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Chong F, Jianping Z, Zhenjie L, Wenxing L, Li Y. Does competition support integrated care to improve quality? Heliyon 2024; 10:e24836. [PMID: 38333801 PMCID: PMC10850910 DOI: 10.1016/j.heliyon.2024.e24836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 01/01/2024] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction This work investigates the compatibility of integrated care and competition in China and analyses the impact of integrated care on regional care quality (DeptQ) within a competitive framework. Method The study was built on multivariate correspondence analysis and a two-way fixed-effects model. The data were collected from Xiamen's Big Data Application Open Platform and represent nine specialised departments that regularly performed inter-institutional referrals between 2016 and 2019. Results First, care quality for referred patients (ReferQ) and the relative scale of referred patients (ReferScale) and competition have an antagonistic but not completely mutually exclusive relationship. Second, ReferQ and competition both have a significant effect on DeptQ, but only when competition is weak can ReferQ and competition act synergistically on DeptQ. When competition is fierce, competition will weaken the impact of ReferQ on DeptQ. Conclusion Changes in the intensity of integrated care and competition ultimately affect care quality.
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Affiliation(s)
- Feng Chong
- School of Mathematics and Statistics, Xiamen University of Technology, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
| | - Zhu Jianping
- School of Management, Xiamen University, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Fujian, Xiamen, China
| | - Liang Zhenjie
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- College of Economics and Management, Minjiang University, Fujian, Fuzhou, China
| | - Lin Wenxing
- Xiamen Health and Medical Big Data Center, Fujian, Xiamen, China
| | - Yumin Li
- School of Economics and Management, Nanjing University of Science and Technology, Jiangsu, Nanjing, China
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Kurteva S, Tamblyn R, Meguerditchian AN. Predictors of frequent emergency department visits among hospitalized cancer patients: a comparative cohort study using integrated clinical and administrative data to improve care delivery. BMC Health Serv Res 2023; 23:887. [PMID: 37608371 PMCID: PMC10464437 DOI: 10.1186/s12913-023-09854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Frequent emergency department (FED) visits by cancer patients represent a significant burden to the health system. This study identified determinants of FED in recently hospitalized cancer patients, with a particular focus on opioid use. METHODS A prospective cohort discharged from surgical/medical units of the McGill University Health Centre was assembled. The outcome was FED use (≥ 4 ED visits) within one year of discharge. Data retrieved from the universal health insurance system was analyzed using Cox Proportional Hazards (PH) model, adopting the Lunn-McNeil approach for competing risk of death. RESULTS Of 1253 patients, 14.5% became FED users. FED use was associated with chemotherapy one-year pre-admission (adjusted hazard ratio (aHR) 2.60, 95% CI: 1.80-3.70), ≥1 ED visit in the previous year (aHR: 1.80, 95% CI 1.20-2.80), ≥15 pre-admission ambulatory visits (aHR 1.54, 95% CI 1.06-2.34), previous opioid and benzodiazepine use (aHR: 1.40, 95% CI: 1.10-1.90 and aHR: 1.70, 95% CI: 1.10-2.40), Charlson Comorbidity Index ≥ 3 (aHR: 2.0, 95% CI: 1.2-3.4), diabetes (aHR: 1.60, 95% CI: 1.10-2.20), heart disease (aHR: 1.50, 95% CI: 1.10-2.20) and lung cancer (aHR: 1.70, 95% CI: 1.10-2.40). Surgery (cardiac (aHR: 0.33, 95% CI: 0.16-0.66), gastrointestinal (aHR: 0.34, 95% CI: 0.14-0.82) and thoracic (aHR: 0.45, 95% CI: 0.30-0.67) led to a decreased risk of FED use. CONCLUSIONS Cancer patients with higher co-morbidity, frequent use of the healthcare system, and opioid use were at increased risk of FED use. High-risk patients should be flagged for preventive intervention.
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Affiliation(s)
- Siyana Kurteva
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.
- Department of Science, Aetion, Inc, New York, USA.
- Clinical & Health Informatics Research Group, Department of Medicine, McGill University, 2001 McGill College Avenue, Suite 1200, H3A 1G1, Montreal, Canada.
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
- Department of Medicine, McGill University Health Center, Montreal, Canada
- McGill University Health Centre, Montreal, Canada
| | - Ari N Meguerditchian
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
- Department of Surgery, McGill University Health Center, Montreal, Canada
- Center for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, Canada
- St. Mary's Research Centre, Montreal, Canada
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Wilfling D, Budke J, Warkentin N, Goetz K. How Do Health Care Professionals Perceive a Holistic Care Approach for Geriatric Patients? A Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1033. [PMID: 36673787 PMCID: PMC9858644 DOI: 10.3390/ijerph20021033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Geriatric patients require holistic care in order to meet their complex care needs. The project RubiN (Continuous Care in a Regional Network) provides case and care management (CCM) for older people to address these needs in a primary care setting in Germany. This study aimed to explore the experiences of health care professionals who provided CCM for geriatric patients. METHODS Focus group interviews with general practitioners (GPs), health care assistants (HCAs), and case managers (CMs) were conducted. Transcribed data were analyzed by using qualitative content analysis. RESULTS Ten focus group discussions (n = 15 GPs, n = 14 HCAs, n = 17 CMs) were conducted. The different health care professionals emphasized the importance of a holistic care approach to geriatric care. Moreover, the GPs stated that the CMs supported the patients in organizing their care. A CCM could help encourage patients to remain at their own homes, which would have an effect on patients' quality of life and satisfaction. CONCLUSION A well-functioning and effective cooperation between those health professionals involved is a prerequisite for a trustful relationship in the holistic care of older people. This creates a feeling of security for all people involved in the care process.
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Affiliation(s)
| | | | | | - Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
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Sørensen M, Garnweidner-Holme L. Hva er god kvalitet i behandling og oppfølging av personer med langtidssykdom? TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-02-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kurteva S, Tamblyn R, Khosrow-Khavar F, Meguerditchian AN. Postoperative duration of opioid use and acute healthcare services use in cancer patients hospitalized for thoracic surgery. J Surg Oncol 2021; 124:431-440. [PMID: 33893741 DOI: 10.1002/jso.26504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/25/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postoperative pain control is an important cancer care component. However, opioid consumption has resulted in a surge of adverse events, with thoracic surgery patients having the highest rate of persistent use. The effect of opioid duration post-discharge and the risk of increased acute healthcare use in this population remains unclear. METHODS A prospective cohort of non-metastatic cancer patients was assembled from an academic health center in Montreal (Canada). Clinical data linked to administrative claims from the universal healthcare program was used to determine the association between time-varying opioid patterns and emergency department (ED) visits/re-admissions/death 3 months following thoracic surgery. RESULTS Of the 610 patients, 77% had at least one opioid dispensed post-discharge. Compared to non-opioid users, <15 days of use was associated with a 42% decreased risk of acute healthcare events, adjusted HR 0.58, 95% CI (0.40-0.85); longer durations were not associated with an increased risk. Compared to short-term use (<15 days), use of >30 days was associated with a 72% increased risk of the outcome, aHR: 1.72, 95% CI (1.01-2.93). CONCLUSION There was a variation in the risk of acute healthcare use associated with postsurgical opioid use. Findings from this study may be used to inform postoperative prescribing practices.
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Affiliation(s)
- Siyana Kurteva
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Farzin Khosrow-Khavar
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Ari N Meguerditchian
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.,St. Mary's Research Institute, Montreal, Quebec, Canada
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Wilfling D, Warkentin N, Laag S, Goetz K. "I Have Such a Great Care" - Geriatric Patients' Experiences with a New Healthcare Model: A Qualitative Study. Patient Prefer Adherence 2021; 15:309-315. [PMID: 33603349 PMCID: PMC7886229 DOI: 10.2147/ppa.s296204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/14/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Coordinated care is important for the health and well-being of geriatric patients. However, continuity of care is lacking in many countries. Several studies have shown that case management can help to meet these requirements in health care and investigated positive effects. The project RubiN (Regional ununterbrochen betreut im Netz; Continuous care in a regional network) was developed to provide regional care- and case management for outpatient care of the elderly (age >70 years) in a primary care setting. The aim of this qualitative approach was to explore experiences and attitudes of geriatric patients towards the newly developed complex care- and case-management intervention RubiN. PATIENTS AND METHODS Qualitative interviews with a purposive sample of geriatric patients enlisted in the RubiN intervention networks were conducted. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories. RESULTS Forty-four telephone interviews were performed. Two key categories were identified to describe patients' experiences regarding care delivered by a care- and case manager (CCM), namely "role of CCM" and "changes through RubiN". Results demonstrated that care performed by CCMs is perceived positively by geriatric patients. A main finding of this study was that geriatric patients experienced a sense of security through the care provided by CCMs. CCMs were perceived as highly competent people, having all the necessary skills to provide continuity of care. CONCLUSION This study illustrates the importance of trust between care provider and care recipient. It also shows that geriatric patients appreciate the continuous, professional care and structural and functional support provided by qualified CCMs.
