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Duevel JA, Baumgartner A, Grosser J, Kreimeier S, Elkenkamp S, Greiner W. A Case Management Approach in Stroke Care: A Mixed-Methods Acceptance Analysis From the Perspective of the Medical Profession. Prof Case Manag 2024; 29:158-170. [PMID: 38015804 DOI: 10.1097/ncm.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
PURPOSE OF STUDY In terms of continuous and coordinated health care, cross-sectoral care structures are crucial. However, the German health care system is characterized by fragmentation of medical services and responsibilities. This fragmentation leads to multiple interfaces frequently causing loss of information, effectiveness, and quality. The concept of case management has the potential to improve cooperation between sectors and health care providers. Hence, a case management intervention for patients with stroke was evaluated with an acceptance analysis on the physicians' willingness to cooperate with stroke managers and their assessment of the potential of case management for the health care of patients with stroke. PRIMARY PRACTICE SETTINGS Primary practice settings included physicians working in the hospital, rehabilitation, and outpatient sectors who had actual or potential contact with a stroke case manager within the project region of East Westphalia-Lippe. METHODOLOGY AND SAMPLE The analysis was conducted using a mixed-methods approach. Expert interviews were conducted in 2020. Afterward a questionnaire was developed, which was then distributed to physicians in 2021. Both the interviews and the questionnaire included questions on conceptual knowledge and concrete expectations prior of the project, on experiences during the project and on recommendations and physicians' assessment of future organization in health care to classify and describe the acceptance. RESULTS Nine interviews were conducted and 23 questionnaires were completed. Only slightly more than 50% of the physicians had prior knowledge of the case management approach. Overall, ambiguous results concerning the acceptance of case managers were revealed. Additional personal assistance for patients with stroke was seen as beneficial at the same time critical perspectives regarding further fragmentation of health care and overlapping of competences with existing professional groups or forms of health care were collected. General practitioners in particular were critical of the case management approach. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE From the physicians' point of view, at least two changes are necessary for the project approach to be integrated into standard care. First, the target group should be adapted according to the case management approach. Second, the delegation of tasks and responsibilities to case managers should be revised. The sectoral difference in the acceptance of case managers by physicians indicates that active cooperation and communication in everyday work has direct impact on the acceptance of a new occupational profession. Physician acceptance has a significant impact on the implementation of new treatment modalities and thus influences the overall quality of health care.
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Affiliation(s)
- Juliane Andrea Duevel
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Alina Baumgartner
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - John Grosser
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Simone Kreimeier
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Svenja Elkenkamp
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Wolfgang Greiner
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
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Berret R, Senn N, Maisonneuve H, Cohidon C. Case managers within general practices in 11 Western countries: repeat cross-sectional studies. Swiss Med Wkly 2024; 154:3425. [PMID: 38885527 DOI: 10.57187/s.3425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND In the context of an ageing population and increasing health needs, primary care reform is needed and several new models have emerged, including the introduction of case managers in general practitioner practices. AIM To describe the frequency of case managers in general practices in eleven Western countries between 2012 and 2019 and to investigate the characteristics of general practitioners and their practices associated with case manager frequency. METHODS A secondary analysis of the Commonwealth Fund International Health Policy Surveys of Primary Care Physicians, which were international cross-sectional studies conducted in 2012, 2015 and 2019. Random samples of general practitioners were selected in 11 Western countries (2012: n = 9776; 2015: n = 12,049; 2019: n = 13,200). The use of case managers in general practitioner practices was determined with the question "Does your practice use personnel, such as nurses or case managers, to monitor and manage care for patients with chronic conditions that need regular follow-up care?", with possible answers "Yes, within the practice", "Yes, outside the practice", "Yes, both within and outside the practice" or "No". Other variables characterising general practitioners and their practices were considered. Mixed-effects logistic regression was performed. RESULTS The frequency of case managers within general practitioner practices varied greatly by country, with an overall trend towards an increase from 2012 to 2019. In the multivariate analysis, more case managers were found in practices located in small towns (odds ratio [OR] 1.4; 95% confidence interval [CI] 1.2-1.7) and in rural areas (OR 1.9; 95% CI 1.5-2.4) compared to cities. The frequency of case managers was higher in larger practices, as shown in comparisons of practices in the second, third and fourth quartile of full-time equivalent employee counts compared to those in the first quartile (Q2: OR 1.7, 95% CI 1.4-1.9; Q3: OR 2.1, 95% CI 1.6-2.9; Q4: OR 3.8, 95% CI 3.0-4.9). There was no significant difference in frequency with respect to the age and sex of the general practitioners. CONCLUSION The use of case managers in general practitioner practices is a promising approach, but its practice varies greatly. This practice has been developing in Western countries and is tending to increase. The implementation of case managers seems to be associated with certain characteristics linked to general practitioner practices (practice location, practice size), whereas it does not seem to depend on the personal characteristics of general practitioners, such as age or sex.
