Primary care case management

Primary care case management (PCCM) is a form of managed care used in Medicaid. It is most common in sparsely populated areas where there are no HMOs available to contract with the state. PCCMs are physicians or groups with arrangements with physicians that contract with the state Medicaid agency to coordinate and monitor the use of primary care services by enrolled beneficiaries. PCCM contracts cover less than the full set of Medicaid benefits and typically involve minimal financial risk. 

Sandra is in her early thirties, and was referred to our service when social services had concerns about neglect of her children and some violence in the home. She had actually been a patient of ours before, receiving methadone maintenance for a heroin problem dating back ten years, but in further allocating the cases within the city she had been directed to primary care management, because of her seemingly unproblematic progress. 

The principle of the more straightforward and routine cases being managed in primary care, with more difficult problems being referred to specialists, whether themselves general practitioners or the specialist psychiatrists, is inherent in many health care systems and of course not just in drug misuse. Even so, Brownell and Naik (2003) found in a survey... 

Two individuals with serum triglyceride concentrations over 11.3 mmol/1 (1000 mg/dl) were referred to a pharma-cist-managed lipid clinic by their primary-care provider because of either treatment failure or intolerance of conventional therapies (14). Fish oils were used in one case in lieu of and in the other in addition to conventional treatments. Although fish oil has not been reported to cause hepatotoxicity, both of these patients had increased transaminases while taking fish oil. Whether fish oil truly causes hepatic injury remains to be elucidated. 

Some policies may cover medications but not therapy, and other policies may do the opposite. In addition, patients may be willing to pay out of pocket for some services but not others. Limits or caps may be placed on medication charges or on the number of psychotherapy sessions allowed. Only certain types of providers may be covered by insurance, that is, only a psychiatrist or only certain types of situations, such as case management or crisis intervention only. Some services might require a primary care physician s referral, even when that physician knows very little about the patient or the problem. Finally, the deductible (the amount the patient must pay initially to obtain the service) can vary, depending on the insurance policy. 

Case study level 1 - Primary dysmenorrhoea 150 Case study level 2 - Urinary tract infections in pregnancy 151 Case study level 3 - Pelvic inflammatory disease 152 Case study level Ma - Endometriosis management in secondary care 154... 

The structure and membership of the Inspection Response Team should be agreed upon in accordance with predefined internal guidelines. Inspection Response Teams are usually established at a site level. The Inspection Response Team Manager should not have to negotiate release of key personnel. Table 16.2 suggests Inspection Response Team roles and responsibilities. One individual may fulfill more than one role, but careful consideration should be given to whether certain mixes of roles actually conflict. Named deputies should be recorded in case primary nominations are not available for whatever reason. 

Gender, the socially constructed roles and characteristics assigned to women and men in a specific culture, plays a key role in people s access to, use of and control over biodiversity (Howard, 2003). This is especially relevant in the case of medicinal plants, as in numerous societies, women have primary responsibility for health care at the household level. Literature shows that, worldwide, it is mainly women who are wild plant gatherers and managers, home gardeners and plant domesticators, herbalists and healers, as well as seed custodians (Howard-Borjas, 2002, Howard, 2003). 

Figure 6. Interaction of the red and white plans for the evacuation of casualties following a disaster. The fire service are responsible for rescue and primary evacuation of casualties as far as the advanced medical post. Here, casualties are triaged and receive primary treatment. The hospital white plan for the management of mass casualties is extended to this point using medically manned mobile intensive care units which can carry out extensive early care before transporting the patient to the most appropriate hospital facility. In the case of a toxic release, this will be to a special reference hospital, manned and equipped to deal with casualties from a chemical-biological release...

Many SCCs of the head and neck are treated surgically with primary resection and possibly neck dissection. Some patients can present with metastatic SCC in the neck, but despite careful clinical and radiologic workup, a primary tumor cannot be found. In these cases, TIPV analysis, particularly using an in situ hybridization approach, can be useful. In several series, HPV-associated tumors are largely restricted to the tonsil and tongue base area. When HPV is positive in the neck nodes from a patient with an unknown primary tumor, the clinical management can be directed toward these high-risk areas. 

The workflow should be broken down to manageable chunks each of which become a target for a round of hazard analysis and perhaps our what-if questions. It is at this stage that detailed hazards, causes and controls can be established which will form the bulk of the hazard register. The system business processes themselves may be derived from a number of different sources depending on the material available. Some systems may have detailed use cases with primary and exception flows carefully documented. For others the processes may need to be ascertained from training material, product descriptions or test cases. 

To address the high morbidity and mortality rates of CVD, efficient management of cases of variable severity is crucial [4]. This includes (a) primary CVD prevention, which focuses on reducing the population risk factor burden, toward reducing the overall incidence of disease in the community (b) early and valid identification of subjects at increased risk, for whom timely treatment is important and (c) appropriate treatment of acute events. Efficient management of all these three phases of care is challenged by a number of factors, including (1) lack of multisectoral action to support reduction of behavioral risk factors... 

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