Assisting Lucinda: Depressed Diabetic Patient with Numerous…

jennifer2075979Assisting Lucinda: Depressed Diabetic Patient with Numerous…Assisting Lucinda: Depressed Diabetic Patient with Numerous Complications, Poor Control, and High Service Use The patient, Lucinda, is a 37-year-old overweight Mexican-American female referred for integrated case management by insurance reviewers specifically looking for patients who use many health services. She came to their attention because a request was being made for approval to remove a gangrenous toe. Lucinda has had numerous procedures, hospitalizations, and emergency room visits in the past 2 years. During the past 12 months, she has filled 32 prescriptions for eight different medications from six independent physicians, one of whom is a diabetic specialist, one a psychiatrist (for diazepam), and one a surgeon (for a pain medication). Three prescribers are primary care physicians. Lucinda has four other physicians who have submitted medical charges for her care in the past year. Her last admission was 2 weeks earlier for 2 days and she has been to the emergency room three times in the last month. During her hospitalization, at that time, she had blood sugar levels of 400 +, a gangrenous toe, and a fever of 104 degrees Fahrenheit. Her last HbA1c was 9.2. Assisting Robert: Disabled Employee with Chronic Lung Disease, Panic Attacks, and Alcohol Abuse Robert is a 49-year-old electrician for a large manufacturer who has been identified through the employer’s disability management report. The disability management company at Robert’s worksite notes that he has been on short-term disability for 4 months and would be a candidate for long-term disability soon. Robert’s disability manager, Charlene, is concerned that if Robert is placed on long-term disability, which has more rigorous definitions of what constitutes disability, he will not remain qualified for disability support. Robert would then find it difficult to obtain alternative employment because of his health history. Charlene indicates to her supervisor that Robert has been seen in the emergency room five times in the last 2 months and has been in contact with his personal doctor twice monthly. He is on five medications, all prescribed by his general practitioner, Dr. Couch, who, as a retired surgeon, is supplementing his income doing general practice during a challenging economy. In addition to chronic lung disease, Robert has a long history of anxiety with panic attacks. There is, however, no mental health professional involved in his care. Since the company’s contracting health plan changed 3 years earlier, Robert has been forced to see Dr. Couch because his old primary care doctor was not in the new health plan network. Dr. Couch is. For three years, Robert’s work performance record has deteriorated. Disability and family leave time tracking indicate that he has taken time off for breathing problems, chest pain, back pain, headaches, anxiety, and flu-like episodes. This is, however, the first extended leave that he has taken. Dr. Couch, who signs Robert’s disability forms, projects that he will be permanently disabled according to a discussion he has had with the disability plan’s medical director. Since his early 20s, Robert has been treated for anxiety disorder with panic attacks, a condition that runs in his family, but has stopped going to a therapist or psychiatrist because he can save out-of-pocket expenses by getting all of his care from Dr. Couch. Robert’s last admission of 2 days was 6 months earlier for chest pain. At that time, oxygen saturation was 91% and FEV1 was 58% of predicted. Despite a normal heart tracing and little other evidence of a cardiac origin for his chest pain, Robert refused to leave the emergency room because he thought he was going to die. He smokes two packs of cigarettes per day.Explain which multidisciplinary treatments or services you would recommend given the clinical presentation of each client.Appropriate treatment approaches (medical, mental health, etc.) for each of the chosen clients given their presenting problems. These should be your original recommendations.What treatment goals and objectives you would propose to help with each client’s distress level, including details about motivation?What are some ways to increase and maintain the client’s motivation for treatment, considering responsivity factors?What plan will keep these clients safe considering current and/or potential medical and mental health crises?Social SciencePsychology