What is care management?
The basic principle of care management is to support and empower
individuals to make health behaviour changes that have a positive
effect on their health and improve their well being.
Care management is delivered by Care Managers who are highly
experienced and specifically trained in providing clinical
information and supporting behavioural change via the telephone.
The Care Manager works through the self management challenges and
lifestyle issues that the patient has identified as opportunities
for behavioural change, such as smoking cessation and weight
management. The patient is encouraged to set the agenda; identify
realistic and achievable goals and problem solve to create an
effective action plan for change. The Care Managers take a holistic
approach to supporting patients and enabling them to understand
their condition and encouraging lifestyle changes. The Care
Managers involved in the OwnHealth programmes build on the
professional care provided by the primary care team and also meet
with the GP practice team to share information on their patients'
progress.
Who are the Care
Managers?
They are specially trained healthcare professionals (such as
nurses) from a variety of backgrounds but mostly primary care. The
skill mix across the Care Management team can comprise of both Band
5 and Band 6 nurses (or allied health professionals) which provides
a safe environment for working with both newly diagnosed 'stable'
patients whilst also offering support to patients with a number of
comorbidities or more 'complex' cases.
A Care Manager works with up to 180 patients each; depending on
their working hours. The Care Manager is upskilled by completing a
thorough RCN accredited training programme consisting of
e-learning packages to cover the disease areas such as COPD,
diabetes and cardiovascular disease and to learn about the aspects
of Care Management. They also attend the two day interactive
classroom based OwnHealth Self Care Coaching Course where they are
trained in Motivational Interviewing techniques and includes the
use of actors to support the learning of the Care Managers.
Click here to listen to Motivational Interviewing being used in
a call with a patient.