Member Satisfaction
Diagnosis: Rheumatoid Arthritis, Type II Diabetes
Background:
This patient with a long history of rheumatoid arthritis and a relatively new diagnosis of type II diabetes was not taking good care of herself and was experiencing poor control of her diabetes and inadequate pain management as a result. The patient revealed she had lost both her husband and her mother over the past year and was having difficulty being motivated to care for herself. The patient stated she was overwhelmed by the many responsibilities that had suddenly become hers and was experiencing financial difficulties. The patient was not compliant with diabetic dietary recommendations, was gaining weight, and had stopped exercising. The patient admitted her eating habits have been poor since living alone, as she did "not feel like" preparing meals for just one person. As a consequence, she was often snacking on salty and sweet snacks, high in carbohydrates.
Interventions:
This patient regularly attends church, so the CM has encouraged the patient to see the pastor or pastoral associate to discuss ways her church can help her during her time of grief. As the patient's mother was in hospice care, CM also suggested that the patient call the hospice provider and ask for grief counseling, as this service is usually extended to families during the first year after the death of a patient. CM also asked the patient to speak with her own primary provider to determine if she may require specialized counseling to help her manage her expressed feelings of depression. CM strongly encouraged the patient to discuss her pain issues with her rheumatologist, as her treatment regimen for rheumatoid arthritis was not effective. CM urged the patient to remain compliant with the medication regimen prescribed until the provider prescribes another treatment, and was reminded that depression and inactivity will exacerbate arthritis pain.
CM suggested that the patient begin to make meal-planning part of her weekend routine and to plan out her meals for the week and shop accordingly. CM discussed foods available for single meals, such as Perdue Farms "Perfect Portions" that provide individually packaged boneless chicken breasts for one portion meals. CM also suggested preparing a full meal as she has in the past, but freezing separate portions for use later, thus reducing the time the patient spends cooking for herself. The patient was urged to take immediate steps to improve her diabetes management, as any damage she may experience from neglecting this condition now is likely not going to be reversible in the future. CM provided simple suggestions to help the patient increase daily activity level.
Results:
The patient has moved to a one-bedroom condo and states that although the move was difficult emotionally, it was a good move for her as she is financially stable and now feeling less stressed. She is now walking twice daily with her niece and has been focusing on improving her health. The patient has made changes in her diet that have reduced her overall carbohydrate intake and she is now eating smaller portions. The patient has joined a 50 and over social group and is receiving emotional support from her church community. The patient continued to adhere to the medication regimen of Humira, and reported that this drug has in fact adequately managed her rheumatoid arthritis pain.
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