The following components are recommended in chronic disease management: a multidisciplinary approach, early contact upon hospital admission and following discharge, access to treatment options, patient involvement with monitoring symptoms, and patient/family psychosocial support. Heart failure patients can be managed on an outpatient basis in a clinic or by tele health, depending on the severity of their illness. HF management programs utilize various healthcare providers who make the needs of the patient priority, not the disease. The focus is placed on the patient’s adherence to the plan of care and their ability to recognize symptoms that need to be reported to the proper health …show more content…
The referrals made under this plan usually last 3 months and will taper off as the patient’s condition improves. The case manager will review long-term programs anywhere from 3 to 9 months and the goal of case management for the patient is stability. Quality of life (QoL) can be difficult to measure with certain conditions (Mullahy, 2010). QoL can be measured from the patient’s perspective. Cardiac rehabilitation (CR) can help reduce the mortality/morbidity rate among patients with heart failure and increases QoL. However, CR programs are shown to be more effective for patients in short-term case management programs, those in long-term programs decrease their participation prior to a year’s timeframe. Cardiac rehabilitation programs include stress management, smoking cessation, diet modification, and anxiety/depression management (Blum, Schmid, Eser, & Saner, 2013).
Conclusion
As a health care professional, it is important to assist patients with chronic illnesses to manage independently and function in the community with ease. There are some patients who do not follow the plan of care, this can cause an ethical dilemma for the case manager who has committed themselves to securing resources and services for the patient. The overall goal is for the patient to become self-sufficient and improve their quality of life. At the end of the day, it is up to the patient to be willing to comply with the short and long-term individualized plan created for cost-effective quality