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Affiliation(s)
- Denise Wilfling
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Correspondence: Denise Wilfling Institute for Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany Email
| | - Nicole Warkentin
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Sonja Laag
- Barmer Health Insurance, Wuppertal, Germany
| | - Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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"Not Alone Anymore": The Experiences of Adults With Diabetes in New York's Medicaid Health Home Program. Med Care 2020; 58 Suppl 6 Suppl 1:S60-S65. [PMID: 32412954 DOI: 10.1097/mlr.0000000000001296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND New York State Medicaid's Health Home program is an example of a natural experiment that could affect individuals with diabetes. While evaluations of interventions such as the Health Home program are generally based solely on clinical and administrative data and rarely examine patients' experience, patients may add to the understanding of the intervention's implementation and mechanisms of impact. OBJECTIVE The objective of this study was to qualitatively examine the health and nonmedical challenges faced by Medicaid-insured patients with diabetes and their experiences with the services provided by New York's Health Homes to address these challenges. RESEARCH DESIGN We performed 10 focus groups and 23 individual interviews using a guide developed in collaboration with a stakeholder board. We performed a thematic analysis to identify cross-cutting themes. SUBJECTS A total of 63 Medicaid-insured individuals with diabetes, 31 of whom were enrolled in New York's Health Home program. RESULTS While participants were not generally familiar with the term "Health Home," they described and appreciated services consistent with Health Home enrollment delivered by care managers. Services addressed challenges in access to care, especially by facilitating and reminding participants about appointments, and nonmedical needs, such as transportation, housing, and help at home. Participants valued their personal relationships with care managers and the psychosocial support they provided. CONCLUSIONS From the perspective of its enrollees, the Health Home program primarily addressed access to care, but also addressed material and psychosocial needs. These findings have implications for Health Home entities and for research assessing their impact.
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HUGHES GEMMA, SHAW SARAE, GREENHALGH TRISHA. Rethinking Integrated Care: A Systematic Hermeneutic Review of the Literature on Integrated Care Strategies and Concepts. Milbank Q 2020; 98:446-492. [PMID: 32436330 PMCID: PMC7296432 DOI: 10.1111/1468-0009.12459] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Policy Points Integrated care is best understood as an emergent set of practices intrinsically shaped by contextual factors, and not as a single intervention to achieve predetermined outcomes. Policies to integrate care that facilitate person-centered, relationship-based care can potentially contribute to (but not determine) improved patient experiences. There can be an association between improved patient experiences and system benefits, but these outcomes of integrated care are of different orders and do not necessarily align. Policymakers should critically evaluate integrated care programs to identify and manage conflicts and tensions between a program's aims and the context in which it is being introduced. CONTEXT Integrated care is a broad concept, used to describe a connected set of clinical, organizational, and policy changes aimed at improving service efficiency, patient experience, and outcomes. Despite examples of successful integrated care systems, evidence for consistent and reproducible benefits remains elusive. We sought to inform policy and practice by conducting a systematic hermeneutic review of literature covering integrated care strategies and concepts. METHODS We used an emergent search strategy to identify 71 sources that considered what integrated care means and/or tested models of integrated care. Our analysis entailed (1) comparison of strategies and concepts of integrated care, (2) tracing common story lines across multiple sources, (3) developing a taxonomy of literature, and (4) generating a novel interpretation of the heterogeneous strategies and concepts of integrated care. FINDINGS We identified four perspectives on integrated care: patients' perspectives, organizational strategies and policies, conceptual models, and theoretical and critical analysis. We subdivided the strategies into four framings of how integrated care manifests and is understood to effect change. Common across empirical and conceptual work was a concern with unity in the face of fragmentation as well as the development and application of similar methods to achieve this unity. However, integrated care programs did not necessarily lead to the changes intended in experiences and outcomes. We attribute this gap between expectations and results, in part, to significant misalignment between the aspiration for unity underpinning conceptual models on the one hand and the multiplicity of practical application of strategies to integrate care on the other. CONCLUSIONS Those looking for universal answers to narrow questions about whether integrated care "works" are likely to remain disappointed. Models of integrated care need to be valued for their heuristic rather than predictive powers, and integration understood as emerging from particular as well as common contexts.
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Affiliation(s)
- GEMMA HUGHES
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
| | - SARA E. SHAW
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
| | - TRISHA GREENHALGH
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
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Lambert AS, Legrand C, Cès S, Van Durme T, Macq J. Evaluating case management as a complex intervention: Lessons for the future. PLoS One 2019; 14:e0224286. [PMID: 31671116 PMCID: PMC6822731 DOI: 10.1371/journal.pone.0224286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
The methodological challenges to effectiveness evaluation of complex interventions has been widely discussed. Bottom-up case management for frail older person was implemented in Belgium, and indeed, it was evaluated as a complex intervention. This paper presents the methodological approach we developed to respond to four main methodological challenges regarding the evaluation of case management: (1) the standardization of the interventions, (2) stratification of the frail older population that was used to test various modalities of case management with different risks groups, (3) the building of a control group, and (4) the use of multiple outcomes in evaluating case management. To address these challenges, we developed a mixed-methods approach that (1) used multiple embedded case studies to classify case management types according to their characteristics and implementation conditions; and (2) compared subgroups of beneficiaries with specific needs (defined by Principal Component Analysis prior to cluster analysis) and a control group receiving 'usual care', to evaluate the effectiveness of case management. The beneficiaries' subgroups were matched using propensity scores and compared using generalized pairwise comparison and the hurdle model with the control group. Our results suggest that the impact of case management on patient health and the services used varies according to specific needs and categories of case management. However, these equivocal results question our methodological approach. We suggest to reconsider the evaluation approach by moving away from a viewing case management as an intervention. Rather, it should be considered as a process of interconnected actions taking place within a complex system.
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Affiliation(s)
- Anne-Sophie Lambert
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle aux Champs, Brussels, Belgium
- * E-mail:
| | - Catherine Legrand
- Institute of Statistics, Biostatistics and Actuarial Sciences (ISBA-IMMAQ), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Sophie Cès
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle aux Champs, Brussels, Belgium
| | - Thérèse Van Durme
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle aux Champs, Brussels, Belgium
| | - Jean Macq
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle aux Champs, Brussels, Belgium
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Askerud A, Conder J. Patients' experiences of nurse case management in primary care: a meta-synthesis. Aust J Prim Health 2019; 23:420-428. [PMID: 28923163 DOI: 10.1071/py17040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/15/2017] [Indexed: 11/23/2022]
Abstract
The health system in New Zealand and Australia requires health practitioners to prepare for the challenge of long-term conditions. Wagner's 1998 Chronic Care Model advocates a move away from the traditional acute model of primary health care to a model that addresses the long-term episodic nature of chronic disease. Nurse case management has been developed over the last 2 decades as a means to coordinate health services for people with long-term conditions. This meta-synthesis combines the results of 15 qualitative research studies that have a similar research question regarding peoples' perceptions of nurse case management. The research synthesises the experiences of people with long-term conditions on the quality of care under a nurse case management model of primary health care. Over 1000 people were represented across the studies, and the results suggest that people had a high degree of confidence and trust in their nurse case manager, were better able to manage their health conditions with nurse case management support, and had better access to appropriate health care. This research suggests that nurse case management is an effective model of care and may contribute to improved quality of life and better health care for those with long-term health conditions.
