In America, Medicare is deemed as a national social insurance program which was administered by the United States federal administration starting from 1966 and it is currently employing about thirty private insurance companies within United States. Medicare offers community with health insurance particularly to younger individuals cumbered with diverse disabilities and various illnesses. By 2014, however, the Medicare payment rules were changed so as to ensure effectual and effective treatments of the society. With regard to this, the hospitals are currently penalized if patient return for similar treatment in a hospital within 30 days with same problem. At this juncture, amongst targeted medical diagnoses for this compensation is chronic obstructive pulmonary disease (COPD). Otherwise, this assignment is aimed at providing essential practices which can be employed by interdisciplinary team while ensuring safe transition betwixt the acute care settings and home for individuals suffering from COPD(Barnes, 2012).
Part 1: Medication Adherence
COPD is viewed to be common in the elderly individuals, and it leads to significant mortality and morbidity. Recently, there are noteworthy gaps in managing COPD like asthma and they involve stepwise medication approaches. Although this malady cannot be cured, optional management has issued symptoms controls which involve slow progression of diseases, and this can improve the quality of livelihood. The management of COPD has emerged as suboptimal while physicians are not able to prescribe effectual therapies, as a result of poor adherence to evidence-linked under-diagnosis and guidelines, or when the enduring fails to stick on prescribed treatment regimens(Center for Disease Control and Prevention, 2012).
Foremost, smoking cessation is amongst effectual way of slowing the decline in lung functioning to patient cumbered with COPD. This involves elimination of risk factor which is considered as the highest priority within the management of this disease particularly in various severities. In particular, in the view of multidisciplinary COPD clinic located at ST. Paul’s Hospital, smoking cessation is confirmed to have addressed 76.2 percents of issues while compared with 57.5 percent within the general respiratory clinic settings. Actually, this is a successful way of helping patients while addressing the addiction, accompanied with drug therapy(Adcock, Caramori & Barnes, 2010).
Secondly, pulmonary rehabilitation is also considered as a structured and multidisciplinary intervention where patients with chronic pulmonary diseases, are shown the way of improving their body fitness, improving the health-linked livelihood’s quality, and also reduction of dyspnea. Indeed, pulmonary rehabilitation in connection to self-management and education has been confirmed to emanate from substantial reduction of hospital admissions. The current randomized and controlled attempt by COPD personal management program has included exercise and clinical means of reducing impacts of this malady(Barnes, 2012).
Thirdly, the inhaled bronchodilators are also used as an alternative for symptomatic management within the stable COPD, both through use of an as-needed course or regular treatment. WHY AR Recently, there is confirmatory information indicating that bronchodilators anticholinergic and agonists has improved compliance and more efficacious as compared to their shorter-acting equivalents. Apart from the inhaled corticosteroids having no impact in declining FEV1, they have been witnessed to minimize the exacerbation rate in patients who are moderate to severe COPD, and there is some authentication for their function in reduction of entire mortality. The enduring cumbered with challenges while mastering inhaler method through metered-dose inhaler is advised to use a spacer contained with a device. Otherwise, diverse forms of inhalers and spacers devices must be experimented during an attempt to determine whether the patient can easily and effectively use it(Barnes, 2012).
Moreover, rescue medications are also applied during COPD exacerbation and it is viewed as the most feasible discussion for overuse. At the time of exacerbation, an average of single additional puff at the day time and half during at the night is experienced two weeks before and after an exacerbation not considering the COPD stage. Otherwise, changes in rescue medication intake are considered to poorly correlate with exacerbations. At this juncture during application of LABA, ICS has been linked with significant minimization on average puffs per day during SABA which significantly heightens the percentage of nights without needs of awakening SABA as well as placebo, and an essential distinction in median portion of days without application of relief treatment(Centers for Disease Control and Prevention, 2012).
In the view of this medication, pharmacoeconomics has been confirmed to formalize the decision-making process during adoption of new devices and treatments. Additionally, the implementation of clinical practice procedures is considered as expensive. Based on the exploration done in US in 2000, the total yearly costs linked with COPD were excess amounting to 32 billion dollars. Similarly, it was viewed that 97 percent of Americans in the age of 65 years are always receiving incomplete treatment coverage hence requiring supplemental insurance so as to cumber danger of losing individuals cumbered with COPD(Brusselle, Joos & Bracke, 2011).
Part 2: Dietary Modifications
Good nutrition has been viewed to boost breathing since inhaling requires more energy particularly to individuals who are cumbered by COPD. The muscles facilitating breathing always require 10 times more calories as compared to that of individuals who are not cumbered by COPD. Similarly, suitable nutrition aids the body to fight infections including COPD. Moreover, individuals are also advised to maintain moderate body weights through maintaining effectual level of calories in their body. Overweight people has been observed to be affected by lungs and heart problems, thus making breathing to be more difficult since weight always demand for extra oxygen(Barnes, 2012).
