HCM 305 Managed Care Plan for Hepatitis A in North America

Managed Care Plan for Hepatitis A in North America
Kelly Shelton
HCM 305
1/28/13

Introduction
This project contains a discussion on hepatitis A with regard to its causes, symptoms, and diagnostic process. In addition, there is the current mode of hepatitis treatment, Prognosis for Current Mode(s) of Treatment, costs associated with current diagnostics and treatment, Novel Plan for Treating Hepatitis A, and the projected costs of the Novel Plan for Treating Hepatitis A. Moreover, contains the prospectus planning worksheet, annotated bibliography of the sources used in the discussion as well as the conclusion of the discussion.
Hepatitis A is a serious disease, which affects mainly the livers of the patients. It infects the cells of the liver and causes inflammation. In most cases, majority of the victims of this disease get hospitalized when the effects are at a severe stage. In such conditions, victims may die if not given due care. The disease, which is highly contagious, is believed to be spreading at a faster rate not only in North America but also around the globe (CDC, 2012). Although it is widely believed that there is no reliable cure for this ailment, preventive mechanisms such as immunization and vaccinations are widely employed to curb the severity of the diseases. Notwithstanding the latest series of disease outbreaks in North America, the rates of Hepatitis A have been constant since 1984. Additionally, the rates can be comparable to those reported in the United States during the years of 1960s and 1970s (Berger, 2011).
The American liver foundation notes that the recurring increases in hepatitis A come about in every 10 years in America, but in between the outbreaks, the relatively high rates continue to be manifested. Within North America and United States in general, each state, community and county could be considered having low, intermediate or high rates of hepatitis A on the grounds of epidemiological characteristics. In the historical context, there are specific communities in America, which are vulnerable to the risks associated with hepatitis A disease. These communities include Alaskan Natives, Hispanic Americans, Native Americans, and migrant populations. However, because of the modern vaccination methods, these rates are now being altered (ALF, 2012).
Portfolio Prospectus Planning Worksheet
Causes of Hepatitis A
Hepatitis A virus (HAV) is the main cause for hepatitis A disease. The disease, which is contagious, is transmitted when an individual inhales tiny particles of fecal substances, which are contaminated. Transmission occurs in these ways: When an infected individual handles food to be eaten by another without first washing hands after visiting the toilet, drinking water which is contaminated, eating not well cooked fish or shellfish from polluted water, being in close contact with a person who is suffering from the disease and having sexual intercourse with an infected person. The (HAV) virus is a Picornavirus that harbors an RNA, which is single stranded as its genome, and covered by a protein shell. It enters the blood system through the epithelium in the gut or mouth and transfers itself to the liver in a period of two to six weeks (American Academy of Pediatrics 2010).
While in the liver, the virus continues to multiply itself and the several of its symptoms begin to manifest in the patient. The virus uses the ribosomes in the liver cell’s alignment for the reproduction process. This interferes with the normal functioning of the cells thus causing liver problems. If the number of the liver cells affected is high, then the symptoms will be depicted, but if the number of cells affected is low, then the symptoms may not show themselves. The HAV virus is transmitted in the tract by the bile, which is manufactured in the liver. Many infected people may however recover from the condition with no serious liver damage (CDC, 2012).
Symptoms of Hepatitis A
Davis (2011) observed that majority of HAV have no common symptoms at all. This is because, in many instances, the symptoms may be so mild that they go undetected. This aspect makes the virus spread more easily since it is difficult to differentiate between the one who is exposed and the one who is not. The symptoms may start to develop after a period of 2 to 6 weeks. These symptoms may also be not very much severe and may disappear after a short while. The most spectacular symptoms include the following: Vomiting, Nausea, HYPERLINK "/script/main/art.asp?articlekey=59276"Diarrhea, Pale or grey colored stools, lack of appetite, rash, fever, fatigue, Jaundice (a yellow pigmentation of the skin and whitening of the eyes), a dark brown urine, and pain in the liver area,(on the right side of the abdomen next to the rib cage.
In the case of severe vomiting for an infected person, the patient may experience dehydration. This may be extreme and life threatening to persons who are infected. Symptoms of dehydration may include the following; headaches, irritation, fatigue, feeling confused, high heartbeat rate. These hepatitis symptoms usually do not go on for more than two months, but in some case, they may go on for a period of nine months. An approximation of 15% of the patients suffering from hepatitis A portrays symptoms that come and go. However, it should be noted that one could not be infected simply by being closer to the carrier of the disease (Davis, 2012).
Diagnostic Process in hepatitis A
The medic may conduct a physical examination and may find a tender and enlarged liver. Additionally, the blood tests may indicate an increase in IgG and IgM antibodies as well as the elevated liver enzymes. In diagnosing hepatitis A, medical practitioners may undertake physical examinations and a series of blood tests to a patient. The series of blood tests is meant to evaluate the functioning of the liver. The doctor will measure certain substances in the blood to a certain the presence of HAV virus in the suspected individual. The following substance if present in the blood will indicate the presence of the virus.