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Affiliation(s)
- Anna Askerud
- Otago Polytechnic School of Nursing, Forth Street, Private Bag 1910, Dunedin 9054, New Zealand
| | - Jenny Conder
- University of Otago Postgraduate School of Nursing, 72 Oxford Terrace, Christchurch, 8011, New Zealand
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Gurr B, Tanskanen SL. The psychological nature of seizure conditions. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.10.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Epilepsy is a long-term health condition that is associated with multiple biological, psychological and behavioural factors. Psychogenic or non-epileptic conditions have caused much debate and controversy among clinicians and researchers. This paper outlines comprehensive assessments with the aim of describing the psychological nature of different types of seizure conditions. Methods: The retrospective study reports on a range of self-report psychometric data of 26 patients with epileptic, non-epileptic, or both types of seizure conditions. The Hospital and Anxiety and Depression Scale, the Dissociative Experiences Scale and the Emotional Processing Scale were used to assess psychological functioning and emotional distress. The Quality of Life in Epilepsy Inventory and the MOS Short-Form Health Survey 36 were administered to evaluate subjective experiences related to quality of life and disability. Results: Epileptic and non-epileptic seizures are formulated in the background of biopsychosocial stress theories. The questionnaire outcomes revealed complex profiles. All patient groups reported reduced quality of life. Differential patterns of psychological distress were discovered for both diagnostic groups. Conclusion: The findings from this heterogeneous clinical population suggest that patients with epileptic and non-epileptic conditions demonstrate secondary psychological and functional difficulties. Future systematic research is required to establish valid measures of long-term psychosocial strain and to provide evidence for the link between maladaptive physiological mechanisms and psychological problems (and vice versa).
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Affiliation(s)
- Birgit Gurr
- Consultant clinical neuropsychologist; clinical lead of the Community Brain Injury and Adult Neuropsychology Services Dorset; Poole Stroke Care Unit; visiting fellow, Bournemouth University, UK
| | - Sanna-Leena Tanskanen
- Clinical psychologist, Kingston Crescent Surgery, Southern Health NHS Foundation Trust, Portsmouth, UK
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Taube E, Kristensson J, Midlöv P, Jakobsson U. The use of case management for community-dwelling older people: the effects on loneliness, symptoms of depression and life satisfaction in a randomised controlled trial. Scand J Caring Sci 2017; 32:889-901. [PMID: 28895175 DOI: 10.1111/scs.12520] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 08/15/2017] [Indexed: 12/21/2022]
Abstract
AIM To investigate the effects of a case management intervention for community-dwelling frail older people, with functional dependency and repeated contacts with the healthcare services, focusing on loneliness, depressive symptoms and life satisfaction. DESIGN A two-armed, nonblinded, randomised control trial with repeated follow-ups, of N = 153 participants at baseline allocated to an intervention (n = 80) and control (n = 73) group. METHOD Inclusion criteria were the following: ≥65 years of age, living in ordinary housing, in need of assistance in two or more self-reported activities of daily living, having at least two hospital admissions or at least four visits in outpatient care 12 months prior to enrolment. Case managers (nurses and physiotherapists) provided an intervention of general case management, general information, specific information and continuity and safety. The intervention ranged over 12 months with one or more home visit(s) being conducted per month. An intention-to-treat analysis was applied for the primary outcomes of loneliness, depressive symptoms and life satisfaction, along with complete case and sensitivity analyses. RESULTS During the trial period n = 12 died and n = 33 dropped out. No significant difference was found between the groups at baseline regarding sociodemographic characteristics, subjective health or primary outcomes. The intention-to-treat analysis did not result in any significant effects for the primary outcomes at any of the follow-ups (6 and 12 months). The complete case analysis resulted in a significant difference in favour of the intervention regarding loneliness (RR = 0.49, p = 0.028) and life satisfaction (ES = 0.41, p = 0.028) at 6 months and for depressive symptoms (ES = 0.47, p = 0.035) at 12 months. CONCLUSIONS The use of case management for frail older people did not result in clear favourable effects for the primary outcomes. However, the study indicates that case management may be beneficial in terms of these outcomes. Due to the complexity of the outcomes, an elaboration of the components and assessments is suggested.
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Affiliation(s)
- Elin Taube
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jimmie Kristensson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Ulf Jakobsson
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Experiences of health care for older people who need support to live at home: A systematic review of the qualitative literature. Geriatr Nurs 2017; 38:315-324. [DOI: 10.1016/j.gerinurse.2016.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/02/2016] [Accepted: 12/04/2016] [Indexed: 11/20/2022]
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Charles L, Brémault-Phillips S, Parmar J, Johnson M, Sacrey LA. Understanding How to Support Family Caregivers of Seniors with Complex Needs. Can Geriatr J 2017; 20:75-84. [PMID: 28690707 PMCID: PMC5495539 DOI: 10.5770/cgj.20.252] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE OF THE STUDY The purpose of this study was to describe the experiences and challenges of supporting family caregivers of seniors with complex needs and to outline support strategies and research priorities aimed at supporting them. DESIGN AND METHODS A CIHR-funded, two-day conference entitled "Supporting Family Caregivers of Seniors: Improving Care and Caregiver Outcomes" was held. An integrated knowledge translation approach guided this planning conference. Day 1 included presentations of research evidence, followed by participant engagement Qualitative data was collected regarding facilitators, barriers/gaps, and recommendations for the provision of caregiver supports. Day 2 focused on determination of research priorities. RESULTS Identified facilitators to the provision of caregiver support included accessibility of health-care and community-based resources, availability of well-intended health-care providers, and recognition of caregivers by the system. Barriers/gaps related to challenges with communication, access to information, knowledge of what is needed, system navigation, access to financial resources, and current policies. Recommendations regarding caregiver services and research revolved around assisting caregivers to self-identify and seek support, formalizing caregiver supports, centralizing resources, making system navigation available, and preparing the next generation for caregiving. IMPLICATION A better understanding of the needs of family caregivers and ways to support them is critical to seniors' health services redesign.
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Affiliation(s)
- Lesley Charles
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB
| | - Jasneet Parmar
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB
| | - Melissa Johnson
- Network of Excellence in Seniors' Health and Wellness, Edmonton, AB
| | - Lori-Ann Sacrey
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
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Balard F, Gely-Nargeot MC, Corvol A, Saint-Jean O, Somme D. Case management for the elderly with complex needs: cross-linking the views of their role held by elderly people, their informal caregivers and the case managers. BMC Health Serv Res 2016; 16:635. [PMID: 27825342 PMCID: PMC5101789 DOI: 10.1186/s12913-016-1892-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/01/2016] [Indexed: 11/22/2022] Open
Abstract
Background In 2009, case management interventions were a new social service in France implemented within the framework of the PRISMA-France program (2006–2010). People who had benefitted from case management intervention were individuals, over 60 years old living at home in situations deemed complex by professionals. Their informal caregivers were also considered as users of the service. This research accompanied the interventions during the implementation of PRISMA-France attempting to explore the users’ (old people and their informal caregivers) and case managers’ first experiences of case management. Its aim is to provide a thorough knowledge of the dispositive in order to reveal any initial failings and to ensure optimum conditions for the onset of full implementation. Methods The study had a qualitative explorative design. Cross-linked representations of case-management were obtained through opened-ended and guided interviews with three types of informants: old people (19), their informal caregivers (11) and the case managers (5) who participated in the program during the first 6 months. Thematic analysis of the data was carried out. Results The analysis revealed that each group of people generated its own representations of the case manager’s role, even though the three groups of informants shared the idea that the case manager is first and foremost a helper. The case managers insisted on their proximity to the old people and their role as coordinators. The informal caregivers saw the professional as a partner and potential provider of assistance in accompanying old people. The old people focused on the personal connections established with the case manager. Conclusion The innovative and experimental dimension of case management in France and the flexible nature of the role generated a broad spectrum of representations by those involved. These different representations are, in part, the fruit of each individual’s projected expectations of this social service. Analyzing the first representations of the case manager’s role during the implementation phase of the CM service appears as a necessary step before considering the effects of the services. The implementation and the success of a case management model have to be evaluated regarding the previous healthcare context and the expectations of the people involved.
