Introduction
COPD is an acronym for chronic obstructive pulmonary disease. This is a progressive disease which affects one’s lungs, rendering it increasingly difficult to breathe. The term progressive in the definition of chronic obstructive pulmonary disease implies that the disease increases in severity over time. Chronic obstructive pulmonary disease causes coughing in affected individuals and is characterized by copious amounts of mucus, shortness of breath, wheezing and tightness of the chest among other symptoms (National Heart, Lung and Blood Institute. 2013).
This paper delves in this population, with an aim of studying chronic obstructive pulmonary disease. The paper will ventilate on the scope of chronic obstructive pulmonary disease in the general population and also the priorities for disease management within the health care system. This will enable the paper to rationalize the need for a formal case management program for chronic obstructive pulmonary disease. This will also enable the paper to highlight the potential benefits that a formal case management program for chronic obstructive pulmonary disease. Finally the paper will justify why the coordination of this plan of care should be done by nurses
Scope of chronic obstructive pulmonary disease
A further 56% reported a limited ability to perform their household chores. 53%, 50% and 46% of the people surveyed reported limited ability in performing their social activities, sleeping ad family activities respectively (American Lung Association, 2014). It is also important to focus on the financial burden that chronic obstructive pulmonary disease place on the general population. In 2010, chronic obstructive pulmonary disease was responsible for 49.9 billion dollars. The constituents of this amount include 29.5 billion dollars from direct health care expenditures, 8 billion dollars from indirect morbidity costs and indirect mortality costs amounting to 12.4 billion dollars (American Lung Association, 2014).
The prevalence of the condition in 2011 was at 12.7 million for adults aged above 18 years (Center for Disease Control and Prevention & National Center for Health Statistics, 2011). There is an under diagnosis of the condition given that in the same year, 24 million adults showed signs of impaired lung functions (Centers for Disease Control and Prevention, 2002). In 2011, close to 10.1 million people were diagnosed with chronic bronchitis, with the highest rate witnessed in people above 65 years where 64.2 people in every 1000 people reported a diagnosis of chronic bronchitis (American Lung Association, 2014). 4.7 million Americans have by far been diagnosed with emphysema, of which 92% are above 45 years.
Rationale for a Formal Case Management Program
Chronic obstructive pulmonary requires a formal case management program. According to the American Lung Association (2013), chronic obstructive pulmonary disease does not have a cure. However, various measures can be instituted in order to slow the rate at which the disease progresses and also prevent the exacerbations of chronic obstructive pulmonary disease. The fact that the disease has no cure means that management of the manifestations is required in order to help those diagnosed with chronic obstructive pulmonary disease breathe with ease. As a result of this, there might be long hospitalization days for the patients as the manifestations and exacerbations are managed.
During this period, the costs of management could escalate beyond what the patient can comfortably pay. In the same respect, it is also important to consider that since the disease is not curable; its management is long term. For this reason, a formal case management program is required. Among other reason, it will reduce the hospitalization days for the patients, and by association, the costs associated with hospitalization. Additionally, a formal case management program will also help reduce the exacerbation of chronic obstructive pulmonary disease. According to the Ministry of Health (2011), the therapeutic objectives include the reduction in the severity and frequency of exacerbations, alleviation of respiratory symptoms and breathlessness, smoke cessation in order to prevent the progression of the disease and the improvement of health status. The achievement of these objectives, especially considering the dynamics involved requires a formal case management program. Besides, statistics from the Ministry of Health (2011) indicate that self-management approach of chronic diseases that is supervised by health professionals can reduce the hospital admissions as a result of exacerbations by 40%.
Potential Benefits for a Systematic Case Management Plan
There are several benefits resulting from the implementation of s systematic case management plan. Firstly, the plan will help improve the quality of life for the patients. As identified previously, hospitalization as a result of exacerbations can be reduced by up to 40% when self management is supervised by health professionals, as the case would be in this plan. This would also encompass the mitigation of the progression of the disease through the achievement of cessation of smoking as one of the therapeutic objectives.
