In my previous role, I encountered a patient with diabetes, hypertension, and chronic kidney disease. I coordinated with specialists, primary care physicians, and the patient's family to develop a comprehensive care plan. This included medication management, dietary adjustments, and regular monitoring. By ensuring clear communication and follow-up, we were able to stabilize the patient's condition and improve their quality of life.

I prioritize tasks based on the urgency and complexity of each patient's condition. For instance, I immediately address any acute issues or emergencies. For chronic conditions, I focus on preventive care and patient education. I also use tools like care plans and checklists to ensure nothing is overlooked. Balancing these tasks requires effective time management and clear communication with the care team.

When a patient is non-compliant, I first try to understand the underlying reasons, such as fear, lack of understanding, or practical barriers. I then tailor my approach to address these issues, providing clear explanations, offering support, and involving the patient in decision-making. For example, I might simplify instructions, provide educational materials, or connect the patient with community resources to overcome barriers.

I have extensive experience with telehealth, which has become crucial in care management, especially during the pandemic. Telehealth allows for regular check-ins, medication reviews, and patient education without the need for in-person visits. It also helps in reaching patients in remote areas. I ensure that telehealth sessions are as comprehensive as in-person visits, using visual aids and clear communication to maintain high-quality care.

Ensuring continuity of care involves thorough documentation and clear communication. I create detailed care transition plans that include patient history, current medications, and specific care instructions. I also coordinate with the receiving care team to discuss the patient's needs and any ongoing issues. Regular follow-ups and patient education further help in maintaining continuity and improving outcomes.