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Affiliation(s)
- Frédéric Balard
- Laboratoire Lorrain de sciences sociales, Université de Lorraine, Nancy, France.
| | | | - Aline Corvol
- Centre Hospitalier de Rennes, Service de Gériatrie, Rennes, France
| | | | - Dominique Somme
- Université de Rennes 1, Centre Hospitalier de Rennes, Service de Gériatrie, Laboratoire CRAPE Centre de Recherches sur l'Action Politique en Europe, UMR 6051, Rennes, France
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Gowing A, Dickinson C, Gorman T, Robinson L, Duncan R. Patients' experiences of a multidisciplinary team-led community case management programme: a qualitative study. BMJ Open 2016; 6:e012019. [PMID: 27612540 PMCID: PMC5020758 DOI: 10.1136/bmjopen-2016-012019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the views and experiences of patients on the care they have received while enrolled on the Northumberland High Risk Patient Programme (NHRPP). This programme involved case finding of frail patients using a multidisciplinary team (MDT)-led community case management programme, and support of patients through care planning and regular reviews using primary, community, secondary and social care professionals. DESIGN A qualitative study using semistructured interviews, which were digitally recorded, transcribed and subject to thematic analysis. SETTING Community patients receiving primary care in the county of Northumberland, England. PARTICIPANTS 23 participants took part, of which 16 were patients enrolled on the NHRPP, and 7 carers. GP practices were selected purposively by size, deprivation and location, and patients identified and invited by General Practitioners to participate. RESULTS 4 main themes emerged from the data: awareness and understanding of the NHRPP, confidence in the primary healthcare team, limitations of home care and the active role of being a patient. Despite having a low level of awareness of the details of the NHRPP, participants did think that its broad aim made sense. Participants discussed their high level of satisfaction with their care and access to team members. However, some limitations of alternatives to hospital care were identified, including the need to consider psychological as well as medical needs, the importance of overnight care and the needs of those without informal carers. Finally, participants discussed the active nature of being a patient under the NHRPP if they were to contribute fully to planning and managing their own care. CONCLUSIONS This study has identified that a programme of MDT-led case management was generally very well received by patients and their families. However, a number of factors were identified that could improve the implementation of the programme and further research needs to be undertaken to address these.
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Affiliation(s)
- Alice Gowing
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Dickinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Tom Gorman
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Duncan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Maio L, Botsford J, Iliffe S. Family carers' experiences of the Admiral Nursing Service: a quantitative analysis of carer feedback. Aging Ment Health 2016; 20:669-75. [PMID: 26062969 DOI: 10.1080/13607863.2015.1052776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Family carers of people with dementia often experience difficulty in accessing information, services and adequate support. Admiral Nurses, registered nurses specialising in dementia, provide holistic and person-centred support to families living with dementia. This study assessed the effectiveness of the Admiral Nurses' approach from the perspective of family carers who had accessed their service. METHOD A questionnaire was developed with input from family carers and Admiral Nurses and questions were based around the Admiral Nursing Standards. 685 questionnaires were sent out in total to carers in receipt of care from three different regions in England. RESULTS 207 questionnaires (30.2% response rate) were analysed. Admiral Nurses' knowledge and skills and their interventions were found helpful by 81.5% and 82.6% of respondents, respectively (mean values). Respondents also rated them effective in developing rapport (96.5%, mean value) and recognising and supporting the needs of the dyad (85.8%, mean value). More varied views were expressed in relation to activities and stimulation for the person with dementia, and to advice around medications and their effects, with around a third (n = 57, 31% and n = 63, 33.9%, respectively) of respondents finding Admiral Nurses not helpful, whilst 24.6% (n = 46) thought so in relation to care coordination. A higher number of contacts with Admiral Nurses (5+) and carer gender (female) were significant predictors of carers' satisfaction. CONCLUSION Whilst some aspects of supporting carers are performed less well from the carers' perspective, overall family carers in receipt of Admiral Nursing support perceived their family-centred approach as helpful/effective.
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Affiliation(s)
- Laura Maio
- a Research Department of Primary Care and Population Health , University College London , London , UK.,b Dementia UK , London , UK
| | | | - Steve Iliffe
- a Research Department of Primary Care and Population Health , University College London , London , UK
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19
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Jones S. Alternative perspectives of safety in home delivered health care: a sequential exploratory mixed method study. J Adv Nurs 2016; 72:2536-46. [PMID: 27199085 DOI: 10.1111/jan.13006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to discover and describe how patients, carers and case management nurses define safety and compare it to the traditional risk reduction and harm avoidance definition of safety. BACKGROUND Care services are increasingly being delivered in the home for patients with complex long-term conditions. However, the concept of safety remains largely unexplored. DEIGN A sequential, exploratory mixed method design. METHODS A qualitative case study of the UK National Health Service case management programme in the English UK National Health Service was deployed during 2012. Thirteen interviews were conducted with patients (n = 9) and carers (n = 6) and three focus groups with nurses (n = 17) from three community care providers. The qualitative element explored the definition of safety. Data were subjected to framework analysis and themes were identified by participant group. Sequentially, a cross-sectional survey was conducted during 2013 in a fourth community care provider (patient n = 35, carer n = 19, nurse n = 26) as a form of triangulation. FINDINGS Patients and carers describe safety differently to case management nurses, choosing to focus on meeting needs. They use more positive language and recognize the role they have in safety in home-delivered health care. In comparison, case management nurses described safety similarly to the definitions found in the literature. However, when offered the patient and carer definition of safety, they preferentially selected this definition to their own or the literature definition. CONCLUSION Patients and carers offer an alternative perspective on patient safety in home-delivered health care that identifies their role in ensuring safety and is more closely aligned with the empowerment philosophy of case management.
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20
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Tremblay D, Touati N, Roberge D, Breton M, Roch G, Denis JL, Candas B, Francoeur D. Understanding cancer networks better to implement them more effectively: a mixed methods multi-case study. Implement Sci 2016; 11:39. [PMID: 27000152 PMCID: PMC4802906 DOI: 10.1186/s13012-016-0404-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/12/2016] [Indexed: 11/16/2022] Open
Abstract
Background Managed cancer networks are widely promoted in national cancer control programs as an organizational form that enables integrated care as well as enhanced patient outcomes. While national programs are set by policy-makers, the detailed implementation of networks is delegated at the service delivery and institutional levels. It is likely that the capacity to ensure more integrated cancer services requires multi-level governance processes responsive to the strengths and limitations of the contexts and capable of supporting network-based working. Based on an empirical case, this study aims to analyze the implementation of a mandated cancer network, focusing on governance and health services integration as core concepts in the study. Methods/design This nested multi-case study uses mixed methods to explore the implementation of a mandated cancer network in Quebec, a province of Canada. The case is the National Cancer Network (NCN) subdivided into three micro-cases, each defined by the geographic territory of a health and social services region. For each region, two local health services centers (LHSCs) are selected based on their differences with respect to determining characteristics. Qualitative data will be collected from various sources using three strategies: review of documents, focus groups, and semi-directed interviews with stakeholders. The qualitative data will be supplemented with a survey that will measure the degree of integration as a proxy for implementation of the NCN. A score will be constructed, and then triangulated with the qualitative data, which will have been subjected to content analysis. Qualitative, quantitative, and mixed methods data will be interpreted within and across cases in order to identify governance patterns similarities and differences and degree of integration in contexts. Discussion This study is designed to inform decision-making to develop more effective network implementation strategies by thoroughly describing multi-level governance processes of a sample of settings that provide cancer services. Although the study focuses on the implementation of a cancer network in Quebec, the rich descriptions of multiple nested cases will generate data with a degree of generalizability for health-care systems in developed countries. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0404-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dominique Tremblay
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada. .,Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada.