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Affiliation(s)
- Romane Berret
- Center for Primary Care and Public Health (Unisanté), Department of Family medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- Center for Primary Care and Public Health (Unisanté), Department of Family medicine, University of Lausanne, Lausanne, Switzerland
| | - Hubert Maisonneuve
- University Institute of Family and Child Medicine (IuMFE), Geneva Faculty of medicine, Geneva, Switzerland
| | - Christine Cohidon
- Center for Primary Care and Public Health (Unisanté), Department of Family medicine, University of Lausanne, Lausanne, Switzerland
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Li C, Gong X, Wei Z, Gao L, Graham Y, Yang W. Novice Chinese Bariatric Nurses' Perceptions of Their Role as Bariatric Case Managers: A Qualitative Study. Obes Surg 2024; 34:1464-1470. [PMID: 38504064 DOI: 10.1007/s11695-024-07177-6] [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: 02/26/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Bariatric case managers (BCM) are integral healthcare team members for patients undergoing bariatric surgery in China. As the demand for bariatric surgery increases in China, the number of BCMs has also risen. However, more is needed to know about the perceptions of novice bariatric nurses toward their role as case managers. This study aims to investigate the perceptions of novice Chinese bariatric nurses toward their roles during the early stages of their careers. METHODS This qualitative study employed semi-structured individual interviews with 15 novice bariatric nurses who received training as BCMs. The interviews were audio-recorded, transcribed line-by-line, and analyzed thematically. The study was conducted in a bariatric surgery center of a public tertiary hospital in Southern China. RESULTS Three themes emerged from the data related to the perceptions of being a BCM: "negotiating the ambiguity of the BCM role," "establishing a core set of behaviors for the BCM role," and "identifying areas of competence to develop a BCM role framework." The novice bariatric nurses expressed both positive and negative feelings toward their role. They highlighted the need for further training to improve their qualifications and the importance of support from colleagues, and hospital management. CONCLUSIONS The findings illuminate the role of the BCM in China. Future research should investigate effective and acceptable job descriptions and cooperation modes between BCMs, colleagues and hospital management. We recommend using these findings to develop training programs for novice BCMs and improve their capacity to provide quality care to patients undergoing bariatric surgery.
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Affiliation(s)
- Chunqun Li
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong Province, China
| | - Xue Gong
- School of Medical Technology and Nursing, Shenzhen Polytechnic University, Xili Lake, Nanshan District, Shenzhen, Guangdong Province, China
| | - Zhuoqi Wei
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong Province, China
| | - Lilian Gao
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong Province, China
| | - Yitka Graham
- Helen McArdle Nursing and Care Research Institute, University of Sunderland, Sunderland, SR1 3SD, UK.
- Bariatric Surgical Unit, South Tyneside and Sunderland NHS Foundation Trust, Kayll Road, Sunderland, SR4 7TP, UK.
- Faculty of Psychology, University of Anahuac, Mexico City, Mexico.
- Department of Biomedical Sciences, University Hospital Austral, Buenos Aires, Argentina.
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong Province, China.
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McQueen A, Von Nordheim D, Thompson T, Manley K, Pool AJ, Kreuter MW. What Do Medicaid Members Want From Their Health Plan? Insights From a Qualitative Study to Improve Engagement in Case Management. Prof Case Manag 2024:01269241-990000000-00014. [PMID: 38421729 DOI: 10.1097/ncm.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF STUDY Managed care organizations (MCOs) provide case management services to address unmet health and social needs among their members. Few studies have examined factors influencing members' decision to participate in these programs. The purpose of the present study was to describe the life circumstances of Medicaid members offered case management, what they wanted from their MCO, and their perceptions of case management and barriers to participation. Results will inform practice to raise the awareness, engagement, and impact of case management programs. PRIMARY PRACTICE SETTINGS Case management offered through a Midwestern Medicaid MCO. METHODOLOGY AND SAMPLE Adult members who had been offered case management services in the 6 months preceding the study were eligible for the study. Fifteen people from each strata were recruited: members who engaged with case management, declined it, or declined it initially but later engaged (N = 45). Participants completed a qualitative interview by phone and a brief health survey online. RESULTS Across strata, only 22 participants recalled engagement with case management. Members described a variety of life challenges (e.g., chronic health conditions, caregiver responsibilities, and limited finances) and services they desired from their MCO (e.g., stipends for over-the-counter health expenses, improved transportation services, and caregiver assistance). Participants identified direct communication, emotional support, and referrals for resources as benefits of case management.
