Case Management Considerations
These patients have more healthcare needs and therefore high healthcare costs. The out of pocket cost of their care, including the cost for prescription drugs, can be devastating. There are some things the Case Manager can do or suggest to assist the patient including:
- Samples from the doctor’s office
- Generic drugs when appropriate
- Co-pay assistance programs
- Disease specific financial assistance
Patients with multiple co-morbidities are typically prescribed medications from multiple providers which can lead to overmedication or medication interactions. For this reason it is important for the case manager to review all medications at the opening of the case, after each hospitalization and after each visit to the doctor’s office. Along with reviewing the medications the Case Manager should screen for medication compliance.
Patients can be easily overwhelmed by all the information available to them. Instead of giving them all the handouts, pamphlets and booklets at one time, ask them what information they would like to start with. You can add additional handouts with each interaction.
Management- Where to start
In cases where one condition is extremely critical or complex knowing where to start will be obvious. These include recent diagnoses of cancer or other serious disease, end-stage disease and severely symptomatic disease.
In the absence of a clinically dominate condition, a good place to start would be with concordant conditions. These are conditions that have the same overall pathophysiologic risk profile and are more likely to have similar management plans. Examples would be hypertension, coronary artery disease, peripheral vascular disease and diabetes.
At times, one disease complicates the management of other co-morbid conditions. In these cases, it is important to get this disease under control before other conditions can be successfully dealt with. One example of this is depression.
If none of the above circumstances apply, the best place to start is where the patient feels most likely to have success.
No matter where you start remember, Patients with multiple co-morbidities often have numerous lifestyle changes as well as dietary changes or restrictions. It is overwhelming for the patient to work on everything at once. To start, identify no more than 2-3 initial goals that the patient feels they can accomplish. Commending even the smallest achievement and focusing on the things they are doing right will help build a foundation for future success.