| | - Nassera Touati
- École nationale d'administration publique, 4750 Henri-Julien Avenue, 5th Floor, H2T 3E5, Montreal, Quebec, Canada
| | - Danièle Roberge
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada.,Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada
| | - Mylaine Breton
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada.,Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, G1V 0A6, Quebec, Quebec, Canada.,Centre de recherche du CHU de Québec - Université Laval, 11 Côte du Palais, Quebec, G1R 2J6, Quebec, Canada
| | - Jean-Louis Denis
- École nationale d'administration publique, 4750 Henri-Julien Avenue, 5th Floor, H2T 3E5, Montreal, Quebec, Canada
| | - Bernard Candas
- Institut national d'excellence en santé et en services sociaux, 2535, boulevard Laurier, 5e étage, Quebec, G1V 4M3, Quebec, Canada
| | - Danièle Francoeur
- Institut national de santé publique du Québec, 190 Crémazie Blvd. East, 2nd Floor, H2P 1E2, Montreal, Quebec, Canada
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Bunn F, Goodman C, Pinkney E, Drennan VM. Specialist nursing and community support for the carers of people with dementia living at home: an evidence synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:48-67. [PMID: 25684210 DOI: 10.1111/hsc.12189] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 06/04/2023]
Abstract
Specialist nurses are one way of providing support for family carers of people with dementia, but relatively little is known about what these roles achieve, or if they are more effective than roles that do not require a clinical qualification. The aim of this review was to synthesise the literature on the scope and effectiveness of specialist nurses, known as Admiral Nurses, and set this evidence in the context of other community-based initiatives to support family carers of people with dementia. We undertook a systematic review of the literature relating to the scope and effectiveness of Admiral Nurses and a review of reviews of interventions to support the family carers of people with dementia. To identify studies, we searched electronic databases, undertook lateral searches and contacted experts. Searches were undertaken in November 2012. Results are reported narratively with key themes relating to Admiral Nurses identified using thematic synthesis. We included 33 items relating to Admiral Nurses (10 classified as research) and 11 reviews evaluating community-based support for carers of people with dementia. There has been little work to evaluate specific interventions provided by Admiral Nurses, but three overarching thematic categories were identified: (i) relational support, (ii) co-ordinating and personalising support and (iii) challenges and threats to the provision of services by Admiral Nurses. There was an absence of clearly articulated goals and service delivery was subject to needs of the host organisation and the local area. The reviews of community-based support for carers of people with dementia included 155 studies but, in general, evidence that interventions reduced caregiver depression or burden was weak, although psychosocial and educational interventions may reduce depression in carers. Community support for carers of people with dementia, such as that provided by Admiral Nurses, is valued by family carers, but the impact of such initiatives is not clearly established.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Emma Pinkney
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University and St Georges University, London, UK
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Hjelm M, Holst G, Willman A, Bohman D, Kristensson J. The work of case managers as experienced by older persons (75+) with multi-morbidity - a focused ethnography. BMC Geriatr 2015; 15:168. [PMID: 26675288 PMCID: PMC4682280 DOI: 10.1186/s12877-015-0172-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 12/15/2015] [Indexed: 12/04/2022] Open
Abstract
Background Complex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care. Case management could be one way to address this difficulty. Currently, there is a need to extend the knowledge regarding case management as experienced by those utilising the services, namely older persons (75+) with multi-morbidity. The study aimed to explore older persons’ (75+) with multi-morbidity experiences of case managers. Methods The study design was qualitative and used a focused ethnographic approach. Data was collected through individual interviews with 13 older persons and by participant observations with accompanying field notes, all conducted in 2012–2013. Results The data revealed four themes illustrating the older persons’ experiences of case managers: 1) Someone providing me with a trusting relationship; 2) Someone assisting me; 3) Someone who is on my side; and 4) Someone I do not need at present. Conclusions This study illustrates the importance of establishing trusting relationships between older persons and their case managers in order to truly provide assistance. The older persons valued the case managers acting as informed but unbiased facilitators. The findings could be of help in the development of case management interventions better designed for older persons with multi-morbidity.
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Affiliation(s)
- Markus Hjelm
- Department of Health, Blekinge Institute of Technology, SE-371 45, Karlskrona, Sweden. .,Department of Health Sciences, Lund University, SE-221 00, Lund, Sweden.
| | - Göran Holst
- Department of Health, Blekinge Institute of Technology, SE-371 45, Karlskrona, Sweden.
| | - Ania Willman
- Department of Health, Blekinge Institute of Technology, SE-371 45, Karlskrona, Sweden. .,Department of Care Science, Malmö University, SE-211 18, Malmö, Sweden.
| | - Doris Bohman
- Department of Health, Blekinge Institute of Technology, SE-371 45, Karlskrona, Sweden.
| | - Jimmie Kristensson
- Department of Health Sciences, Lund University, SE-221 00, Lund, Sweden.
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23
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Jones S. Implications of case managers' perceptions and attitude on safety of home-delivered care. Br J Community Nurs 2015; 20:602-7. [PMID: 26636894 DOI: 10.12968/bjcn.2015.20.12.602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Perceptions on safety in community care have been relatively unexplored. A project that sought to understand the multiple perspectives on safety in the NHS case-management programme was carried out in relation to the structure, process, and outcome of care. This article presents a component of the nursing perspective that highlights an important element in the structure of nursing care that could potentially impede the nurses' ability to be fully effective and safe. A single case study of the case-management programme was undertaken. Three primary care organisations from three strategic health authorities participated, and three focus groups were conducted (one within each organisation). In total, 17 case management nurses participated. Data were audiotaped and transcribed verbatim and subjected to framework analysis. Nursing staff attitudes were identified as a structure of care that influence safety outcomes, particularly their perceptions of the care setting and the implications it has on their role and patient behaviour. Greater understanding of the expected role of the community nurse is necessary, and relevant training is required for nurses to be successful in empowering patients to perform more safely. In addition, efforts need to be made to improve patients' trust in the health-care system to prevent harm and promote more effective utilisation of resources.
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Hudon C, Chouinard MC, Diadiou F, Lambert M, Bouliane D. Case Management in Primary Care for Frequent Users of Health Care Services With Chronic Diseases: A Qualitative Study of Patient and Family Experience. Ann Fam Med 2015; 13:523-8. [PMID: 26553891 PMCID: PMC4639377 DOI: 10.1370/afm.1867] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although case management (CM) is increasingly being implemented to address the complex needs of vulnerable clienteles, few studies have examined the patient experience of CM. This study aimed to examine the experience of patients and their family members with care integration as part of a primary care CM intervention. Patients in the study were frequent users of health care services who had chronic diseases. METHODS A descriptive, qualitative approach was conducted involving 25 patients and 8 of their family members. Data were collected through in-depth interviews of the patients and 2 focus groups of family members and were analyzed thematically. RESULTS While some participants did not fully understand the CM intervention and a few believed that it involved too many appointments, the CM nurses were patients' preferred contact with primary care. The nurses actively involved the patients in developing and carrying out their individualized services plans (ISPs) with other health care partners. Patients felt that their needs were taken into consideration, especially regarding access to the health care system. The case manager facilitated access to information as well as communication and coordination among health care and community partners. This improved communication comforted the patients and nurtured a relationship of trust. Participants were actively involved in decision-making. Their ISPs helped them know where they were going and improved transitions between services. CONCLUSIONS The experience of patients and family members was overall very positive regarding care integration. They reported improved access, communication, coordination, and involvement in decision-making as well as better health care transitions.
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Affiliation(s)
- Catherine Hudon
- Département de médecine de famille et médecine d'urgence, Université de Sherbrooke, Québec, Canada Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Québec, Canada
| | - Maud-Christine Chouinard
- Centre de santé et de services sociaux de Chicoutimi, Québec, Canada Département des sciences de la santé, Université du Québec à Chicoutimi, Québec, Canada
| | - Fatoumata Diadiou
- Centre de santé et de services sociaux de Chicoutimi, Québec, Canada
| | - Mireille Lambert
- Centre de santé et de services sociaux de Chicoutimi, Québec, Canada
| | - Danielle Bouliane
- Centre de santé et de services sociaux de Chicoutimi, Québec, Canada
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25
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Zhao L, Xie H, Dong R. Volunteers as caregivers for elderly with chronic diseases: An assessment of demand and cause of demand. Int J Nurs Sci 2015. [DOI: 10.1016/j.ijnss.2015.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Cheng SL, Zhao JZ, Bai J, Zang XY. Continuity of Care for Older Adults with Chronic Illness in China: An Exploratory Study. Public Health Nurs 2014; 32:298-306. [PMID: 25308128 DOI: 10.1111/phn.12163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore nurses' understanding of continuity of care and existing problems in implementation of continuity of care for Chinese elders with chronic illnesses. DESIGN AND SAMPLE Cross-sectional survey and semi-structured interview were performed on 15 nurses and older patients and 1,902 older patients between July 2010 and February 2011. MEASURES Semi-structured interview guideline and four-section scale were used. RESULTS The interviews showed nurses lacked knowledge of continuity of care, and nurses from small towns or rural areas had less understanding of continuity of care and discharge planning than nurses from central cities. Significant differences were found among patients located in referred areas in selection of medical institutions for treatment, suggesting older adults were more likely to choose general hospitals for treatment. Self-reported surveys demonstrated more than 70% of hospitalized elders chose community hospitals for further recovery after discharge from general hospitals. CONCLUSIONS Chinese nurses lack knowledge of continuity of care, and significant discontinuity exists between health care provided by general hospitals, community hospitals and other institutions for elders. A further model for the development of continuity of care should be established that addresses older patients' demands and current barriers in China.
