The number of drug overdoses related to opioids has more than quadrupled in the U.S. since 1999, according to the National Institute on Drug Abuse (NIDA). As of 2014, some 2.5 million Americans were thought to have a substance abuse disorder related to prescription opioid painkillers or heroin?and they're coming into hospitals where case managers are increasingly being called on to manage their care.
"The substance abuse epidemic seems exactly like that, an epidemic, with the numbers of patients suffering from substance abuse growing, with many presenting to the hospitals with serious overdoses and/or medical complications of their drug habits," says June Stark, RN, BSN, MEd, director of care coordination at St. Elizabeth's Medical Center-Steward Healthcare in Boston.
Scarce resources and the complex needs of these patients make helping patients with opioid addictions a challenge. Not only do case managers need to manage the challenges and social issues that go along with addiction, such as homelessness and lack of family connections, but they may also struggle to find placements for patients?there just aren't enough beds out there, Stark says, a possible side effect of years of cutbacks and reductions in these types of care options.
While in the past, many patients came into St. Elizabeth's Comprehensive Addictions Program suffering from alcohol dependence, today there's been a huge increase in individuals abusing prescriptions and other opiates, says Mary Ellen Peters, RN, BSN, CARN, a substance abuse case manager at St. Elizabeth's Medical Center in Boston. The growing number of opioid users and the increased publicity surrounding this issue has prompted more people to come in and seek help, she says.
In Massachusetts, you can't pick up a newspaper without hearing stories of struggles with addiction and the community's effort to get ahead of the crisis, says Peters. Even police departments are changing their approach, arming police officers and first responders with a lifesaving opioid overdose-reversal treatment, Narcan. The Gloucester (MA) Police Department is not only using Narcan, but has publicly changed its focus to trying to get people treatment, not jail time, says Peters.
While some changes are in the works that may help future case management efforts, today's case managers still face major challenges. Peters says they manage these challenges by taking a multi-pronged approach to address patient needs, consisting of:
A thorough assessment
Community referrals for follow-up care
Reaching out to family members for support
A focus on reversing social issues, which provide barriers to recovery
Research shows that ethnic and racial minorities may wind up back in the hospital after discharge more often than their white counterparts for certain conditions, such as pneumonia and heart failure. This increased rate of readmissions is due to many factors, including:
A higher incidence of some chronic diseases
Social, economic, cultural, and linguistic barriers to care
CMS is hoping to change that with a new publication, "Guide to Preventing Readmissions Among Racially and Ethnically Diverse Beneficiaries." Its authors said that the guide aims to accomplish three main goals:
Providing an overview of the issues that can lead to higher readmission rates among this group
Outlining actions hospital leaders can take to reduce these avoidable readmissions
Providing case studies and examples of initiatives that have worked to reduce readmissions among racial and ethnically diverse Medicare beneficiaries