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Affiliation(s)
- Amy McQueen
- Amy McQueen, PhD, is Professor of Medicine and Co-Director of the Health Communication Research Lab. She primarily designs and tests behavioral interventions to prevent cancer and improve self-management of chronic conditions. She also has experience using mixed methods with diverse samples. She can be reached at
- David Von Nordheim, MA, is a data analyst in the Health Communication Research Lab. He contributes to projects investigating health and social needs in underserved populations. His focus is on applying the best statistical methods for analyzing survey and health claims data. He can be reached at
- Tess Thompson, PhD, is an Assistant Professor at the University of North Carolina-Chapel Hill. She studies health promotion, cancer prevention, and cancer survivorship. She can be reached at
- Kayla Manley, MA, is an Evaluation Coordinator at the Evaluation Center at Washington University in St. Louis. She has expertise in conducting qualitative interviews, coding, and analyzing qualitative data. She can be reached at
- Albert J. Pool, MPH, is a Research Project Coordinator in the Health Communication Research Lab. He assists in the management of research projects, especially data collection and data management. He can be reached at
- Matthew W. Kreuter, PhD, is an endowed professor and founded the Health Communication Research Lab. He is an international leader in designing and testing tailored communications and novel interventions to improve the health of low-income and minority populations. He can be reached at
| | - David Von Nordheim
- Amy McQueen, PhD, is Professor of Medicine and Co-Director of the Health Communication Research Lab. She primarily designs and tests behavioral interventions to prevent cancer and improve self-management of chronic conditions. She also has experience using mixed methods with diverse samples. She can be reached at
- David Von Nordheim, MA, is a data analyst in the Health Communication Research Lab. He contributes to projects investigating health and social needs in underserved populations. His focus is on applying the best statistical methods for analyzing survey and health claims data. He can be reached at
- Tess Thompson, PhD, is an Assistant Professor at the University of North Carolina-Chapel Hill. She studies health promotion, cancer prevention, and cancer survivorship. She can be reached at
- Kayla Manley, MA, is an Evaluation Coordinator at the Evaluation Center at Washington University in St. Louis. She has expertise in conducting qualitative interviews, coding, and analyzing qualitative data. She can be reached at
- Albert J. Pool, MPH, is a Research Project Coordinator in the Health Communication Research Lab. He assists in the management of research projects, especially data collection and data management. He can be reached at
- Matthew W. Kreuter, PhD, is an endowed professor and founded the Health Communication Research Lab. He is an international leader in designing and testing tailored communications and novel interventions to improve the health of low-income and minority populations. He can be reached at
| | - Tess Thompson
- Amy McQueen, PhD, is Professor of Medicine and Co-Director of the Health Communication Research Lab. She primarily designs and tests behavioral interventions to prevent cancer and improve self-management of chronic conditions. She also has experience using mixed methods with diverse samples. She can be reached at
- David Von Nordheim, MA, is a data analyst in the Health Communication Research Lab. He contributes to projects investigating health and social needs in underserved populations. His focus is on applying the best statistical methods for analyzing survey and health claims data. He can be reached at
- Tess Thompson, PhD, is an Assistant Professor at the University of North Carolina-Chapel Hill. She studies health promotion, cancer prevention, and cancer survivorship. She can be reached at
- Kayla Manley, MA, is an Evaluation Coordinator at the Evaluation Center at Washington University in St. Louis. She has expertise in conducting qualitative interviews, coding, and analyzing qualitative data. She can be reached at
- Albert J. Pool, MPH, is a Research Project Coordinator in the Health Communication Research Lab. He assists in the management of research projects, especially data collection and data management. He can be reached at
- Matthew W. Kreuter, PhD, is an endowed professor and founded the Health Communication Research Lab. He is an international leader in designing and testing tailored communications and novel interventions to improve the health of low-income and minority populations. He can be reached at
| | - Kayla Manley
- Amy McQueen, PhD, is Professor of Medicine and Co-Director of the Health Communication Research Lab. She primarily designs and tests behavioral interventions to prevent cancer and improve self-management of chronic conditions. She also has experience using mixed methods with diverse samples. She can be reached at
- David Von Nordheim, MA, is a data analyst in the Health Communication Research Lab. He contributes to projects investigating health and social needs in underserved populations. His focus is on applying the best statistical methods for analyzing survey and health claims data. He can be reached at
- Tess Thompson, PhD, is an Assistant Professor at the University of North Carolina-Chapel Hill. She studies health promotion, cancer prevention, and cancer survivorship. She can be reached at
- Kayla Manley, MA, is an Evaluation Coordinator at the Evaluation Center at Washington University in St. Louis. She has expertise in conducting qualitative interviews, coding, and analyzing qualitative data. She can be reached at
- Albert J. Pool, MPH, is a Research Project Coordinator in the Health Communication Research Lab. He assists in the management of research projects, especially data collection and data management. He can be reached at
- Matthew W. Kreuter, PhD, is an endowed professor and founded the Health Communication Research Lab. He is an international leader in designing and testing tailored communications and novel interventions to improve the health of low-income and minority populations. He can be reached at