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Affiliation(s)
- Shu-Ling Cheng
- Tianjin Stomatological Hospital of Nankai University, Tianjin, China
| | - Jin-Zhi Zhao
- Seven-Year System of Basic Medical College, Tianjin Medical University, Tianjin, China
| | - Jinbing Bai
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xiao-Ying Zang
- School of Nursing, Tianjin Medical University, Tianjin, China
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Liu LF, Yao HP. Examining the need assessment process by identifying the need profiles of elderly care recipients in the Ten-year Long-Term Care Project (TLTCP) of Taiwan. J Am Med Dir Assoc 2014; 15:946-54. [PMID: 25244959 DOI: 10.1016/j.jamda.2014.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 06/29/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To deal with the increasing long-term care (LTC) needs of elderly people in Taiwan, the government launched the Ten-year Long-term Care Project (TLTCP) in 2007, and through the care management system, care plans for those in need were distributed and implemented by care managers according to the single assessment process. Based on the emphasis of linking the right need assessment to the care plan, this study aimed to explore the need profiles of LTC recipients with regard to their health indicators to serve as a validity check on the identified dependency levels and care plans in the current care management system. DESIGN A model based on latent class analysis (LCA) was used for dealing with the issue of health heterogeneity. LCA provides an empirical method that examines the interrelationships among health indicators and characterizes the underlying set of mutually exclusive latent classes that account for the observed indicators. The analysis included a total of 2901 elderly care recipients in the LTC dataset from a southern city, 1 of the 5 major metropolitan areas in Taiwan. The identified dependency levels of the samples and their care plans in need assessment were compared and discussed. RESULTS Four need profiles were explored in the LTC dataset. Apart from the low (LD) (32.95%) and moderate dependent groups (MD) (17.48%), there were 2 groups identified among the high-dependency levels, including the severe physical and psychological dependency (SPP) (26.37%) and the comorbidities and severe dependency (CSD) groups (23.20%), which in sum were approximately identified as high dependency (HD) by care managers in the LTC dataset. In addition, the CSD group currently costs more for their care plans on average in LTC services (NT. 277,081.15, approximately 9200 USD) than the SPP group (NT. 244,084.21) and the other groups. CONCLUSION Need assessment is a key to success in care management in LTC. The results of this study showed the importance of focusing on multifacet indicators, especially the mental and social health indicators in need assessments by improving the unified assessment process to sensitively detect those with various needs and then link them to the right care plan.
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Affiliation(s)
- Li-Fan Liu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Hui-Ping Yao
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Corbett S, Williams F. Striking a professional balance: interactions between nurses and their older rural patients. Br J Community Nurs 2014; 19:162-7. [PMID: 24893550 DOI: 10.12968/bjcn.2014.19.4.162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Close relationships between older adults and their health-care professionals in community settings can enhance wellbeing and support positive health in older age. In rural areas, health-care workers may know their patients socially as well as professionally, and roles are mediated. This article reports the findings from 16 qualitative interviews with older adults and health and social care professionals in rural areas of Wales. The study found that the sharing of nonclinical information in rural home-care situations is both likely and desirable, supporting the sense of social connectedness experienced by the older adult, contributing towards the development of the nurse/carer-client relationship and improving older adult wellbeing. However, it is recognised that there is potential for boundaries to become blurred and, in some situations, nurses and carers may need support to negotiate the divide between appropriate and inappropriate disclosure while maintaining a close relationship with the older adult.
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Bodenmann P, Velonaki VS, Ruggeri O, Hugli O, Burnand B, Wasserfallen JB, Moschetti K, Iglesias K, Baggio S, Daeppen JB. Case management for frequent users of the emergency department: study protocol of a randomised controlled trial. BMC Health Serv Res 2014; 14:264. [PMID: 24938769 PMCID: PMC4071797 DOI: 10.1186/1472-6963-14-264] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/11/2014] [Indexed: 12/04/2022] Open
Abstract
Background We devised a randomised controlled trial to evaluate the effectiveness and efficiency of an intervention based on case management care for frequent emergency department users. The aim of the intervention is to reduce such patients’ emergency department use, to improve their quality of life, and to reduce costs consequent on frequent use. The intervention consists of a combination of comprehensive case management care and standard emergency care. It uses a clinical case management model that is patient-identified, patient-directed, and developed to provide high intensity services. It provides a continuum of hospital- and community-based patient services, which include clinical assessment, outreach referral, and coordination and communication with other service providers. Methods/Design We aim to recruit, during the first year of the study, 250 patients who visit the emergency department of the University Hospital of Lausanne, Switzerland. Eligible patients will have visited the emergency department 5 or more times during the previous 12 months. Randomisation of the participants to the intervention or control groups will be computer generated and concealed. The statistician and each patient will be blinded to the patient’s allocation. Participants in the intervention group (N = 125), additionally to standard emergency care, will receive case management from a team, 1 (ambulatory care) to 3 (hospitalization) times during their stay and after 1, 3, and 5 months, at their residence, in the hospital or in the ambulatory care setting. In between the consultations provided, the patients will have the opportunity to contact, at any moment, the case management team. Participants in the control group (N = 125) will receive standard emergency care only. Data will be collected at baseline and 2, 5.5, 9, and 12 months later, including: number of emergency department visits, quality of life (EuroQOL and WHOQOL), health services use, and relevant costs. Data on feelings of discrimination and patient’s satisfaction will also be collected at the baseline and 12 months later. Discussion Our study will help to clarify knowledge gaps regarding the positive outcomes (emergency department visits, quality of life, efficiency, and cost-utility) of an intervention based on case management care. Trial registration ClinicalTrials.gov Identifier: NCT01934322.
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Affiliation(s)
- Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne CH-1015, Switzerland.
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Sandberg M, Jakobsson U, Midlöv P, Kristensson J. Case management for frail older people - a qualitative study of receivers' and providers' experiences of a complex intervention. BMC Health Serv Res 2014; 14:14. [PMID: 24410755 PMCID: PMC3897947 DOI: 10.1186/1472-6963-14-14] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 01/07/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Case management interventions have been widely used in the care of frail older people. Such interventions often contain components that may act both independently of each other and interdependently, which makes them complex and challenging to evaluate. Qualitative research is needed for complex interventions to explore barriers and facilitators, and to understand the intervention's components. The objective of this study was to explore frail older people's and case managers' experiences of a complex case management intervention. METHODS The study had a qualitative explorative design and interviews with participants (age 75-95 years), who had received the case management intervention and six case managers who had performed the intervention were conducted. The data were subjected to content analysis. RESULTS The analysis gave two content areas: providing/receiving case management as a model and working as, or interacting with, a case manager as a professional. The results constituted four categories: (1 and 2) case management as entering a new professional role and the case manager as a coaching guard, as seen from the provider's perspective; and (3 and 4) case management as a possible additional resource and the case manager as a helping hand, as seen from the receiver's perspective. CONCLUSIONS The new professional role could be experienced as both challenging and as a barrier. Continuous professional support is seemingly needed for implementation. Mutual confidence and the participants experiencing trust, continuity and security were important elements and an important prerequisite for the case manager to perform the intervention. It was obvious that some older persons had unfulfilled needs that the ordinary health system was unable to meet. The case manager was seemingly able to fulfil some of these needs and was experienced as a valuable complement to the existing health system.
