We do monthly staff meetings. The Case Manager, and Nurse Manager, nurse navigator and adherence nurse all work together to follow up with clients who are due for visits.
Phone calls and letters are sent, we also work with home care nurses who may be seeing our pts to reinforce that they come in for visits.
If all else fails, we refer them to outreach case managers who also attempt to engage pt in care.
• Treatment fatigue in long standing clients. Many are tired of the up to 20+ years of care and treatment.
• Drug abuse continues to be an issue and barrier to care.
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