| | - Albert J Pool
- Amy McQueen, PhD, is Professor of Medicine and Co-Director of the Health Communication Research Lab. She primarily designs and tests behavioral interventions to prevent cancer and improve self-management of chronic conditions. She also has experience using mixed methods with diverse samples. She can be reached at
- David Von Nordheim, MA, is a data analyst in the Health Communication Research Lab. He contributes to projects investigating health and social needs in underserved populations. His focus is on applying the best statistical methods for analyzing survey and health claims data. He can be reached at
- Tess Thompson, PhD, is an Assistant Professor at the University of North Carolina-Chapel Hill. She studies health promotion, cancer prevention, and cancer survivorship. She can be reached at
- Kayla Manley, MA, is an Evaluation Coordinator at the Evaluation Center at Washington University in St. Louis. She has expertise in conducting qualitative interviews, coding, and analyzing qualitative data. She can be reached at
- Albert J. Pool, MPH, is a Research Project Coordinator in the Health Communication Research Lab. He assists in the management of research projects, especially data collection and data management. He can be reached at
- Matthew W. Kreuter, PhD, is an endowed professor and founded the Health Communication Research Lab. He is an international leader in designing and testing tailored communications and novel interventions to improve the health of low-income and minority populations. He can be reached at
| | - Matthew W Kreuter
- Amy McQueen, PhD, is Professor of Medicine and Co-Director of the Health Communication Research Lab. She primarily designs and tests behavioral interventions to prevent cancer and improve self-management of chronic conditions. She also has experience using mixed methods with diverse samples. She can be reached at
- David Von Nordheim, MA, is a data analyst in the Health Communication Research Lab. He contributes to projects investigating health and social needs in underserved populations. His focus is on applying the best statistical methods for analyzing survey and health claims data. He can be reached at
- Tess Thompson, PhD, is an Assistant Professor at the University of North Carolina-Chapel Hill. She studies health promotion, cancer prevention, and cancer survivorship. She can be reached at
- Kayla Manley, MA, is an Evaluation Coordinator at the Evaluation Center at Washington University in St. Louis. She has expertise in conducting qualitative interviews, coding, and analyzing qualitative data. She can be reached at
- Albert J. Pool, MPH, is a Research Project Coordinator in the Health Communication Research Lab. He assists in the management of research projects, especially data collection and data management. He can be reached at
- Matthew W. Kreuter, PhD, is an endowed professor and founded the Health Communication Research Lab. He is an international leader in designing and testing tailored communications and novel interventions to improve the health of low-income and minority populations. He can be reached at
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Hudon C, Bisson M, Chouinard MC, Delahunty-Pike A, Lambert M, Howse D, Schwarz C, Dumont-Samson O, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Luke A, Macdonald M, Gaudreau A, Porter J, Rubenstein D, Scott C, Warren M, Wilhelm L. Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada. BMC Health Serv Res 2023; 23:377. [PMID: 37076851 PMCID: PMC10116737 DOI: 10.1186/s12913-023-09379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 04/08/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Case management is one of the most frequently performed interventions to mitigate the negative effects of high healthcare use on patients, primary care providers and the healthcare system. Reviews have addressed factors influencing case management interventions (CMI) implementation and reported common themes related to the case manager role and activities, collaboration with other primary care providers, CMI training and relationships with the patients. However, the heterogeneity of the settings in which CMI have been implemented may impair the transferability of the findings. Moreover, the underlying factors influencing the first steps of CMI implementation need to be further assessed. This study aimed to evaluate facilitators and barriers of the first implementation steps of a CMI by primary care nurses for people with complex care needs who frequently use healthcare services. METHODS A qualitative multiple case study was conducted including six primary care clinics across four provinces in Canada. In-depth interviews and focus groups with nurse case managers, health services managers, and other primary care providers were conducted. Field notes also formed part of the data. A mixed thematic analysis, deductive and inductive, was carried out. RESULTS Leadership of the primary care providers and managers facilitated the first steps of the of CMI implementation, as did the experience and skills of the nurse case managers and capacity development within the teams. The time required to establish CMI was a barrier at the beginning of the CMI implementation. Most nurse case managers expressed apprehension about developing an "individualized services plan" with multiple health professionals and the patient. Clinic team meetings and a nurse case managers community of practice created opportunities to address primary care providers' concerns. Participants generally perceived the CMI as a comprehensive, adaptable, and organized approach to care, providing more resources and support for patients and better coordination in primary care. CONCLUSION Results of this study will be useful for decision makers, care providers, patients and researchers who are considering the implementation of CMI in primary care. Providing knowledge about first steps of CMI implementation will also help inform policies and best practices.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
- Centre Hospitalier Universitaire de Sherbrooke Research Centre, Sherbrooke, QC, Canada.