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Affiliation(s)
- Magnus Sandberg
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, Lund SE-221 00, Sweden
- The Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, P.O. Box 187, Lund SE-221 00, Sweden
| | - Ulf Jakobsson
- Center for Primary Health Care Research, Faculty of Medicine, Lund University, Malmö SE-205 02, Sweden
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, Malmö SE-205 02, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Faculty of Medicine, Lund University, Malmö SE-205 02, Sweden
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, Malmö SE-205 02, Sweden
| | - Jimmie Kristensson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, Lund SE-221 00, Sweden
- The Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, P.O. Box 187, Lund SE-221 00, Sweden
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Buchanan DA, Denyer D, Jaina J, Kelliher C, Moore C, Parry E, Pilbeam C. How do they manage? A qualitative study of the realities of middle and front-line management work in health care. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This project addressed three questions. First, how are middle management roles in acute care settings changing, and what are the implications of these developments? Second, how are changes managed following serious incidents, when recommendations from investigations are not always acted on? Third, how are clinical and organisational outcomes influenced by management practice, and what properties should an ‘enabling environment’ possess to support those contributions?Data were gathered from around 1200 managers in six trusts through interviews, focus groups, management briefings, a survey with 600 responses, and serious incident case studies. For this project, ‘middle management’ meant any role below board level that included managerial responsibilities. Evidence provided by trust workforce information offices revealed that the management function is widely distributed, with > 30% of hospital staff holding either full-time management posts or ‘hybrid’ roles combining managerial with clinical or medical responsibilities. Hybrids outnumber full-time managers by four to one, but most have only limited management training, and some do not consider themselves to be managers. Management capabilities now at a premium include political skills, resilience, developing interprofessional collaboration, addressing ‘wicked problems’, performance management and financial skills.Case study evidence reveals multiple barriers to the implementation of change following serious incidents. These barriers relate to the complex causes of most incidents, the difficulties in establishing and agreeing appropriate action plans and the subsequent problems of implementing ‘defensive’ change agendas. The conclusions from these case studies suggest that the management of serious incidents could potentially be strengthened by adding a change management perspective to the current organisational learning focus, by complementing root cause and timeline analysis methods with ‘mess mapping’ processes and by exploring opportunities to introduce systemic changes and high-reliability methods in addition to fixing the root causes of individual incidents.Interview, focus group and survey evidence shows that middle managers are deeply committed but face increasing workloads with reduced resources, creating ‘extreme jobs’ with long hours, high intensity and fast pace. Such roles can be rewarding but carry implications for work–life balance and stress. Other pressures on middle management included rising patient and public expectations, financial challenges, burdensome regulation (external and internal), staffing problems, incompatible and dated information systems, resource and professional barriers to implementing change and problematic relationships with external agencies. Despite these pressures, management contributions included maintaining day-to-day performance, ‘firefighting’, ensuring a patient experience focus in decision-making, translating ideas into working initiatives, identifying and ‘selling’ new ideas, facilitating change, troubleshooting, leveraging targets to improve performance, process and pathway redesign, developing infrastructure (information technology, equipment, estate), developing others and managing external partnerships. Actions required to maintain an enabling environment to support those contributions would involve individual, divisional and organisational steps, most of which would be cost neutral.Recommendations for future research concern the assessment of management capacity, the advantages and drawbacks of service-line organisation structures, the incidence and implications of extreme managerial jobs, evaluating alternative serious incident investigation methods, and the applicability of high-reliability organisation perspectives in acute care settings.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Case management of individuals with long-term conditions by community matrons: report of qualitative findings of a mixed method evaluation. Prim Health Care Res Dev 2013; 15:26-37. [PMID: 23374197 DOI: 10.1017/s1463423612000667] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM To consider findings from a study that evaluated case management of individuals with long-term conditions (LTCs) by a community matron (CM) service. The paper highlights issues related to the implementation of a new role and the impact this had on the experience of care across hospital and community settings for patients and their carers. BACKGROUND The introduction of the role of CM was intended to increase effective management of patients with complex comorbid LTCs through the introduction of case management, thereby reducing unplanned hospital admissions. METHODS The overall methodological approach was one of mixed methods. This paper reports the qualitative findings from CMs (n = 15); patients (n = 13); family carers (n = 8); and secondary care staff who interface with the CM service (n = 7). Data were collected between October 2009 and May 2010. FINDINGS A thematic analysis resulted in the identification of four themes: (1) visibility; (2) interpersonal relationships; (3) leadership; and (4) systems/professional boundaries. Patients enjoyed being seen as a whole and family carers appreciated the coordination aspect of the role. Difficulties arose from the limited understanding of the CM role and from a lack of a shared vision across healthcare professionals concerning the role and its goals.
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Procter S, Wilson PM, Brooks F, Kendall S. Success and failure in integrated models of nursing for long term conditions: multiple case studies of whole systems. Int J Nurs Stud 2012; 50:632-43. [PMID: 23131723 DOI: 10.1016/j.ijnurstu.2012.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 10/10/2012] [Accepted: 10/11/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current projections indicate that the UK faces a 252% increase in people aged over 65 with one or more long term conditions (LTC) by 2050. Nurses, managing their own caseloads and clinics, working across sectors and organisational boundaries and as part of a wider multi-disciplinary team, are frequently seen as key to managing this growing demand. However, the evidence base informing the nursing role in managing LTC, the most effective configuration of the multi-disciplinary team and the policy evidence relating to the infrastructure required to support cross organisational working, remains weak. OBJECTIVES To explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to such models. DESIGN Case study whole systems analysis using qualitative interview methods. SETTINGS Two community matron services, two primary care (GP) practice nursing services, two hospital based specialist nursing services were purposefully sampled from across England and Wales. PARTICIPANTS Selection criteria were derived using a consensus conference. The nurses in the service, all patients and carers on the caseload, members of the multi-disciplinary team and stakeholders were invited to participate. METHODS Semi-structured interviews with all participants, thematic analysis within a whole system framework. RESULTS The study found high levels of clinical nursing expertise which in the case of the community matrons was meeting the aim of reducing hospital admissions. Both the primary care and hospital nurse specialist indicate similar levels of clinical expertise which was highly valued by medical colleagues and patients. Patients continued to experience fragmented care determined by diagnostic categories rather than patient need and by the specific remit of the clinic or service the patient was using. Patient data systems are still organised around the impact on services and prevalence of disease at an individual level and not around the patient experience of disease. CONCLUSION Nurses are making a major contribution to meeting the policy objectives for long term conditions. Primary care nurses and hospital nurse specialists do broadly similar roles. The scope of the nursing roles and services studied were idiosyncratic, opportunistic and reactive, rather than planned and commissioned on an analysis of local population need.
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Wilson PM, Brooks F, Procter S, Kendall S. The nursing contribution to chronic disease management: a case of public expectation? Qualitative findings from a multiple case study design in England and Wales. Int J Nurs Stud 2011; 49:2-14. [PMID: 22093577 DOI: 10.1016/j.ijnurstu.2011.10.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 08/01/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND The global response to the rise in prevalence of chronic disease is a focus on the way services are managed and delivered, in which nurses are seen as central in shaping patient experience. However, there is relatively little known on how patients perceive the changes to service delivery envisaged by chronic care models. OBJECTIVES The PEARLE project aimed to explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to the models. Design, settings and participants Case study design of seven sites in England and Wales ensuring a range of chronic disease management models. Participants included over ninety patients and family carers ranging in age from children to older people with conditions such as diabetes, respiratory disease, epilepsy, or coronary heart disease. METHODS Semi-structured interviews with patients and family carers. Focus groups were conducted with adolescents and children. A whole systems approach guided data collection and data were thematically analysed. RESULTS Despite nurses' role and skill development and the shift away from the acute care model, the results suggested that patients had a persisting belief in the monopoly of expertise continuing to exist in the acute care setting. Patients were more satisfied if they saw the nurse as diagnostician, prescriber and medical manager of the condition. Patients were less satisfied when they had been transferred from an established doctor-led to nurse-led service. While nurses within the study were highly skilled, patient perception was guided by the familiar rather than most appropriate service delivery. Most patients saw chronic disease management as a medicalised approach and the nursing contribution was most valued when emulating it. CONCLUSIONS Patients' preferences and expectations of chronic disease management were framed by a strongly biomedical discourse. Perceptions of nurse-led chronic disease management were often shaped by what was previously familiar to the patient. At a strategic level, autonomous nursing practice requires support and further promotion to wider society if there is to be a shift in societal expectation and trust in the nurse's role in chronic disease management.
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Freij M, Weiss L, Gass J, Trezza C, Wiener A, Melly J, Volland P. "Just like I'm saving money in the bank": client perspectives on care coordination services. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2011; 54:731-748. [PMID: 21967141 DOI: 10.1080/01634372.2011.594490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Older adults face many challenges to community living. The literature has not sufficiently explored the roles of care coordination in the maintenance of housing and access to health care among older adults, particularly from their own perspectives. This qualitative study analyzes the findings from 25 interviews and 6 focus group discussions (48 participants) with a multiethnic sample of older adults in the New York City area. Care coordination services appear to assist older adults access health care, and to a lesser extent, maintain affordable housing. Disparities in access to care coordination appear to remain for immigrant, minority and suburban populations.
