E Glettler | PubMed Health

PubMed1996

The advanced practice nurse as case manager.

The dynamic interactions of the client, service provided, and payer are complex relationships in today's health care environment. An advanced practice nurse's abilities to care physically and psychosocially for clients and their families are essential within the case management framework. With a holistic view of clients' health status, the nurse case manager develops and carries out advanced practice functions that help achieve the best outcome for the client through effective interactions with clients, payers, and providers. Those functions, illustrated by the Star Case Management Model, include interpretation, advocacy, and surveillance.

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From policy to practice: physicians' views on OBRA and mental health resources in long-term care.

OBJECTIVES: The purpose of this national survey was to seek to clarify physician beliefs about nursing home mental health needs, understand the perceived effectiveness of OBRA legislation, determine physician exposure to OBRA PASARR Level II assessments, and understand the current role of community mental health interventions in the nursing home. DESIGN: A self-administered questionnaire. SETTING: Surveyed physicians were nursing home medical directors and/or attending physicians. PARTICIPANTS: The overall response rate for the 1000 physicians surveyed nationally, was 62% (n = 620). Fifty-nine percent (n = 361) of all responders were family physicians, and 41% (n = 250) were general internists. MEASUREMENTS/RESULTS: Only 48% (n = 291) of all respondents ever saw the recommendations from their patient's OBRA PASARR Level II assessment screening. Approximately one-third of all respondents viewed each discipline's recommendations as "very" or "somewhat" helpful. Thirty-seven percent (n = 228) of respondents viewed OBRA's psychotropic guidelines as only somewhat helpful. More than two-thirds (n = 412) believed OBRA regulations had not improved access to mental health care for their nursing home patients. CONCLUSIONS: This survey demonstrated that OBRA PASARR Level II assessments are not being viewed or valued by many physicians. In nursing homes, limited access to community mental health staff and psychiatric input may leave primary care physicians treating difficult behavioral problems themselves. Collaborating on helpful mental health interventions for nursing home patients is an ongoing critical issue in long-term care.

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