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | | | | | - Mireille Lambert
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Memorial University, St-John's, NL, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Olivier Dumont-Samson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John's, NL, Canada
| | - Fred Burge
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Marilyn Macdonald
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Judy Porter
- Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Cathy Scott
- Canadian Cancer Society, Toronto, ON, Canada
| | - Mike Warren
- Patient Advisory Council, Newfoundland and Labrador SPOR SUPPORT Unit, St. John's, NL, Canada
| | - Linda Wilhelm
- Canadian Arthritis Patient Alliance, Ottawa, ON, Canada
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Hudon C, Chouinard MC, Dumont-Samson O, Gobeil-Lavoie AP, Morneau J, Paradis M, Couturier Y, Poitras ME, Poder T, Sabourin V, Lambert M. Integrated case management between primary care clinics and hospitals for people with complex needs who frequently use healthcare services: A multiple-case embedded study. Health Policy 2023; 132:104804. [PMID: 37028261 DOI: 10.1016/j.healthpol.2023.104804] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Case management (CM) is recognized to improve care integration and outcomes of people with complex needs who frequently use healthcare services, but challenges remain regarding interaction between primary care clinics and hospitals. This study aimed to implement and evaluate an integrated CM program for this population where nurses in primary care clinics worked with a hospital case manager. METHODS A multiple embedded case study was conducted in the Saguenay-Lac-Saint-Jean region (Québec, Canada), in four dyads including a clinic and a hospital. Mixed data collection included, at baseline and 6 months, interviews and focus groups with stakeholders, patient questionnaires (patient experience of integrated care and self-management), and emergency department (ED) visits in the previous 6 months. RESULTS Integrated CM implementation was optimal when all stakeholders provided collective leadership, and were supportive of the program, particularly the physicians. The 6-month program enabled the observation of positive qualitative outcomes in most clinic-hospital dyads where implementation occurred. Full implementation was associated with improved care integration. DISCUSSION AND CONCLUSION Integrated CM between primary care clinics and hospitals is a promising innovation to improve care integration for people with complex needs who frequently use healthcare services. Collective leadership and physicians' buy-in to integrated CM are important to foster the implementation.
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Nadolny S, Bruland D, Grunwald M, Gröndahl A, Grammatico J, Richter MT, Grebe C, Latteck ÄD. Case management and care expertise as a prevention approach for adults with intellectual disabilities (FaPP-MgB): study protocol for a randomized-controlled trial. Trials 2023; 24:136. [PMID: 36814350 PMCID: PMC9946867 DOI: 10.1186/s13063-023-07155-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Adults with intellectual disabilities have a higher prevalence of unhealthy eating habits, stress, low levels of mobility, and comparable drug consumption as the general population. Consequently, they suffer from several chronic diseases earlier and more often, but there are fewer prevention and health promotion services including this population. The goal of this study is to determine if an advanced practice nursing approach in the community with home visits is an effective way to improve the health status of adults with intellectual disabilities. METHODS We will conduct a randomized-controlled trial with waiting list design in Hamburg, Germany. Inclusion criteria are diagnosis ICD F70-F79 and exclusion criteria are care level > 3 according to the German Social Code XI or being at the end-of-life. Participants will be block randomized. The intervention consists of advanced practice nurses performing case management, social space analysis, prevention planning, and counseling through four outreach home visits on nutrition, mobility, addiction, and stress. Comparison is usual care. The primary outcome is health status (WHODAS) after 12 months. Secondary outcomes are health-related quality of life (EQ-5D) and resilience (RS-11) after 6 and 12 months. The calculated sample size is 256 with an estimated dropout of 30%. Raters and analysts will be blinded. Analysis will be performed using ANCOVAs. DISCUSSION By providing case management and utilizing their nursing expertise, advanced practice nurses will provide valuable input and guidance on prevention and health promotion for people with intellectual disabilities. They will close the gap between health and social care, which is prominent in Germany, through cooperation between the existing care sectors. The findings will be disseminated in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION German Clinical Trials Register, DRKS00028771 , registered 4 July 2022, Universal Trial Number: U1111-1277-0595.