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Affiliation(s)
- Maysoun Freij
- Center for Evaluation and Applied Research, New York Academy of Medicine, New York, New York 10029, USA.
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Challis D, Hughes J, Berzins K, Reilly S, Abell J, Stewart K, Bowns I. Implementation of case management in long-term conditions in England: Survey and case studies. J Health Serv Res Policy 2011; 16 Suppl 1:8-13. [DOI: 10.1258/jhsrp.2010.010078] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Our aim was to describe the current provision of case management arrangements in primary care for people with long-term conditions in England and identify the extent and nature of self-care support services within it. Methods Cross-sectional survey of primary care trusts (PCTs) in England and four case studies using semi-structured interviews and focus groups. Results Services were predominantly nurse-led, typically by community matrons, and delivered on a geographical basis. Often multiple arrangements existed within a PCT but integration of services with local authority adult social care was not widespread. A range of self-care support services were utilized and often tuition was provided by case managers to patients in their own homes. Assessment, care coordination and direct support to patients were the principal tasks. Often care plans were limited to primary care services and did not include service costings. Links with nurse-led services within PCTs were evident but operational links with adult social care were poorly developed. This is consistent with previous research relating to the introduction of care management in social services in England which also resulted in a plethora of organizational arrangements. Conclusions Case management for patients with long-term conditions is at an early stage of development. Effective links with a range of local services are required if care plans are going to be comprehensive.
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Affiliation(s)
- David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester
| | - Jane Hughes
- Personal Social Services Research Unit, University of Manchester, Manchester
| | - Kathryn Berzins
- Personal Social Services Research Unit, University of Manchester, Manchester
| | - Siobhan Reilly
- Personal Social Services Research Unit, University of Manchester, Manchester
| | - Jessica Abell
- Personal Social Services Research Unit, University of Manchester, Manchester
| | - Karen Stewart
- Personal Social Services Research Unit, University of Manchester, Manchester
| | - Ian Bowns
- Public Health Priorities, Buxton, UK
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McEvoy P, Escott D, Bee P. Case management for high-intensity service users: towards a relational approach to care co-ordination. HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:60-69. [PMID: 21143543 DOI: 10.1111/j.1365-2524.2010.00949.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study is based on a formative evaluation of a case management service for high-intensity service users in Northern England. The evaluation had three main purposes: (i) to assess the quality of the organisational infrastructure; (ii) to obtain a better understanding of the key influences that played a role in shaping the development of the service; and (iii) to identify potential changes in practice that may help to improve the quality of service provision. The evaluation was informed by Gittell's relational co-ordination theory, which focuses upon cross-boundary working practices that facilitate task integration. The Assessment of Chronic Illness Care Survey was used to assess the organisational infrastructure and qualitative interviews with front line staff were conducted to explore the key influences that shaped the development of the service. A high level of strategic commitment and political support for integrated working was identified. However, the quality of care co-ordination was variable. The most prominent operational factor that appeared to influence the scope and quality of care co-ordination was the pattern of interaction between the case managers and their co-workers. The co-ordination of patient care was much more effective in integrated co-ordination networks. Key features included clearly defined, task focussed, relational workspaces with interactive forums where case managers could engage with co-workers in discussions about the management of interdependent care activities. In dispersed co-ordination networks with fewer relational workspaces, the case managers struggled to work as effectively. The evaluation concluded that the creation of flexible and efficient task focused relational workspaces that are systemically managed and adequately resourced could help to improve the quality of care co-ordination, particularly in dispersed networks.
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Affiliation(s)
- Phil McEvoy
- Salford Community Health, NHS Salford, Salford, UK.
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Williams V, Smith A, Chapman L, Oliver D. Community matrons - an exploratory study of patients’ views and experiences. J Adv Nurs 2010; 67:86-93. [DOI: 10.1111/j.1365-2648.2010.05458.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bamm EL, Rosenbaum P, Stratford P. Validation of the measure of processes of care for adults: a measure of client-centred care. Int J Qual Health Care 2010; 22:302-9. [DOI: 10.1093/intqhc/mzq031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Abstract
ABSTRACTThis paper presents a structured literature review that focused on comprehensive case management by nurses for adults with long-term conditions living in the community. The emphases of the review are the implementation of case-management approaches, including its roles, core tasks and components, and the coverage and quality of the reported implementation data. Twenty-nine studies were included: the majority were concerned with case management for frail older people, and others focused on people with multiple chronic diseases, high-cost patients, or those at high risk of hospital admissions. All the studies reported that case managers undertook the core tasks of assessment, care planning and the implementation of the care plan, but there was more variation in who carried out case finding, monitoring, review and case closure. Few studies provided adequate implementation information. On the basis of the reviewed evidence, three issues were identified as key to the coherent and sustainable implementation of case management for people with long-term conditions: fidelity to the core elements of case management; size of caseload; and case-management practice, incorporating matters relating to the continuity of care, the intensity and breadth of involvement, and control over resources. It is recommended that future evaluations of case-management interventions include a comprehensive process component or, at the very least, that interventions should be more fully described.
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Minkman MMN, Ligthart SA, Huijsman R. Integrated dementia care in The Netherlands: a multiple case study of case management programmes. HEALTH & SOCIAL CARE IN THE COMMUNITY 2009; 17:485-494. [PMID: 19694030 DOI: 10.1111/j.1365-2524.2009.00850.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The number of dementia patients is growing, and they require a variety of services, making integrated care essential for the ability to continue living in the community. Many healthcare systems in developed countries are exploring new approaches for delivering health and social care. The purpose of this study was to describe and analyse a new approach in extensive case management programmes concerned with long-term dementia care in The Netherlands. The focus is on the characteristics, and success and failure factors of these programmes.A multiple case study was conducted in eight regional dementia care provider networks in The Netherlands. Based on a literature study, a questionnaire was developed for the responsible managers and case managers of the eight case management programmes. During 16 semistructured face-to-face interviews with both respondent groups, a deeper insight into the dementia care programmes was provided. Project documentation for all the cases was studied. The eight programmes were developed independently to improve the quality and continuity of long-term dementia care. The programmes show overlap in terms of their vision, tasks of case managers, case management process and the participating partners in the local dementia care networks. Differences concern the targeted dementia patient groups as well as the background of the case managers and their position in the local dementia care provider network. Factors for success concern the expert knowledge of case managers, investment in a strong provider network and coherent conditions for effective inter-organizational cooperation to deliver integrated care. When explored, caregiver and patient satisfaction was high. Further research into the effects on client outcomes, service use and costs is recommended in order to further analyse the impact of this approach in long-term care. To facilitate implementation, with a focus on joint responsibilities of the involved care providers, policy recommendations are to develop incentives for collaborative financial contracts between insurers and providers.
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Sheaff R, Boaden R, Sargent P, Pickard S, Gravelle H, Parker S, Roland M. Impacts of case management for frail elderly people: a qualitative study. J Health Serv Res Policy 2009; 14:88-95. [PMID: 19299262 DOI: 10.1258/jhsrp.2008.007142] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the impacts of different forms of case management for people aged over 65 years at risk of unplanned hospital admission, in particular the impacts upon patients, carers and health service organization in English primary care; and, in these respects, compare the Evercare model with alternatives. METHODS Multiple qualitative case studies comparing case management in nine English Primary Care Trusts which piloted the Evercare model of case management and four sites which implemented alternative forms of case management between 2003 and 2005. Data were obtained from 231 interviews with patients, carers and other key informants, and from content analysis of documents and observation of meetings. RESULTS All the projects established functioning case management services, but none led to major service reorganization or savings elsewhere in the health care system. Many informants reported examples of admissions which case management had prevented, but overall hospital admissions did not significantly change, possibly due to increased case-finding. Patients and carers valued case management for improving access to health care, increasing psychosocial support and improving communication with health professionals. CONCLUSION Case management was highly valued by patients and their carers, but there were few major differences in outcomes between Evercare and other models.
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The cost of caring: Commentary on Corbin (2008). Int J Nurs Stud 2008; 45:805-6. [DOI: 10.1016/j.ijnurstu.2007.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 10/20/2007] [Indexed: 11/20/2022]
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