Another benefit that can be drawn from this plan is the reduction in the financial burden resulting from the disease. As identified earlier, chronic obstructive pulmonary disease amounted to 29.5 billion dollars from direct health care expenditures, 8 billion dollars from indirect morbidity costs and indirect mortality costs amounting to 12.4 billion dollars (American Lung Association, 2014). The direct costs can be reduced by reducing hospitalization days through case management. The indirect costs can be reduced by improving the quality of life, thereby reducing mortality rates and enabling those diagnosed to remain economically productive.
Additionally, the implementation of this plan will enable those diagnosed to remain socially active. Statistics adduced previously have shown that 53% of people re inhibited from performing their social activities by chronic obstructive pulmonary disease. The implementation of this plan will enable these people to participate actively in the society by reducing their hospitalization days, preventing exacerbation and the progression of the disease.
The Coordination of the Plan of Care
The responsibility for the coordination of this plan should be bestowed upon the nursing institution. Nurse case managers act as patient educators. In this capacity, they educate the patients on the therapeutic objectives in the management of chronic obstructive pulmonary disease. This helps in the self management of the disease. As pointed out earlier, the fact that the disease has no cure means that patient has to manage the risk factors in order to reduce exposure and also prevent disease progression. The nursing institution, acting in the capacity of a patient educator, prepares the patients for self management when they are discharged (Finkelman, 2011).
Additionally, nurses offer the continuum of care in various settings for the patients. In order to put this to perspective adequately, it is important to consider that community health nurses not only work within health institutions, but also within the context of the community. In this capacity, nurses are able to mobilize resources to help the patients achieve the therapeutic achievements. With regards to the continuum of care concept, nurses can follow up on the patients in the home care setting in order to ensure that they remain steadfast on the treatment plans and also planned patient outcomes are achieved (Finkelman, 2011).
Other team Members
Various members are also required in the implementation of this plan. One of the members required in this team are counselors. Counselors are important in the achievement of cessation of smoking as a therapeutic objective. Counseling helps reinforce the objectives for cessation of smoking. Through counseling, the patient can also develop coping mechanisms. A pharmacotherapy specialist is also required as a member of the team. The use of bronchodilators is one of the mainstays in pharmacotherapy for chronic obstructive pulmonary disease (Ministry of Health, 2011).
Conclusion
Chronic obstructive pulmonary disease is used to collectively describe lung conditions like emphysema and chronic bronchitis. This is one of the disease conditions whose prevalence is rising. This is probably because the disease has no cure. As such, the scope for the general population is mitigating the burden that the disease places on people, as highlight by the statistics from surveys performed. From a health care perspective, the scope of the condition entails disease management in order to mitigate the burden in terms of health care costs resulting from hospitalizations and mortality. It is for this reason, and others that a formal case management program for chronic obstructive pulmonary disease is required. The coordination of this program should be the responsibility of nurses. As patient educators and workers in many health settings such as acute care, primary care organizations and in the home care setting, they are better placed in terms of knowledge and skill to coordinate the care plan. This is of course in conjunction with other members such as counselors and pharmacotherapy specialists.
References
American Lung Association. (2000). Confronting COPD in America. Retrieved 24 Dec. 2014 from http://www.lung.org/assets/documents/EXESUM.pdf
American Lung Association. (2014). Chronic obstructive pulmonary disease (COPD) fact sheet. Retrieved 24 Dec. 2014 from http://www.lung.org/lung-disease/copd/resources/facts- figures/COPD-Fact-Sheet.html#Burden
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Finkelman, A. (2011). Case management for nurses. Upper Saddle River. Pearson Education Inc.
Ministry of Heath. (2011). Chronic obstructive pulmonary disease(COPD). Retrieved 24 Dec. 2014 from http://www.bcguidelines.ca/guideline_copd.html
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National Heart, Lung and Blood Institute. (2013). What is COPD? Retrieved 21 Dec. 2014 from http://www.nhlbi.nih.ogov/health/health-topics/topics/copd