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Affiliation(s)
- Stephan Nadolny
- Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619, Bielefeld, Germany. .,Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany.
| | - Dirk Bruland
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Marie Grunwald
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany ,grid.434095.f0000 0001 1864 9826Institute for Management and Technology, Osnabrück University of Applied Sciences, Kaiserstraße 10C, 49809 Lingen, Germany
| | - Annika Gröndahl
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Jessica Grammatico
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Miriam Tariba Richter
- grid.11500.350000 0000 8919 8412Competence Center for Health, Hamburg University of Applied Sciences, Alexanderstraße 1, 20099 Hamburg, Germany
| | - Christian Grebe
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Änne-Dörte Latteck
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
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Pastor-López Á, Ventura-Puertos PE, Hernández-Ascanio J, Cantón-Habas V, Martínez-Angulo P, Rich-Ruiz M. Emotional Universe of Nurse Case Managers Regarding Care for Elderly at Risk in Spain: A Hermeneutical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16445. [PMID: 36554326 PMCID: PMC9778613 DOI: 10.3390/ijerph192416445] [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: 11/08/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
The role of nurse case managers (NCM) involves a rarely visible emotional labor, even more when their role focuses on the care of elders at risk (EAR). Motivated by the lack of qualitative research on the emotional universe of NCM, this study explores the emotional universe (EU) of NCM regarding the care they provide to EAR in primary health care as well as the reasons that generate these emotions. An interpretative-phenomenological approach was implemented in southern Spain, with a purposive sampling that included nurses playing the NCM role for at least three years. Data collection was conducted in two periods (between September 2019 and July 2022). The primary collection tool was the semi-structured individual interview, with starting categories based on Bisquerra's EU taxonomy. The analysis followed Ricoeur's considerations, using the Nvivo software. In the NCM's EU, the recognition of the social phenomena stands out, with an open feeling of empathy regarding the desire of the EAR to continue living at home. However, there was also helplessness, resignation, disappointment, and frustration when EAR rejected their proposals. Furthermore, the system's limitations aroused compassion in the NCM and made them go beyond the limits of their role. This EU requires that their role be valued more, and higher responsiveness must be enforced to improve EAR care.
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Affiliation(s)
- Ángeles Pastor-López
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), 14004 Córdoba, Spain
- Distrito Sanitario Córdoba-Guadalquivir, Servicio Andaluz de Salud (SAS), 14011 Córdoba, Spain
| | - Pedro E. Ventura-Puertos
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), 14004 Córdoba, Spain
- Interdisciplinary Research Group in Discourse Analysis (HUM380), Universidad de Córdoba (UCO), 14071 Córdoba, Spain
| | - José Hernández-Ascanio
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), 14004 Córdoba, Spain
| | - Vanesa Cantón-Habas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), 14004 Córdoba, Spain
| | - Pablo Martínez-Angulo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), 14004 Córdoba, Spain
- Interdisciplinary Research Group in Discourse Analysis (HUM380), Universidad de Córdoba (UCO), 14071 Córdoba, Spain
| | - Manuel Rich-Ruiz
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), 14004 Córdoba, Spain
- Ciber Fragility and Healthy Aging (CIBERFES), 28029 Madrid, Spain
- Nursing and Healthcare Research Unit (Investén-isciii), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Cohidon C, Gallay E, Wild P, Stiefel F, Bourquin C, Senn N. Identifying complex patients in family medicine for potential benefit from a case manager: a short questionnaire derived from the INTERMED Self-Assessment (IMSA) questionnaire. BMC PRIMARY CARE 2022; 23:276. [PMID: 36333794 PMCID: PMC9636696 DOI: 10.1186/s12875-022-01876-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
Purpose To investigate how useful the Intermed-Self Assessment (IMSA) questionnaire and its components were for identifying which patient candidates would benefit most from case management (CM) in general practice. Methods The study was carried out in a group family medicine practice in Lausanne comprising seven GPs and four medical assistants, from February to April 2019. All the patients attending the practice between February and April 2019 were invited to complete the IMSA questionnaire. Additionally, their GPs were asked for their opinions on the potential benefits of each patient being assigned a case manager. Each IMSA item’s value has been assessed as a predictor of GPs’ opinions by using multivariate logistic models. A score including items retained as predictor was built. Results Three hundred and thirty one patients participated in the study (participation rate: 62%). Three items from the 20 item IMSA were sufficient to predict GPs’ opinions about whether their patients could be expected to benefit if assigned a case manager. Those items addressed the patient’s existing chronic diseases (item1), quality of life in relation to existing diseases (item 3), and their social situation (item 9). Using these three items as a score, a cut-off at 4 gave a sensitivity of 70% (ability to correctly identify patients who could benefit from a CM) and specificity of 73% (ability to correctly identify patients who should not benefit from a CM) and concerned about one patient in two. Conclusion Identifying complex patients suitable for case management remains a challenge for primary care professionals. This paper describes a novel approach using a structured process of combining the results of standardized tools such as the one defined in this study, and the experience of the primary care team. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01876-8.
