THE CARE MANAGEMENT PROCESS
A ‘brown bag checkup’ is the single best thing that patients can do to avoid medication mistakes and cut down on unnecessary medications.
DOUGLAS PAAUW, M.D., PROFESSOR OF MEDICINE,
UNIVERSITY OF WASHINGTON IN SEATTLE
The Integrated Care Management Professional may work in many settings with individuals or systems whenever there is a diagnosis of depression. They may be in call centers, acute hospitals, specialized psychiatric hospitals,
managed mental c health companies, managed emergency rooms, a r e / i n s u r a n c e c o m p a n i e s , w o r k e r s ’ c o m p e n s a t i o n i n s u r a n c e o f f i c e s , psychiatrists offices, and primary care and specialists offices. They may assist support groups; work at different kinds of clinics; be part of a team at the workplace, assisting employers and EAPs; in prisons, both military and independent; and in the community touching, all of the groups mentioned. Their roles may range from taking the first call from an individual who is experiencing depression symptoms and/or is actively suicidal, to the individual who has a long history of multiple hospitalizations and countless treatments.
The Integrated Care Management Professional is a concept that allows for the breaking down of silos and includes all professionals who practice utilization review, utilization management, discharge planning, case management, care coordination, wellness coordination, occupational health management, demand management, disease management and mental health management.
This description of the care management process defined the development of the Case Management Adherence Guidelines (CMAG)66 to allow adoption in varying forms. The tools of CMAG cross all boundaries to address adherence. It is up to the Integrated Care Management Team to adapt these guidelines to fit their population and workflow.
Assessment is always the first phase of the care management process. Tools are readily available for the assessment of the individual with depression. Many have been listed in previous sections. One of the first steps is to make sure the individual is safe and in the least restrictive environment. If suicidal ideation is present, contact the proper professionals or authority. Basic needs must be met before going further into any care management process. Many individuals do not eat, sleep too much or not at all, isolate themselves, falter on daily hygiene, and are filled with feelings of hopelessness. The first role of the care manager is to support the individual in fulfilling basic needs. Be mindful of the fact that taking medications may be the treatment plan, and adherence to these medications may improve the ability of the individual to be able to resolve these issues. Nonetheless, the process may take time. Make sure the assessment includes clarification and understanding of the patient’s expectation regarding time for medication response.