[attach id=403275 size="medium"][/attach]

Caring for patients with long-term or complex disorders is one of the most significant problems facing practitioners today. It has become essential to ensure that patients do not get lost and confused in the myriad of appointments, medications, medical and paramedical practitioners involved in their care.

A holistic approach to patient care is becoming more, not less important, when specialties and sub-specialties are mushrooming all over the place resulting in a very real possibility of fragmentation of practice.

Hence the need for a book like this one, Just in Case: Care and Case Management in Malta, which is meant to guide those who are involved with caring for such patients, presented in a logical and comprehensive way, for the benefit of the patient and also for the better administration of scarce resources.

One might argue that historically the general practitioner has been the focal point for non-hospital practice, but, frankly, there is currently no equivalent person who can act as a co-ordinator in a busy hospital practice. This book emphasises the need for monitoring the quality of care delivered and the evaluation of all services.

The authors point out that patient care takes place at different levels. At the individual level one must consider the case history with its unique conditions, while at the system’s level one has to consider the care and support that is available within a particular social and health care system.

It is the latter aspect that may not have been given its due importance in the style of medical practice as has been practised in Malta for generations and where a system as described in this book could be most useful.

Patients also depend on informal sources of help, which include their families, neighbours, friends and the wider community as well as the totality of services for the community, all these being referred to as ‘social capital’, which may be resorted to in cases of need. In fact, medical needs may not always be the pre-dominant problem that a patient faces. Quite frequently, medical problems could be complicated and made worse through lack of co-ordination of other services.

The book also refers to the laid-back attitude that patients may have to their own medical problems. Often, they depend on other (often younger) members of the family to take the responsibility of managing their condition. It makes a plea for: “Empowering clients to take on an active role in their own care through active participation in decision-making.” This requires “a cultural shift” towards enabling patients to take a more active role in the management of their condition.

It is also a fact that, with changing economic and social conditions, dependence on other family members (often married daughters, who are now more likely to have a profession and a job to attend to) can no longer be relied on. Outside help is more frequently being requested.

Com Care Malta is an example of an organisation which has been set up to provide care and case management. To be eligible for this service, the individual must be entitled to free health care, is home-bound, requires specific procedures or is terminally ill. It is also available to individuals who require respite care. Com Care may liaise and link up with other organisations such as MMDNA, Hospice Malta, as well as with the general practitioner, hospitals and other relevant organisations.

Com Care ensures that the needs of the client/patient are examined holistically as well as addressing the issue of efficiency to promote quality cost effective outcomes and provide integration and continuity of care.

The book emphasises the importance of a holistic approach to patient care

The authors refer to the model followed by the German Society for Care and Case Management (DGCC). A unique aspect of this programme is the use of special ‘tools’ for assessing the patient’s overall condition and needs. It includes documentation of such findings as demographics, family history, social history, assessment of risk factors, past medical history, systems review, screening assessment and nursing examination which involves the taking of weight and height for the calculation of the body mass index, a blood pressure reading, a urine screening for glucose, or if a known diabetic, a haemoglucotest is performed and an examination of pedal pulses.

Documenting information on a ‘resource map’ is helpful as a visual and objective summary of these findings, which are comprehensive and which can be easily assessed. Such a service could have considerable benefits. Patients with chronic disease (e.g. asthma, heart failure, diabetes or mental health issues) and others who have minimal community support would also benefit from such a scheme.

The expected ‘uncoupling away from the in-patient care scenario’, would possibly reduce the pressure on the hospital system.

From the economic point of view there would be cost-benefit considerations in caring for these patients, including a reduced need to occupy hospital beds. Not least, one would hope for an improvement of the quality of life and increased satisfaction on the part of the patient.

One must bear in mind that with increasing longevity, it is very likely that in future chronic conditions will be demanding increasing attention. The authors conclude: “Over the next decade and beyond, broad shifts in demographics, disease status and an ageing population will mean that patients with long-term chronic conditions will absorb the largest and growing share of health and social care budgets.”

The book should be made widely available to all those health care professionals who are interested in the well-being of persons with chronic health issues. It opens vistas for ensuring that health care is no longer to be considered as simply a matter of the occasional visit to a medical practitioner, but that it is a continuing existential responsibility of the individual patient, an aspect which has all but been neglected by our educational system.

It also emphasises the importance of a holistic approach to patient care where the specific medical problem that patients are presented with may just be the tip of the iceberg, with a whole massive substratum which would include physical, social, economical and psychological issues among others. All of these need to be taken into consideration, investigated and controlled.

The book will be launched at the auditorium of the Faculty of Health Sciences, University of Malta, Mater Dei Hospital on Thursday at 5.30pm.

If you would like to attend send an e-mail to melitafarrugia@mmdna.com by tomorrow.

Sign up to our free newsletters

Get the best updates straight to your inbox:
Please select at least one mailing list.

You can unsubscribe at any time by clicking the link in the footer of our emails. We use Mailchimp as our marketing platform. By subscribing, you acknowledge that your information will be transferred to Mailchimp for processing.