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Affiliation(s)
- Christine Cohidon
- grid.9851.50000 0001 2165 4204Department of Family Medicine, Center for Primary Care and General Medicine (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Emilie Gallay
- grid.9851.50000 0001 2165 4204Department of Family Medicine, Center for Primary Care and General Medicine (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Friedrich Stiefel
- grid.8515.90000 0001 0423 4662Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Céline Bourquin
- grid.8515.90000 0001 0423 4662Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Nicolas Senn
- grid.9851.50000 0001 2165 4204Department of Family Medicine, Center for Primary Care and General Medicine (Unisanté), University of Lausanne, Lausanne, Switzerland
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10
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Li A, Gao J, Ni J, Che Y, Zhang Q, Hu Q, Pan J, Ge Y, Cao Z, Ni J. Influence of Case Management Model Combined with Continuous Nursing Care on Compliance Behavior and Adverse Emotions in Elderly Patients with Lung Cancer: A Prospective Single-Center Case-Control Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2601852. [PMID: 36060666 PMCID: PMC9433228 DOI: 10.1155/2022/2601852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/10/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
Aims To ask lots of questions about finding the truth about the influence of the case management model combined with continuous nursing care on following the law behavior and negative feelings of love, hate, fear, etc. in old patients with lung scale-like cell cancer. Materials and Methods One hundred and forty-three elderly patients with squamous cell carcinoma of the lung were selected for this prospective study, 10 cases were shed due to epidemic and transfer, and finally 68 cases were in the control group and 65 cases in the observation group. The differences in anxiety and depression scores, quality of life, and compliance behavior between the two groups were observed and compared. Results After nursing, the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) of the observation group were lower than those of the control group, while the social support score was significantly higher than that of the control group. The scores of psychological behavior, exercise status, drug taking, and balanced diet of the two groups were significantly improved, and the observation group was significantly improved. The scores of medical compliance behavior in the observation group were significantly higher than those in the control group, and the mental vitality score, social interaction score, emotional restriction score, and mental status of the patients in the observation group were significantly higher than those in the control group, and the above statistics showed that the difference was statistically significant (P < 0.05). Conclusion The use of a case management model combined with extended care significantly improved the compliance behavior and anxiety and depression of elderly patients with squamous cell carcinoma of the lung and improved the quality of life and social support.
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Affiliation(s)
- Aomei Li
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Jie Gao
- Department of Cadre Ward, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Juan Ni
- Department of Nursing, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Yuxin Che
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Qing Zhang
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Qian Hu
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Jie Pan
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - YuXin Ge
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Zhenzhu Cao
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Juan Ni
- Department of Respiratory and Critical Care Medicine, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
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11
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Bodenheimer TS, Willard-Grace R. Care Management For Patients With Type 2 Diabetes: The Roles Of Nurses, Pharmacists, And Social Workers. HEALTH AFFAIRS (PROJECT HOPE) 2022; 41:947-954. [PMID: 35759701 DOI: 10.1377/hlthaff.2022.00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Managing patients with type 2 diabetes takes time. Clinicians in primary care, where most diabetes visits take place, lack that time. Planned visits by diabetes care managers-nurses, pharmacists, social workers, and other team members-assist clinicians and are associated with improved glycemic control. Particularly effective is care management featuring nurses or pharmacists adjusting medications without prior physician approval. Care management programs need to pay close attention to inequities in diabetes care and outcomes. The widespread implementation of diabetes care management in primary care faces several barriers: lack of an adequate, diverse, trained care manager workforce; regulations limiting care managers' scope of practice; and financial models not supportive of care management. Wide-ranging policies are needed to address these barriers. In particular, payment reform is needed to stimulate the spread of diabetes care management: adding fee-for-service codes that adequately pay care managers for their work, adopting shared savings models that channel savings back to primary care, and increasing the percentage of health care spending dedicated to primary care. In this article we explore key questions around type 2 diabetes care management, review the published evidence, examine the barriers to its wider use, and describe policy solutions.
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Affiliation(s)
- Thomas S Bodenheimer
- Thomas S. Bodenheimer , University of California San Francisco, San Francisco, California
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12
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Hudon C, Chouinard MC, Bisson M, Brousselle A, Lambert M, Danish A, Rodriguez C, Sabourin V. Case Management Programs for Improving Integrated Care for Frequent Users of Healthcare Services: An Implementation Analysis. Int J Integr Care 2022; 22:11. [PMID: 35221827 PMCID: PMC8833259 DOI: 10.5334/ijic.5652] [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: 11/24/2020] [Accepted: 01/28/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Case management programs (CMP) for frequent users of healthcare services presenting complex healthcare needs constitute an effective strategy to improve patient experience of integrated care and to decrease healthcare overuse and cost. This study sought to identify characteristics of these programs, and their implementation contexts, that help to improve patient self-management, experience of integrated care, and healthcare services use. METHODS A mixed methods multiple embedded case study design was conducted, with six CMP implemented in six hospitals of a region of Quebec (Canada). RESULTS Within-case analysis describes the structural, environmental, organizational, practitioner, patient, and innovation level characteristics of each CMP and their services integration outcomes based on patient experience, self-management and healthcare services use. Cross-case analysis suggests that the skills, leadership and experience of the case manager, providers' access to the individualized services plan, consideration of the needs of the patient and family members, their participation in decision-making, and the self-management approach, impact integrated care and healthcare services use. CONCLUSION AND DISCUSSION This study underscores the necessity of an experienced, knowledgeable and well-trained case manager with interpersonal skills to optimize CMP implementation such that patients are more proactive in their care and their outcomes improve.
