Subject(s)
Aging , COVID-19/therapy , Case Management/organization & administration , Case Management/statistics & numerical data , Case Managers/supply & distribution , Case Managers/statistics & numerical data , Personnel Loyalty , Adult , Aged , Female , Humans , Male , Middle Aged , United StatesABSTRACT
PURPOSE: This article describes "Guided Care," a promising new model of case management that includes disease management, self-management, transitional care, and caregiver support for multimorbid patients and their families. PRIMARY PRACTICE SETTINGS: Guided Care nurses, based at primary care practices, extend services to the home and all the other settings where their patients receive care. FINDINGS AND CONCLUSIONS: Guided Care nurses take responsibility for 50-60 multimorbid patients. For each patient, the nurse performs a home assessment and creates an evidence-based plan of care. In partnership with the primary physician, the Guided Care nurse then monitors and coaches the patient monthly, coordinates the patient's transitions between providers and sites of care, educates and supports family caregivers, and facilitates access to community resources. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: As a next stage in the evolution of case management, Guided Care may be supported by Medicare and, therefore, adopted widely throughout the American healthcare.
Subject(s)
Case Management/organization & administration , Chronic Disease/prevention & control , Models, Nursing , Nurse's Role , Patient Care Planning/organization & administration , Primary Health Care/organization & administration , Aged , Baltimore , Chronic Disease/nursing , Chronic Disease/psychology , Comorbidity , Continuity of Patient Care/organization & administration , Disease Management , Evidence-Based Medicine , Feasibility Studies , House Calls , Humans , Nursing Assessment , Nursing Evaluation Research , Nursing Process/organization & administration , Patient Education as Topic/organization & administration , Pilot Projects , Program Evaluation , Self Care/methods , Social SupportABSTRACT
PURPOSE/OBJECTIVES: The Case Management Society of America (CMSA) developed evidence-based guidelines (Case Management Adherence Guidelines, CMAG) for case managers to support increased efficacy of case managers in helping patients become more adherent to medication regimens. The effort was in response to documented high levels of nonadherence, and evidence demonstrating that lack of adherence negatively impacts patient health status. The CMSA engaged in a massive training program to support case manager adoption of the CMAG tools and approaches to improve patient knowledge and motivation. This article reports on findings of a follow-up survey that evaluated case manager's use of the tools and strategies discussed in the CMAG. PRIMARY PRACTICE SETTING(S): Seven hundred fifty case managers from all settings were trained in the use of the CMAG. FINDINGS/CONCLUSIONS: In a follow-up survey, 42% of respondents reported that there has been a very, or fairly, significant impact of using their new skills to increase their effectiveness in helping patients reach their outcome improvement goals. In addition, 43% reported that there has been a very, or fairly, big improvement in patient adherence since they took the training, while 39% did not see a major impact. At the time of the survey (up to 1 year after training), 43% of respondents indicated that the training was very valuable; another 39% reported that it was fairly valuable. Participants continue to use the skills and information adopted in the training sessions: 26% report that they currently use at least some of the information and skills very often, while another 49% use them fairly often. Sixty-six percent of respondents indicated that they specifically use motivational interviewing to help address patient knowledge and motivation regarding medication adherence. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Medication adherence is a key issue in case management practice; efforts to positively impact low patient knowledge and motivation can be frustration for case managers. The CMAG offer evidence-based assessment tools to evaluate patient knowledge of medications and their motivation to adhere, and recommend the strategy of motivational interviewing to help case managers address adherence more effectively with patients. A 1-time training on the CMAG and motivational interviewing had some effect on self-reported case manager effectiveness in addressing medication adherence. Case managers appreciated the training; many reported that they continue to use skills and that they have observed changes in patient outcomes. Additional training, skill building, and reinforcement may help case managers apply CMAG and motivational interviewing effectively to support patients' adherence to medication regimens. The CMSA may continue to evaluate the impact of the CMAG and CMAG training to refine the tools and the training approach.
Subject(s)
Case Management/organization & administration , Education, Continuing/organization & administration , Guideline Adherence/organization & administration , Inservice Training/organization & administration , Practice Guidelines as Topic , Attitude of Health Personnel , Clinical Competence/standards , Computer-Assisted Instruction , Drug Therapy/psychology , Evidence-Based Medicine/education , Evidence-Based Medicine/organization & administration , Follow-Up Studies , Health Knowledge, Attitudes, Practice , Health Services Needs and Demand , Humans , Internet , Motivation , Patient Compliance/psychology , Patient Education as Topic , Professional Role/psychology , Program Evaluation , Self Efficacy , Societies, Scientific , United StatesABSTRACT
The health-care system works, for the most part, and patients who need help from case management are the exception rather than the rule. This has always been my belief, and this is what I have always advised. We even had statistics: 5%-10% of Medicare patients are high risk and need a case manager, and 6%-10% of patients account for 85%-90% of costs. Although these figures may be accurate, the small percentage indicating patients who need a case manager is no longer accurate. The health-care system is fraught with pitfalls, bureaucracy, disinterest, and delay. Even straightforward care is no longer straightforward in its delivery. Case managers may not be the answer to the woes of the health-care system, but we are surely the patient's last hope for navigating the maze.
Subject(s)
Case Management , Health Services Accessibility , Quality of Health Care , Humans , United StatesABSTRACT
The Case Management Society of America (CMSA) was pleased to announce the winner of the first annual Award for Excellence in Adherence Management (AEAM), presented to the case manager who used CMSA's Case Management Adherence Guidelines (CMAG) and CMAG Tracker database most effectively in 2005. Jerri Post was awarded the AEAM at CMSA's 15th Annual Conference in Orlando, Florida. CMAG provides the first evidence-based guidelines for case managers to support health behavior change interventions. Pfizer, Inc. partnered with CMSA to provide national CMAG training programs for CMSA members and sponsored the award.
Subject(s)
Awards and Prizes , Case Management , Drug Therapy , Guidelines as Topic , Patient Compliance , Humans , United StatesSubject(s)
Case Management/organization & administration , Drug Therapy/psychology , Long-Term Care/psychology , Patient Compliance/psychology , Practice Guidelines as Topic , Algorithms , Decision Trees , Drug Therapy/standards , Evidence-Based Medicine , Health Knowledge, Attitudes, Practice , Humans , Internet , Long-Term Care/standards , Models, Educational , Models, Psychological , Motivation , Needs Assessment , Nursing Assessment/organization & administration , Outcome Assessment, Health Care/organization & administration , Patient Education as Topic/organization & administration , Patient-Centered Care/organization & administration , Professional Role , Professional-Patient Relations , Social Support , Total Quality Management/organization & administrationSubject(s)
Drug Therapy , Patient Compliance , Case Management , Humans , Patient Compliance/psychology , Patient-Centered Care , United StatesABSTRACT
Poor adherence to medical therapy may cause as much as dollar 100 billion in unnecessary healthcare expenses each year. Nonadherence is a complicated and dynamic problem that involves patient, medication, and prescriber factors. The Case Management Adherence Guidelines (CMAG-1) are an evidence-based algorithm that introduces concepts and strategies for assessing medical knowledge and readiness to change (motivational interviewing). Once the assessment has been made, the guidelines can be used regularly to help patients become and remain adherent to their medication regimens. CMAG-1 and its tools, based on up-to-date information about adherence and ways to promote behavioral change, are designed to identify motivational and knowledge deficiencies that may block adherence. As information accumulates from centers that use it, CMAG-1 will be modified accordingly, with the goal of creating structured interaction with patients that will increase their knowledge and motivation to take medication appropriately.
