COPD by making therapy and follow-up decisions and seeing the patient regularly to monitor disease progression and the effectiveness of treatment.
Conclusion
Providing care for a person with a chronic condition necessitates the involvement of a complete team of healthcare providers. Focusing on lowering the risk of illness aggravation can reduce avoidable hospitalizations and readmissions, enhance patient quality of life, and lower healthcare costs. Involving a case manager in a patient’s care suffering from chronic disease improves adherence to treatment suggestions and professional follow-ups. The rationale for case management is that it facilitates patients’ illness control and contributes to lowering the cost load on the individual and the healthcare system.
References
De Regge, M., Pourcq, K. D., Meijboom, B., Trybou, J., Mortier, E., & Eeckloo, K. (2017). The role of hospitals in bridging the care continuum: A systematic review of coordination of care and follow-up for adults with chronic conditions. BMC Health Services Research, 17
Riley, C. M., & Sciurba, F. C. (2019). Diagnosis and outpatient management of chronic obstructive pulmonary disease: a review. Jama, 321(8), 786-797.
Ritchie, A. I., & Wedzicha, J. A. (2020). Definition, causes, pathogenesis, and consequences of chronic obstructive pulmonary disease exacerbations. Clinics in chest medicine, 41(3), 421-438.
Summers, N. (2015). Fundamentals of case management practice: Skills for the human services. Cengage Learning.
Tai-Seale, M., Downing, N. L., Jones, V. G., Milani, R. V., Zhao, B. (2019). Technology-enabled consumer engagement: Promising practices at four health.
Wadhera, R. K., Yeh, R. W., & Maddox, K. E. J. (2019). The hospital readmissions reduction program—time for a reboot. The New England journal of medicine, 380(24), 2289.
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