CM can help patients better control chronic conditions

Survey identified five steps to success’

Case manager interventions can benefit patients who are dealing with chronic conditions, a member of an advisory board working to improve health care says.

Chronic Care in America, a comprehensive study of behaviors across chronic conditions, demonstrates why some people succeed and other struggle to manage their conditions.

The survey identifies five "steps to success" based on the behavior of people in the survey who indicated that they have succeeded in managing their conditions and observations from physicians.

Steps to success

Case managers can help patients take these steps to success by working with the patients and their physicians to coordinate care and information, says Gerard Anderson, PhD, a professor at Johns Hopkins University in Baltimore and director of the Partnership for Solutions, a program funded by the Robert Wood Johnson Foundation.

"We need somebody in charge of delivering care for people with multiple chronic conditions who deal with multiple doctors. That’s where case management is important," Anderson says.

Here are the steps to success and Anderson’s suggestion of how case managers can be involved:

1. Get a "prescription for information."

Patients who view themselves as being most successful at living with their condition also are those most likely to read about their condition, the researchers found. While patients are accessing health information on the Internet, 86% report that they rely more on their physicians for information.

"Getting information to the patient in a way he or she can understand is a critical role for case managers, and it’s not a role that physicians typically play. Case managers should step up to the plate and make sure the patients get the information they need," Anderson says.

2. Be aware of depression.

Depression affects 25% to 33% of people who have a chronic disease, the researchers found. Less than half the patients who reported they had been diagnosed with depression had been successful at managing their condition.

"Depression is harder to detect, but it may have a more profound effect than other diseases. Case managers don’t always recognize depression as a comorbidity, but they should be aware that they are going to be dealing with a high percentage of patients with some level of depression," Anderson says.

He suggests that case managers be on the lookout for signs of depression in their chronically ill patients and use their clinical judgment to decide whether the patients need interventions.

3. Make the physician a partner in care.

It’s vital for the case managers to get involved in this initiative and coordinate the care the patient receives from all physicians, Anderson says.

Patient reminders

"When patients are dealing with five or 10 different clinicians, the case manager is the one person who has the role of being care coordinator for all the conditions. When specialists have patients with comorbidities, they are likely to treat one condition but not the others," Anderson says.

He suggests that case managers make sure they keep reminding patients to alert their physicians to all of their other conditions when they are being treated for one condition. Case managers should work with physicians to make them aware of the comorbidities, the care the patient is receiving from other physicians, and other issues that arise, he adds.

4. Take action immediately after your diagnosis.

People who successfully managed their chronic conditions responded quickly to make lifestyle changes, while 65% of the unsuccessful patients said they wished their condition would "just go away."

Case managers should make sure there is immediate follow-up when patients are diagnosed with chronic conditions, Anderson adds.

"They may have to become coaches for care or cheerleaders for some patients, encouraging them to be compliant with the treatment plan," he says.

5. Make a health investment in you.

"We know that patients don’t take their prescription drugs or stop smoking and that they behave inappropriately. Case managers have an important role in helping patients make lifestyle changes," he adds.

(Editor’s note: For more information on dealing with patients with chronic illnesses, see www.partnershipforsolutions.org.)