Care Management and Coordination of the Chronically Ill Diabetic Patient Essay

Care Management and Coordination of the Chronically Ill Diabetic Patient Essay

Care Management and Coordination of the Chronically Ill Diabetic Patient

Diabetes mellitus is one of the most important chronic health conditions that have far-reaching complications. It is an endocrine disease caused by either the lack of insulin or an insufficient response by the tissues (tissue resistance) to insulin. It exists in two types namely type I and type II diabetes mellitus or DM. Type I DM occurs since childhood and is more genetic in etiology, while type II DM occurs as mature onset disease and is linked to lifestyle factors interacting with genetics (Hammer & McPhee, 2018). The diagnosis of DM is best made through a test known as the HbA1c test or glycated hemoglobin. This test shows the average blood sugar level of a person within the last two to three months (Lind e al., 2019; Hammer & McPhee, 2018). Most diabetic patients also suffer from hypertension as comorbidity and the two are closely related both in pathophysiology and management. The purpose of this paper is to discuss the management of a 45 year-old Caucasian male with type II diabetes as a chronic condition.

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A Description of the Patient, their Health Issues, their Diagnoses, and their Plan of Care

The patient is a 45 year-old Caucasian male who is an administrator in a local chain of schools. He is an overweight male with a body mass index (BMI) of 29.6 kg/m² and also a heavy smoker for the past 25 years. He leads quite a sedentary lifestyle as he sits most of the day at work and does not have the habit of walking or jogging. He mostly drinks with friends in the evening after work. He was diagnosed with type II diabetes mellitus at the age of 31 years. At that time, he was already overweight but his BMI was 26.3 kg/m². Since that time, he has oscillated between a BMI of 31.0 kg/m² (obesity) and 25.3 kg/m². At the age of 35 years, he was also diagnosed with hypertension. At present, the patient does not have any other health issues. However, his low-density lipoprotein cholesterol (LDL-C) levels are being monitored closely as he is on the brink of developing hyperlipidemia. His plan of care is as follows:

Quarterly HbA1c laboratory testing to determine how well his blood sugar is being controlled. The goal is to keep it between 6.5-6.9% (48-52 mmol/mol). The blood sugar is to be between 80 and 130 mg/dL before taking meals and a maximum postprandial reading of 180 mg/dL. According to Lind et al. (2019), high values of HbA1c are correlated with diabetic complications such as retinopathy and nephropathy (Narva & Bilous, 2015). They specifically determined that a level of 8.5% (70.5 mmol/ mol) and above places the patient at a high risk of kidney and eye damage due to hyperglycemia. Care Management and Coordination of the Chronically Ill Diabetic Patient Essay
Pharmacotherapy with oral antidiabetic medications as follows (Katzung, 2018):

Metformin 500 mg orally twice daily
Sitagliptin (Januvia) 100 mg once daily
Pharmacotherapy with oral antihypertensives as follows (Katzung, 2018; Ovalle et al., 2018):
Verapamil 200 mg orally q.h.s
Methyldopa 250 mg orally t.d.s

Physical exercise in the form of isotonic aerobic exercise (walking) and resistance exercise.
Dietary modifications with more of fresh fruits and vegetables and less of high-calorific value foods

A Description of the Clinic Setting

The clinic setting where the patient is regularly seen is a private office for private practice. There is a public area where the lounge is located. That is where the patients wait after being registered by the receptionist before entering the consultation room. From the lounge there is access to washrooms and from the other side of the consultation room there is the pharmacy. There is also a procedure room and a minor theater. The clinician is a family nurse practitioner (FNP) and she is assisted by two registered baccalaureate nurses and one certified nurse assistant. The pharmacy is manned by a qualified and licensed pharmacist.

The Types of Patients/ Diagnoses Typically Seen at the Clinic

The types of patients normally seen at this clinic in the majority are those who have lifestyle conditions. The diagnoses are mostly diabetes, hypertension, hyperlipidemia, obesity, and kidney disease. Other types of patients with chronic medical conditions are also seen. They include those with heart disease and respiratory illnesses such as chronic obstructive pulmonary disease or COPD.

Care Coordination Model Proposed

The model of care coordination that is proposed in this case is Preferred Provider Organization (PPO) which is a form of Managed Care Organization or MCO (Grant & Catalano, 2020). This will assist the patients with cost-cutting as well as avoiding care fragmentation by moving from provider to provider outside the PPO because of the cost of care. This model will be operated in an Accountable Care Organization (ACO) framework for better coordination of care that is safe, effective, timely, efficient, equitable, and patient-centered (AHRQ, 2018). An ACO is a group of providers that come together to refer patients among themselves for better care coordination and continuity of care (CMS, 2021).

How the Model above Will be Effective for Patients with Similar Conditions

For patients with similar conditions such as this 45 year-old man, the above model will be very effective as they will be able to receive care coordinated care. This coordinated care will be provided by providers who have a formal arrangement of managing patients among themselves at reasonable costs.

How the Model Will Fit Into the Current Clinic Setting

The above model will fit into the current clinic setting perfectly. This is because the FNP is already part of a network of providers under a MCO that is operating within the framework of an existing ACO.

Begin by identifying a patient from your clinicals who has a chronic health issue such as diabetes, COPD, or hypertension. I have chosen DIABETES for this paper. The paper is to include the following information: 1. Description of the patient and his/her health issues, diagnoses, and current plan of care. 2. Description of the clinic setting, the healthcare providers (number and type), and the support staff. 3. Description of the patients/diagnoses typically seen in this clinic. 4. Description of the care coordination model being proposed. 5. Explain how this model will be effective for patients with similar diagnoses as discussed above. 6. Explain how this model will fit into the current clinic setting. What will need to change in the clinic setting to improve the fit? ***Headings are required and are to be titled as identified above and include these six (6) areas. Care Management and Coordination of the Chronically Ill Diabetic Patient Essay

References

Agency for Healthcare Research and Quality [AHRQ] (2018). Six domains of health care quality. https://www.ahrq.gov/talkingquality/measures/six-domains.html

Centers for Medicare and Medicaid Services [CMS] (2021). Accountable Care Organizations (ACOs): General Information. https://innovation.cms.gov/innovation-models/aco

Grant, M., & Catalano, T.J. (2020). Preferred Provider Organization (PPO). https://www.investopedia.com/terms/p/preferred-provider-organization.asp

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14^th ed. McGraw-Hill Education.

Lind, M., Pivodic, A., Svensson, A., Ólafsdóttir, A.F., Wedel, H. & Ludvigsson, J. (2019). HbA1c level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study. BMJ, 366, l4894, http://dx.doi.org/10.1136/bmj.l4894

Narva, A.S. & Bilous, R.W. (2015). Laboratory assessment of diabetic kidney disease. Diabetes Spectrum, 28(3), 162–166, http://dx.doi.org/10.2337/diaspect.28.3.162

Ovalle, F., Grimes, T., Xu, G., Patel, A.J., Grayson, T.B., Thielen, L.A…. & Shalev, A. (2018). Verapamil and beta cell function in adults with recent-onset type 1 diabetes. Nature Medicine, 24(8): 1108–1112. https://doi.org/10.1038/s41591-018-0089-4 Care Management and Coordination of the Chronically Ill Diabetic Patient Essay