Practice Guidelines, Managed Care, and Utilization Review
"While you were Wheezing"
Possible sources of case management services could be a nurse practitioner or respiratory therapist who conducts asthma education, or a social worker or nurse who specializes in case management for children. Is it is the role of the case manager to assist the family in obtaining medical and ancillary services which might include arranging transportation to the medical provider for scheduled visits, assisting with recording home peak flow readings, facilitating communication with the school nurse to assure that the child receives proper medication at school, and facilitating communication between school personnel and family. The case manager should also help the family arrange routine health assessments (i.e. well-child visits) according to standard periodicity schedules.
Each managed care program makes its own eligibility determinations for case management, and most program cover this services for children with chronic illnesses, including all Texas Medicaid Plans. Moderate to severe persistent asthma will qualify a patient for this service.
In Janie's case, it
would be reasonable to involve her and her grandmother in the asthma
education program you have identified and to follow them closely in your office.
Beyond education, further case management would only be necessary if the family
continues to have transportation difficulties or if you determine that you
cannot provide the necessary communications with her school. If she
and her grandmother understand how to access your office for care, and how to properly manage the symptoms at home,
further case management might not be necessary.
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