The nutritional approach for minimizing chances of cumbering COPD disease can be influenced through various means. Foremost, it is advisable to drink a lot of fluids. It is important to take in between six to eight ounce glasses of non-caffeinated drinks every day so as to keep mucus this and to ease coughing up. Moreover, it is essential to limit caffeine present in coffee, teas and various carbonated beverages including Mountain Dew, Cola and chocolate, since this might conflict with some of COPD medicines. Other individuals who affected by heart problems might require to limit their fluids, thus ascertaining the follow-up of doctor’s procedures(Adcock, Caramori & Barnes, 2010).
Furthermore, individuals are also advised to monitor their weight through checking it once or twice per week, unless the doctor recommends continuous weighing is not required. In case, someone is taking steroids or diuretics including prednisone, then it are advisable to take weight measurement daily since someone’s weight might change. In case someone is having unexplained weight loss or gain, then the enduring should contact personal doctor since this may require diet change to better manage health condition(Adcock, Caramori & Barnes, 2010).
It is important to include higher fibre in all diets including fruits, vegetables, cooked dried beans and peas, bran cereals, whole-grain foods, and fresh in diet. Indeed, fibre is considered as the indigestible part of plant food and it help in moving foods along the digestive tract, since it effectually control levels of glucose, as well as reducing the cholesterol levels in the blood. To be specific, people should consume in between 20 to 25 grams of fibre every day. Exemplarily, people should eat about one cup of all-bran cereal for breakfast, a sandwich contained with two slices of whole-grain bread as well as one medium apple for lunch, dried beans, 1 cup of peas, and lentils at dinner(Barnes, 2012).
Moreover, the society should also control level of sodium in their meals. The consumption of too much salt is fuelling body to retain or keep too much water, hence leading to breathing challenges. To be specific, people should be removing the salt shaker from the table through using herbs or no-salts to flavour food; it is also important to read food labels thus avoiding meals with more than 300 mg serving/sodium; avoid additional salt while cooking foods; before applying salt substitute, it is crucial to check with doctors since salt substitutes might be endowed with other ingredients that can be just detrimental as salt(Brusselle, Joos & Bracke, 2011)
Also individuals should ensure that they are obtaining enough vitamin D and calcium so as to sustain healthy bones. Indeed, good sources of these nutrients are endowed with foods made from milk such as cheese, milk, pudding and ice cream, and foods fortified with vitamin D and calcium. Significantly, people need to take Vitamin D and calcium supplements thus maintaining a healthy exercises and weight that shall help in sustaining healthy status of the bones. In connection to this, wearing of cannula while eating in case oxygen is prescribed is also viewed to reinforce digestion and eating process through providing the body with energy. Besides, people should avoid over eating since this can cause bloating or gas. Conversely, bloated abdomen or full stomach can make breathing uncomfortable. Genuinely, if the community as well as those individuals cumbered by COPD can use these nutrients linked courses, then it is possible to reduce risk factors concerning this disease(Barnes, 2012).
Part 3: Physical Activity
Pulmonary rehabilitation has emerged as an evidence-based medication for patients contained with ruthless pulmonary disease (COPD). Otherwise, huge numbers of patients suffering from mild to moderate COPD obtain medication from the general practitioners (GPs). To motivate compliance, suggestion given to patients in general practice need to be clears, acceptable and practical. Indeed, this is particularly factual of the advice that is provided by GPs to heighten their patient’s physical conditions through cycling, walking or swimming, as stated by the Dutch College of General Practitioners within their guideline for medication of COPD. This start by conducting a literature search on the implications of physical activity for the patients cumbered with mild to sensible COPD on tolerating exercising, quality of life (QOL), and dyspnoea(Centers for Disease Control and Prevention , 2012).
Furthermore, de-conditioned patients require taking extra breaths while carrying out simple activities and this is a specific problematic for patients with minimized lung functionality. As a result, inactive patients shall encounter more symptoms while occasionally engaging in exercise. As a result of this unpleasant nature of the dysponoea and fatigue, enduring shall attempt thus avoiding them to become even less active. Generally, this is vicious circle seems devastating to patients and leading to relentless reduction in health-linked quality of life(Barnes, 2012).
Since regular physical activity is backed with diverse benefits within the universal but particularly in COPD patients, it is beneficial to heighten the level of physical activity within COPD patients. Huge part of evidence on the implications of increasing physical activity within COPD is connected with structured exercise programs embedded within pulmonary rehabilitation settings that are most commonly provided to patients contained with brutal COPD. Genuinely, a 3- week pulmonary rehabilitation program has indicated that the heightened level of physical activity is connected with increasing intensity of the coaching sessions and this is viewed to facilitate change in personal lifestyle concerning longer duration of walking. Actually, the involvement of physical activities to patients with COPD is confirmed as an effectual and effective way of depleting risky level of this malady(Brusselle, Joos & Bracke, 2011).
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