Bilirubin: The presence of Bilirubin substance in the blood is an indicative of hepatitis. This is a yellowish pigment, which in most cases is made in the liver and eventually excreted in the urine. In hepatitis patients, the liver is unable to process bilirubin and therefore, the blood level of this substance is usually high. It is this high level of Bilirubin, which causes the yellowish pigmentation in the patient’s skin, recognized as jaundice (Davis, 2012).
Liver Enzymes: When a person’s liver is damaged, enzymes known as aminotransferases, including alanine (ALT) and aspartate (AST) are released into the blood system. Detection of these enzymes in the blood system is the easiest way to determine the extent of the viral infection in the body. One demerit for this system however is that the level of enzyme differs and May not always is a good indicator of the presence of the disease (Weiss, 2012).
Alkaline Phosphatase (ALP): The High level of ALP depict bile duct blockage, an indication of liver malfunctioning.
Serum Albumin Concentration: The low level of Serum albumin in the blood indicate liver malfunction.
Prothrombin Time (PT): In this test, the doctor measures in seconds the time taken for blood to clot, the longer the time taken, the greater the bleeding risks (Weiss, 2002).
Liver Biopsy
A medic may also opt to perform a liver biopsy for a severe hepatitis that is realized in the later stages of its development. This is a process whereby the doctor inserts a biopsy sharp needle, directed by ultrasound, in removing a tiny substance of liver tissue. Painkillers are used to deaden the area. This process assists the medics in determining the extent of liver damage, treatment possibilities and the long-term measures (Harvey, 2011).
Current Mode of Hepatitis A Treatment
Currently, there is no cure for hepatitis A condition. In case the conditions become severe, the majority of the medical practitioners recommend an extensive rest for the patients. The doctors also recommend that patients of hepatitis A avoid toxic and alcoholic substances at all costs including acetaminophen. In addition, patients are advised against taking fatty foods, as these will cause vomiting. Liver substances are required to digest these fats and hence they should be avoided (Sjogren et al, 2010). The high failure rate and the numerous side effects of the current therapies have lead patients in seeking other alternatives such as in herbal remedies. Herbs such as Silymarin-derived from the milk thistle herb have been used by patients for a long time but there is no scientific evidence to prove its efficacy (Sjogren et al, 2010).
Prognosis for Current Mode(s) of Treatment
After the departure of the infection, the virus does not continue being in the body. A majority of the patients get well after a period of 3 months. Except for a few cases, the infection does not extent to more than 6 months. However, there is a death risk among the aged patients and also people who have chronic liver conditions (Sjogren et al, 2010).
Prognosis for hepatitis A is in most cases determined with the use of prediction models. The most famous of these models is the model for -end stage liver disease. Another equally famous model employed is Maddrey’s discriminate score. A number of websites have tools for calculating these scores and provides and estimation of a 30-to 90 day mortality. The scores generated from this model are used for guiding the treatment (Parada, 2012). (See table 1.1 for treatment considerations for alcoholic hepatitis).
Table 1.1 Treatment Considerations in Alcoholic Hepatitis
Treatment Therapeutic optionsCommentsAbstinence from toxic substancesSelf help groups, rehab programs, a camposate, baclofen, disulfiram, naltexoneNormally after dischargeNutritionTube feeding, eatingGoal: 35-40 calories or kg per dayCorticosteroidsPrednisolone40 mg daily for one month followed by two week taperPhosphodiesterase inhibitorsPentoxifylline400 mg TID for 30 daysSource: The hospitality, (2012). HYPERLINK "-"- ospitalist.org/details/article/1498131/How_Should_Acute_Alcoholic_Hepatitis_be_Treated.html
Costs associated with current diagnostics and treatment
The condition is associated with costs associated with medications and work loss. The rates of hospitalization for hepatitis patients are 11%-to 22%. Those adults who become sick may lose 28 working days per sickness. Additionally, the department of health may incur post exposure prophylaxis costs for an average of 12 contacts per situation. The average indirect and direct costs for hepatitis A victims may range from $1,819 to $2,550 for adult cases and $434 to $1,493 for every pediatric situation. In 2010, the annual total cost estimated for hepatitis A was more than $250 million (CDC, 2010)
Novel Plan for Treating Hepatitis A
There is no reliable cure for hepatitis A condition. Therefore, it would be better if patients could be supported while at home than going to the hospital. I would advise patients to always take health foods and maintain hygiene during the sickness. Additionally, I recommend that patients should have plenty of rest and avoid hard chores. Patients should have plenty of beverages including eight glasses of water every day. However, there is a need for patients to go to the hospital for tests and diagnosis of the condition. Patients at this time may tend to use medicines that had not been recommended and which they imagine could cure their disease, however, I advise against using any medicine such as ibuprofen, acetaminophen, aspirin and so forth unless it is really necessary. Relatives and friends should get vaccinated immediately to prevent them from catching the virus.
Toxic drinks such as alcohol are prohibited among the patients. Vitamins and fruit supplements are paramount for the patients at this time. Before subjecting the patient to herbal treatment, it would be better to determine if such a course would be okay. The caregiver should be able to determine on the quantity to be consumed by the patient. If any medicine, herbal treatment or supplement is taken with no instructions from the doctor, then label directions should be followed strictly. Patients should not attempt to take medicines or supplements in excess.
Specific therapies may be directed to patients with severe hepatit...