When it comes to uncovering social determinants of health, chronic care management nurses have a few special tools in their toolbox. The most powerful among them is trust, and we’re going to show you just how it helps patients to live better lives. To protect their privacy, we’ve changed the names of the characters in these stories, but the facts are all true.

Something was off

Remote Nurse Manager Ruth had been working with Darlene for months, so when she called her patient one morning for a regular check-in, she could tell right away – something was off. Darlene sounded different. Darlene has chronic obstructive pulmonary disease and several other chronic diseases. Ruth spent months getting to know Darlene as her provider and also personally. While she learned about Darlene’s medication regimen and her symptoms, she also learned her voice. So that morning when she spoke with Darlene, she immediately noticed a strained inflection in her voice, and caught a new wheezing she hadn’t heard before. “Are you wheezing? Are you using your inhaler?” Ruth asked Darlene. The two had grown comfortable enough with each other and Darlene had learned to respond truthfully, even when the conversation got personal. Darlene confessed that she had stopped using an inhaler because she could no longer afford it. Now, we arrive at the moment that reveals the true power of CCM. Darlene could have suffered for months, at least until her next primary care physician’s visit, before her care team learned about her medication noncompliance. Instead, a provider learned of her financial struggles and together, Darlene and Ruth worked with her doctor to come up with a solution. Ruth contacted Darlene’s doctor and asked for a few free samples so Darlene could start breathing easier right away. Next, Darlene’s doctor prescribed an alternative inhaler that she could afford. Because she trusted her remote nurse manager, Darlene came forward with some critical details about why she couldn’t stay compliant with her medicine. It was a confession that may have otherwise been seriously delayed.

Meals for real

Food insecurity is one of the most prevalent negative social determinants of health, but also one of the toughest to crack. It’s personal, and patients can feel embarrassed, like they’ve somehow failed when they struggle to buy food for their families. That’s why Judy, a Signallamp remote nurse case manager, decided to build a rapport slowly with Betty, her new patient. Betty had dropped hints that she might suffer from food insecurity, but dodged the topic when asked directly. After a few monthly calls, Judy felt confident to open a line of questioning and get to the bottom of it. She learned that Betty’s family didn’t have transportation, and that they bought groceries from a discount market – their only option within walking distance. Discount and dollar stores dangle a slippery lifeline for people in poorer communities and those without transportation like Betty. While they offer lower prices – typically because they sell things in smaller sizes and portions – they rarely sell fresh food. Most food options come packaged and highly processed. But creativity can prevail. Judy and Betty pulled up the store’s inventory from the internet and together assembled a list of healthier options that Betty could afford from the discount store. Judy also plugged the details from their talks into Betty’s electronic medical record, raising awareness for the rest of Betty’s care team. Judy had earned Betty’s trust over the course of their relationship, and after getting honest, Judy helped set the stage for meaningful intervention.

The other shapes of trust

Trust doesn’t just lead to honesty. It changes behavior. It gives patients a stronger reason to heed their nurse case manager’s advice. That’s what happened when Donna, a 75-year-old patient with several comorbidities, confessed to Shelly, her nurse case manager, that she had fallen over the weekend. Shelly was checking in after Donna returned home from the hospital for a urinary tract infection. Donna has a complex list of chronic diseases and also takes blood thinners. She also sounded disoriented on the phone. Shelly recommended that Donna should go to an urgent care clinic to get checked out. Donna resisted at first because she’s the primary caregiver for her ailing husband. She also didn’t have transportation. Lucky for her, Shelly is always up for a challenge when it comes to advocating for her patients’ well being. She convinced Donna that it was time to go for some tests. Shelly called one of Donna’s neighbors and asked if they could help with a ride. Shelly notified Donna’s primary care doctor, and checked in the following week. She learned that Donna was still struggling to stand, so she arranged for physical therapy. If not for the trust Shelly had nurtured with Donna, the reluctant patient could have landed back in the hospital with a recurrent UTI. From sticky conversations to tough decisions about seeking care, a rich, trusting relationship between provider and patient leads to profound and positive outcomes. At Signallamp, we’ve seen trust in action. We know that it works. It’s why every one of our nurse case managers starts every new patient relationship by establishing trust, paving the way for meaningful care to take place.