Introduction
Case management program for asthma may be the key to reducing the disease incidents, especially in children. This program can be best implemented at the community level since it requires a comprehensive address of the environmental health risks that are associated with asthma. These are some of the risks that can be addressed in collaboration with members of the community and other relevant stakeholders. Adherence to asthma medication is also another issue that calls for case management strategy and this can also be best addressed at the community level. This is because some of the factors that have been found to affect this adherence include some lack of social support, poor asthma knowledge, management skills and other dynamic issues affecting parents, children and the entire family. Therefore, a formal case management program will improve parental oversight in addressing issues such as knowledge and skills of asthma management as well as improving the patient’s communication and self-care roles. All these issues when tackled at the community level, a comprehensive program will be effected that will lead to better outcomes.
The core elements for the asthma case management program at the community level include building capacity for routine assessment, establishing consistency in the patients’ care through education of community health workers as well as patient’s care givers, and a regular reporting system for all outcomes and processes for the care providers through the community health workers. This paper looks at how all these components of a case management plan can be implemented at the community level.
Implementing Case Management of Asthma in the Community
Reducing the burden of asthma in children in the community can be achieved through improved asthma control which is a goal that should be shared by the state, the local leaders, patients, their families, the community health workers and other community stakeholders such as schools. This is because improving the outcomes for asthma treatment requires an integration of clinical, environmental, educational, occupational and public health approaches. Therefore, by engaging people from different perspectives with different strengths and resources can result to better outcomes.
Involving different stakeholders in case management of asthma at the community level aims at coming up with an effective program and policy solutions that will improve the quality of medical care, self-management support, community education and outreach, control of environmental factors that affect asthma and community capacity to control asthma.
Some of the steps involved in implementing case management of asthma in children at the community include the following:
Step 1. Collaborating with stakeholders
This can be done trough formation of task forces or individual efforts by stakeholders (National Heart, Lung and Blood Institute, 2012). The task force may consist of health workers, community leaders and parents. This group can work in collaboration with schools. The role of health workers is to give clinical guidance on the management of asthma. This includes issues such as handling medication by the patients and also on various signs and symptoms. This can be done through health education programs which will be conducted with assistance of schools and local leaders. Public health workers will be involved in dealing with environmental factors that affect asthma. These include dust and other irritants that may be found in the environment. Schools can also provide educational materials that will be used by health workers to conduct community education and outreach programs. Schools also need to ensure that teachers receive training from the health workers on how to take care of the children who are suffering from asthma while in school (National Asthma Education and Prevention, 2007). Parents are also recipients of all the information given during training since they are the main care givers to the children. The role of local leaders will be to mobilize parents and other members of the community to take part in the program as well as offer resources to support the program where they are needed.
Step 2. Conducting needs assessment
This involves identifying which of the areas among the list of outcomes needs more attention. For example, it may be lack of education and information, lack of community capacity to control asthma, environmental issues or lack of self-management support. This can be done by health workers with assistance of care givers at home and in school. The aim will be to identify the key area that is affecting control of asthma in the community (Agency for Healthcare Research and Quality, 2011).
Step 3. Enhancing disease surveillance at the community level
This involves obtaining all the statics related to asthma in the community, such as prevalence, morbidity, mortality, and relevant risk factors. The existing data can be obtained from the health facilities in the community and also from the local leaders. This information should also be updated on a continuous basis.
Step 4. Building accountability
This involves giving responsibility to the variety of stakeholders for ensuring continuous control of asthma in relation to the needs assessment report. For example, the public health officers should be accountable for any environmental factors that relate to asthma control. School and parents should take responsibility for self-management support while the clinicians should take the responsibility of ensuring quality of healthcare provided to asthma patients. Therefore, every individual will have a role to play in control of asthma (National Heart, Lung and Blood Institute, 2012).
Step 5. Advancing policies
This involves coming up with policy guidelines that will enhance the health care systems, public health structures, the environment and schools. These policies will give guidelines for all the actions needed by every stakeholder in asthma control. Formulation of these policies can be done at the national level or at the state level stating the required resources and their source (National Heart, Lung and Blood Institute, 2012).
Approaches to Get the Buy-In Of Key Stakeholders
To ensure that all the relevant stakeholders are committed to the case management program, it is important to make all things as easy as possible for them and also conduct regular follow up. For example, when educating the patients and care givers, it is important to use brief simple education that is highly acceptable to most people (Scottish Intercollegiate Guidelines Network, 2012). This is important in ensuring that things do not appear complex for them to follow. The care givers should be given a record card where they will be providing all the information about progress of the child. Home visits by nurses are also very important during the follow up. This will encourage the patient and the care giver to become more committed since the nurse will also be showing commitment during home visits.
To ensure the collaboration and commitment of the school, the task force can offer some incentives such as reading materials to the school. The school should also be equipped with emergency kits for helping the children (Asthma Foundation, 2012). These will be of benefit to schools and therefore will boost their commitment towards the program.
For other stakeholders, such as the public health officials and other clinicians, commitment can be enhanced by holding them accountable for various responsibilities. This should, however, start by explaining to them the importance of their positions in regard to asthma in children and impact that they can make. For example, the public health officer must be explained how his or her role in environmental management can help in control of asthma. They should therefore be held responsible for any environmental influence on asthma.
Regular reporting and feedback at all levels can also promote commitment of the stakeholders. This will encourage them to be keen on the policy guidelines to ensure that they receive positive feedback after reporting.
The Key Outcomes of Case Management Plan
The key outcomes of asthma case management plan at the community level include reduced disease incidences, reduced inpatient admissions for children, reduced missed school and parent work days and generally improved quality of health care received by the patients.
Reduced disease incidences will be achieved by eliminating all the environmental factors that contribute to asthma. This will ensure that new cases of infection are fewer and the existing ones are under control. The parents will also be educated on how to avoid the exposures that may put children at risk of asthma infection. Reduced inpatient admissions will be achieved by improving the care givers’ skills through education management of asthma. This will mean that the patient can receive good care at home and not necessarily at the hospital. This will also be achieved through home visits by the nurses who will be giving any needed assistance to the patients while at home (Williams, Portnoy & Meyerson, 2010).
Giving guidelines and training to the teachers in school will ensure that children can receive care while in school and they therefore should not miss any school days. Parents also will not miss work days to take care of their children because teachers can give care in school. Training of health care staff, especially at the community level, and follow up through home visits will eventually ensure that patients receive high quality care (Williams, Portnoy & Meyerson, 2010).
Conclusion
Collaboration with stakeholders is the key to ensuring a successful case management plan in the community. This is because they all have a role to play in enhancing disease surveillance at the community level. When they all discharge their responsibilities properly, the incidences of asthma in children will be reduced and also the quality of care will be improved.
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