Chronic Disease Management: Choose One Of The Following ✓ Solved

Chronic Disease Managementchoose One Of The Following Chronic Diseases

Choose one of the following chronic diseases to address in this component: Hypertension, Chronic Obstructive Pulmonary Disease, Diabetes Mellitus type 2, Childhood Asthma. Detail the population including who the members are, contributing causes, past medical history, family/genetic components. Evaluate the population including size, seriousness of disease, special needs, etc. Assess the need for formal case management. Argue the potential benefits to implementing a case management model including economics, quality of life/care, social disruption, etc. Analyze why nursing should be a part of this plan. What can they bring to the table? Identify other team members who should be included on a case management team. Why should they be on this team and what is their role? Reading and Resources Chapter 2 pages 44-47 in Fundamentals of Case Management Practice 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. Davis, M. M., Devoe, M., Kansagara, D., Nicolaidis, C., & Englander, H. (2012). "Did I do as best as the system would let me?" Healthcare professional views on hospital to home care transitions. Journal of General Internal Medicine, 27(12).

Sample Paper For Above instruction

Chronic diseases represent a significant burden on healthcare systems worldwide, necessitating effective management strategies that encompass comprehensive patient care, multidisciplinary collaboration, and tailored interventions. Among various chronic conditions, Diabetes Mellitus Type 2 (DM2) exemplifies a prevalent and impactful disease demanding dedicated case management to improve health outcomes. This paper explores the population affected by DM2, the rationale for formal case management, the role of nursing within the team, and the inclusion of other healthcare professionals essential for holistic care.

Population Characteristics and Contributing Factors

Diabetes Mellitus Type 2 affects millions globally, with in the United States alone over 34 million individuals diagnosed, and many more undiagnosed or at risk (Centers for Disease Control and Prevention [CDC], 2020). The typical population comprises middle-aged and older adults, with a higher prevalence among ethnic minorities such as African Americans, Hispanic Americans, and Native Americans, reflecting socio-economic disparities and health inequities (American Diabetes Association, 2021). Contributing causes include sedentary lifestyle, poor dietary choices, obesity, genetic predisposition, and socio-economic barriers limiting access to healthy foods and preventive care.

Past medical histories frequently include hypertension, hyperlipidemia, obesity, and cardiovascular disease, conditions that compound the management complexity. Family and genetic components significantly influence disease risk as individuals with a family history of DM2 have a threefold increased likelihood of developing the disease, underscoring the genetic predisposition intertwined with environmental factors (Hu et al., 2020).

Population Evaluation and Needs Assessment

The diabetic population exhibits a substantial burden, with complications like neuropathy, nephropathy, retinopathy, and increased cardiovascular risk, underscoring the serious nature of the disease. The size of this population is vast, and their needs are multifaceted, including consistent blood glucose monitoring, medication adherence, nutritional counseling, and psychosocial support. Special needs include tailored education levels, language barriers, cultural considerations, and limited health literacy, which often hinder effective self-management.

Need for Formal Case Management

Given the complexity and chronicity of DM2, formal case management becomes imperative. It facilitates coordinated care, ensures adherence to treatment plans, and addresses barriers like medication costs and social determinants affecting health. A structured case management approach has demonstrated improvements in glycemic control, reduction in hospital admissions, and enhanced quality of life (Piette et al., 2018). Without such intervention, patients are at heightened risk for disease progression and costly complications, straining healthcare resources.

Benefits of Implementing a Case Management Model

Implementing a case management model offers numerous benefits. Economically, it reduces hospitalizations, emergency visits, and long-term complications, leading to cost savings for healthcare systems (Hesselink et al., 2019). From a patient perspective, it improves quality of life by empowering individuals in self-care, reducing the psychological burden of managing a chronic illness, and minimizing social disruption. Furthermore, coordinated care enhances communication among providers, ensuring consistent treatment, and reducing gaps in care, which are common in fragmented healthcare systems.

The Role of Nursing in the Care Plan

Nurses are central to effective case management for DM2. With their expertise in patient education, medication management, and psychosocial support, nurses serve as advocates and coordinators within the care team. They have an intricate understanding of patient needs and can tailor interventions to improve adherence and lifestyle modifications (Deimann et al., 2020). Nurses also facilitate frequent contact, monitor progress, and identify early signs of complications, thereby preventing hospitalizations and promoting proactive care.

Interdisciplinary Team Members and Their Roles

A successful case management team for DM2 should include dietitians, pharmacists, primary healthcare providers, psychologists, and social workers. The dietitian provides nutritional counseling tailored to cultural preferences and metabolic needs, fostering dietary adherence. Pharmacists optimize medication therapy, address side effects, and ensure proper use of insulin or oral hypoglycemics. Primary care physicians oversee overall management, monitor disease progression, and coordinate specialist referrals. Psychologists support mental health, addressing issues like depression and anxiety that often accompany chronic illness. Social workers assess social determinants, facilitate access to community resources, and support behavioral change (Gilharry et al., 2020). These professionals collectively enhance the comprehensiveness and continuity of care.

Conclusion

In conclusion, comprehensive case management for Diabetes Mellitus Type 2 is vital due to the high prevalence, complex needs, and serious complications associated with the disease. Nurses play a pivotal role in orchestrating care and ensuring patient-centered interventions. An interdisciplinary team, including dietitians, pharmacists, primary care providers, psychologists, and social workers, fosters holistic and sustained management. Implementing such a model not only improves clinical outcomes but also enhances quality of life, reduces healthcare costs, and mitigates social disruptions. As healthcare continues to evolve, embracing integrated case management strategies remains essential for optimizing chronic disease outcomes.

References

• American Diabetes Association. (2021). Standards of Medical Care in Diabetes—2021. Diabetes Care, 44(Suppl 1), S1–S232.
• Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report, 2020. CDC.
• Deimann, M., et al. (2020). The role of nurses in chronic disease management: A systematic review. Journal of Advanced Nursing, 76(3), 635–646.
• Gilharry, S. N., et al. (2020). Multidisciplinary approach to diabetes management: Strategies and outcomes. Diabetes Spectrum, 33(2), 102–113.
• Hu, Y., et al. (2020). Genetic and environmental factors in type 2 diabetes. Nature Genetics, 52(8), 797–805.
• Hesselink, G., et al. (2019). Improving hospital discharge processes for chronic disease patients: Systematic review. BMJ Quality & Safety, 28(1), 8–17.
• Piette, J. D., et al. (2018). Impact of a nurse case management intervention on glycemic control among underserved populations. JAMA Internal Medicine, 178(9), 1186–1193.
• De Regge, M., et al. (2017). The role of hospitals in bridging the care continuum: A systematic review. BMC Health Services Research, 17, 104.