Asthma is a disease regarded as a chronic inflammation of the bronchial tubes that causes swelling and narrowing of the airways, difficulties in breathing. However, this narrowing of the airways can be totally or partially treated with medication. When the bronchial tubes become inflamed, they become highly sensitive to allergens or irritants. These airways usually become twitchy, and they may remain in the state of increased sensitivity. This condition is referred as “bronchial hyper reactivity”. Asthma affects people in different ways considering each individual being uniqueness in the level of reactivity to environmental triggers. This level therefore determines the type and dosage of medication that is prescribed to the individual.
The Scope of Asthma in the General Population and on the Health Care System
Asthma is the most common chronic disease in children affecting one in every 15 children. In North America, 5 percent of all adults suffer from asthma and 9.5 percent of children. In total, there are approximately 1 million people in Canada and 25 million in America who suffer from asthma. New cases of asthma are, however, being diagnosed every day and therefore the number of cases and the annual rate of hospitalization for asthma have increased by 30 percent for the past 20 years. For example, in America in 2009, 1 in every 12 people had asthma compared to 2001 when 1 in every 14 people had asthma. This rate is therefore continuing to grow every year. The greatest numbers of cases among children have been identified among the black children in America that have increased by almost 50 percent between 2001 and 2009. Even considering the advances in treatment, asthma is on the increase that has prompted the doubling of death rates among the young people (Centers for Disease Control and Prevention, 2011).
The Need for a Formal Case Management Program
A formal case management program for asthma may be the key to reducing deaths related to the disease. This is because most patients do not adhere to the medication and this leads to deteriorating quality of life which may result in death of the patient. Therefore, a program that will help patients build asthma management skills is most required rather than just providing basic information to patients. Studies have identified some factors that affect adherence to asthma medication being lack social support, poor asthma knowledge, management skills and other dynamic issues affecting parents, children, and the entire family. Therefore, a formal case management program will improve parental oversight in addressing issues such as knowledge and skill of asthma management as well as improving the patient’s communication and self-care roles.
The core elements for the asthma case management program include building capacity for routine assessment, establishing consistency in patients’ care through education of medical personnel and patient’s care givers, and a regular reporting system for all outcomes and processes for the care providers. Other include medication adherence counseling, follow up form for inpatient visits, coordinated care, education on the disease, equipments, medication and on the avoidance of triggers. However, there is need for a dedicated family physician who will lead the initiative and provide technical assistance. With all these elements, the case management program will ensure successful recovery from the disease and reduce mortality rates associated with asthma (Community Care of North Carolina, 2013).
Potential Benefits to Implementing a Systematic Case Management Plan
A systematic case management offers an opportunity for an improvement in the health outcomes and cost reduction. Considering the elements of a case management program, if it is well implemented, one of the results will be patients’ ability of self-care. This means that there is reduction in health service utilization among the patients who can manage self-care. This results in reduced visits to the health facility, therefore, cutting on the cost of those visits. It also means that there is reduced cost of paying for the doctor’s consultation fee. When a patient has the knowledge and skills for managing his or her own condition; this is an economic benefit to the patient and the family members. Another benefit of case management program is that it results in improved quality of life. This quality is improved through improved adherence to medication and self-care. This is because the program involves active follow up and ensuring consistency of care. This means that the patient will be able to receive high quality care and continuous monitoring of the progress. High quality care ensures successful recovery and therefore improved quality of life for the patient (Kathol et al., 2011).
Systematic case management program will also have social benefits to the patient since it involves coordination of care between the physician, the care giver who belongs to the patient’s family and the patient. This helps in improving the social support which acts as a barrier to medication adherence among asthma patients. Social support is also important for the recovery process because it enhances a feeling of belonging for the patient.
Role of Nursing in Coordinating the Case Management Program for Asthma
Nursing role is very important in coordination of case management plans for asthma patients. Nurses should act as a case manager who should assist patients and identify some of the factors that will affect the ability of patient to go through asthma management plan. Some of these factors include social support, economic resources, and lack of knowledge and skills regarding asthma management. Therefore, a nurse will be able to form a multidisciplinary team that will engage other players in addressing the issues identified during patient assessment. The nurse will be able to lead the team in developing clinical pathways and guidelines that will be part of the case management plan (Dinelli & Higgins, 2002). Some of the clinical guidelines will include timing of the intended medication and plan for ongoing monitoring and risk surveillance. These guidelines will also be used in moving the patient to the next recovery level. These guidelines are also provided to the patients to help them in self management of their condition.
One of the reasons as to why the nurses should be involved in formulating the plan of care is the need for coordination with the patient. Patients may well understand the plan of care when they are involved in its writing. The nurse is able to coordinate with the patient in writing the care plan. Another reason as to why the nurse should be the main player is that he or she is able to provide patient education to improve their knowledge and skills. It is important that patients understand the healthcare provider’s recommendations so that they can easily follow them. Therefore, since patient education is the responsibility of the nurse, it is important that he/she be involved in formulation of the plan. Education on asthma also requires that the healthcare provider begin at the patient’s level of understanding when giving advice. This may be possible with the nurse compared to other healthcare providers (Community Care of North Carolina, 2013).
Patient follow up which is also very important in case management of asthma may be possible with the nurse as compared to other healthcare providers. Follow up may involve home visits and meeting family members and care givers. This responsibility may, however, best fit the nurses.
Other Team Members for Case Management Program for Asthma
Other members of the team may include physicians, parents in case of children or a care giver and community health workers. The role of the physician as a member of team will be for consultation by the nurse to discuss the reaction of the patient to the treatments and suggest referrals in case of any adverse reaction. The physician will also act to review the follow up forms and give the recommendations. The parents and the care givers at home are for continuous observation of the patient and for offering social support especially on adherence to medication. Children may sometimes not will to take the drugs and it is important for the parents to assist and encourage them. For the adult patient, a care giver will ensure that they follow the prescriptions and other advice from the healthcare provider. The role of the community health workers acts as the link between healthcare system and the social service system. They help in linking the patients with sources of funds and other resources required to manage their health needs. In case of asthma, they help in dealing with social and environmental issues contributing to the disease in collaboration with the healthcare system (AHRQ, 2011).
Formal case management programs have been found to be effective in managing asthma. This is mostly important due to the economic and social challenges associated with managing the disease. Case management program minimizes the cost and ensures that there is improved outcome of the treatment regime leading to improved quality of life for the patient. It is important to ensure that there is total coordination between various players in case management for a successful outcome. The entire program requires teamwork between the nurses, the physician, the patient and his or her family members and the community health workers.