Introduction A case management plan entails different aspects. These aspects need to integrate cohesively in order to achieve the over goal of the case management plan. In managing chronic obstructive pulmonary disease, case management is very vital. This is because it is not only incurable but also chronic. In developing a case management plan, it is important to incorporate three vital components. These components include best practices in the management of the disease condition, published guidelines pertaining to the management of chronic obstructive pulmonary disease and the clinical pathways. This paper ventilates on these components as it relates to the management of chronic obstructive pulmonary disease.Best Practices Case management of chronic obstructive pulmonary disease is heavily dependent on accurate diagnosis of the disease. Chronic bronchitis and emphysema are some of the conditions described under chronic obstructive pulmonary disease. However, these conditions can be mistaken for asthma since they all exhibit similar symptoms. Patient questionnaires ad physical examination can be used effectively to rule out other conditions that have similar symptoms ad also identify patients who need to be tested further for accurate diagnosis. However, patient questionnaires and physical examinations are not specific and sensitive enough in order to achieve a conclusive diagnosis of the condition (MacReady, 2011). One of the best practices at this juncture is the use of spirometric assessment in order to accurately diagnose chronic obstructive pulmonary disease. After a bronchodilator therapy, spirometry should be performed in order to distinguish between patients with asthma and those with chronic obstructive pulmonary disease. The forced expiratory volume in one second (FEV1) will return to the normal values after the bronchodilator therapy for patients with asthma while the values do not return to normal after a bronchodilator therapy for those diagnosed with chronic obstructive pulmonary disease (MacReady, 2011). Another best practice used in the case management of chronic obstructive pulmonary disease is inhaler technique. In patients who are diagnosed with chronic obstructive pulmonary disease, sometimes inhaled corticosteroids are at times prescribed in order to improve and maintain the patency of the airways of the patient, thereby increasing the ventilation and oxygenation of body tissues. However, evidence has shown that 94% of patients with chronic obstructive pulmonary disease do not use their inhalers correctly. This has an effect on the achievement of the desired outcomes. It is for this reason that this best practice is important and necessary (MacReady, 2011). Another justifiable best practice in the management of chronic obstructive pulmonary disease is patient education. One of the most influential causes of chronic obstructive pulmonary disease is smoking. Patient education is important in the cessation of smoking. Cessation of smoking is one of the therapeutic goals in managing chronic obstructive pulmonary disease. Patient education is vital to the achievement of this therapeutic goal. Patient education also helps prevent exacerbations by enlightening patients on the avoidance of risk factors such as occupational chemicals and pollutants, and also the adherence to the treatment regimens given (MacReady, 2011). The other justifiable best practice in the management of chronic obstructive pulmonary disease is pulmonary rehabilitation. This entails a comprehensive therapy, usually involving activity tolerance through exercise training, psychosocial education, self-management education and nutritional interventions and education. According to MacReady (2011), pulmonary rehabilitation is regarded as the standard of care. Consequently, this best practice has been integrated into main guidelines for chronic obstructive pulmonary disease.Published Guidelines Managing chronic obstructive pulmonary disease is done with regards to certain published guidelines. These guidelines offer appropriate therapeutic approaches when various symptoms are indicated. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released published guidelines that that present global strategies aimed at not only the diagnosis and management of chronic obstructive pulmonary disease, but also its prevention. The Global Initiative for Chronic Obstructive Lung Disease guidelines recommend that therapy towards chronic obstructive pulmonary disease is approached in a stepwise manner. The following are the published guidelines as per this recommendation:1. Group A patients are those patients who present with few symptoms of chronic obstructive pulmonary disease, and run a low risk of developing exacerbations. For this group of patients, short-acting bronchodilators should be used in the first line as is necessary.2. Group B patients include those patients who present with more symptoms of chronic obstructive pulmonary disease even though they run a low risk of developing exacerbations. For this group of patients, long-acting bronchodilators should be started. Short-acting bronchodilators in combination with pulmonary rehabilitation can also be given in addition to the long-acting bronchodilators as needed.3. Group C patients are those patients who present with fewer symptoms of chronic obstructive pulmonary disease, but run a higher risk of developing exacerbations. The published guidelines, these patients should be managed with the inhaled corticosteroid therapy in addition to the long-acting bronchodilators. Short-acting bronchodilators can also be used as required, especially when there are frequent exacerbations4. Group D patients are those patients who present with more symptoms and also run a high risk of developing exacerbations. The therapy approach for the patients in this group should include long term oxygen therapy in addition to the inhaled therapies. Where indicated, surgical interventions can also be consideredIn addition to these therapies, the published guidelines recommend that people diagnosed with chronic obstructive pulmonary disease should be candidates for vaccination, patient education and smoking cessation (Jindal, 2011).Clinical Pathways Clinical pathways are written guides that outline specific directions that the care process will assume in order to meet the unique needs that a patient with a specific medical problem might have (Finkelman, 2011). The chronic obstructive pulmonary disease pathway team will comprise of pulmonary nurses, internal medicine, information technology departments and family practice physicians. This team will most importantly also consist of case managers who will offer outreach services in order to ensure that the patients understand the post-discharge instructions and also follow up on appointments. The clinical pathways for chronic obstructive pulmonary disease consist of various features. One of the features is smart sets. These are developed using evidence-based guidelines. The smart sets will allow the attending doctors to make appropriate orders for the patient with chronic obstructive pulmonary disease. These include medications, referrals, follow-up appointments and vaccinations for the patient. The clinical pathways will also contain flow sheets for chronic obstructive pulmonary disease. This feature will allow the attending physicians to chart the results of the patient over time, thereby enabling comparisons to be drawn (American Medical Group Association, 2012). The clinical pathways will also consist of a synopsis section as one of the features. This feature in the clinical pathways allows the attending physicians to review the data in the flow sheet over time. This feature will also allow the attending physician to draw comparisons between the medications and the data on the flow sheet, thereby making findings that informed the management of the disease. The final feature of the clinical pathways of chronic obstructive pulmonary disease will be materials for patient education. These will be given to the patients in order to enlighten them on various aspects of managing of chronic obstructive pulmonary disease (American Medical Group Association, 2012).Conclusion This paper has highlighted the various best practices in managing chronic obstructive pulmonary disease. Particular emphasis was laid on accurate diagnosis as it is the prerequisite for the other best practices. The paper also highlighted the published guidelines. Their presentation, with special regard to the classification of patients into different groups makes it easy for coordination of the management plan because the use of different therapies based on the indications. The clinical pathways also make it easy for attending physicians and nurse case managers to administer management plans.
References
American Medical Group Association. (2012). Best Practices in Managing Patients With Chronic Obstructive Pulmonary Disease (COPD). Retrieved 30 Dec. 2014 from https://www.amga.org/ wcm/PI/Collabs/COPD/Compendiums/DuPage.pdf
Finkelman, A. (2011). Case management for nurses. Upper Saddle River. Pearson Education Inc.
Jindal, S. (2011). Textbook of pulmonary and critical care medicine. New Delhi: Jaypee Brothers Medical Publishers.
MacReady, N. (2011). Best practices for treating chronic obstructive pulmonary disease in primary care reviewed. Retrieved 30 Dec. 2014 from http://www.medscape.com/viewarticle/736895