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Affiliation(s)
- Catherine Hudon
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada
- Centre de recherche du CHUS, 12e Avenue Nord Porte 6, Sherbrooke, QC, Canada
| | - Maud-Christine Chouinard
- Faculté des sciences infirmières, Université de Montréal, Pavillon Marguerite-d’Youville, 2375 Chemin de la Côte-Sainte-Catherine, Montreal, QC, Canada
| | - Mathieu Bisson
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, Public Administration, HSD building, Room A302, Victoria, BC, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et services sociaux du Saguenay–Lac-Saint-Jean, 930 rue Jacques-Cartier E, Chicoutimi, QC, Canada
| | - Alya Danish
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada
| | - Charo Rodriguez
- Department of Family Medicine, McGill University, 5858, Chemin de la Côte-des-Neiges, Montreal, QC, Canada
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Davis KM, Eckert MC, Hutchinson A, Harmon J, Sharplin G, Shakib S, Caughey GE. Effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface: A quantitative systematic review. Int J Nurs Stud 2021; 121:103986. [PMID: 34242979 DOI: 10.1016/j.ijnurstu.2021.103986] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Globally, chronic disease is a leading cause of illness, disability and death and an important driver of health system utilization and spending. Continuity of care is a significant component of quality healthcare. However, an association between nurse-led services, interventions, patient outcomes and continuity of care at the primary and secondary interface as an outcome, has not been established for people with chronic disease. OBJECTIVE To identify the effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface. DESIGN Quantitative systematic review. DATA SOURCES Systematic searches of Medline, Cochrane, Embase, Emcare, JBI and Scopus databases were conducted of studies published between 1946 and May 2019 using the search terms "nurse", "continuity of care" and "chronic disease". REVIEW METHODS Quality of the included studies was assessed using the Cochrane risk of bias tool for randomized controlled trials and Joanna Briggs Institute quality appraisal checklists. A second reviewer screened 10% of full text articles and all articles in critical appraisal. Studies were excluded from the review if they were of poor methodological quality or the description of the effect of the nurse-led service was inadequately reported. RESULTS Fourteen studies were included in the review (n=4,090 participants). All studies incorporated recognized continuity of care interventions. The nurse-led services were associated with fewer hospitalizations, reduced by 2-8.9% and re-admissions reduced by 14.8-51% (n=886). Reporting of positive patient experiences and improvement in symptoms and lifestyle was also evident. An association of nurse-led services with improved continuity of care between primary and secondary health services as an outcome per se could not be concluded. CONCLUSION Nurse-led services for adults provide coordinated interventions that support continuity of care for people with chronic disease in both the primary and secondary healthcare settings that are associated with reduced hospitalizations or readmissions and patient satisfaction. However, the limited use of validated continuity of care outcome measurement tools precluded establishing correlations between interventions, patient outcomes and continuity of care as a specific outcome.
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Affiliation(s)
- K M Davis
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia.
| | - M C Eckert
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/@DrJoanneHarmon
| | - A Hutchinson
- UniSA, Clinical and Health Sciences, University of South Australia
| | - J Harmon
- UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/marioneckert5
| | - G Sharplin
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia
| | - S Shakib
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - G E Caughey
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
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Gabrielian S, Jones AL, Hoge AE, deRussy AJ, Kim YI, Montgomery AE, Blosnich JR, Gordon AJ, Gelberg L, Austin EL, Pollio D, Holmes SK, Varley AL, Kertesz SG. Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey. J Prim Care Community Health 2021; 12:2150132721993654. [PMID: 33543675 PMCID: PMC7871055 DOI: 10.1177/2150132721993654] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives: Patients experiencing homelessness (PEH) with serious mental illness (SMI) have poor satisfaction with primary care. We assessed if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs)) provide this population with superior experiences than mainstream primary care and explored whether integrated behavioral health and social services were associated with favorable experiences. Methods: We surveyed VA PEH with SMI (n = 1095) to capture the valence of their primary care experiences in 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs). We surveyed clinicians (n = 52) from 29 H-PACTs to elucidate if their clinics had embedded mental health, addiction, social work, and/or housing services. We counted these services in each H-PACT (0-4) and classified H-PACTs as having high (3-4) versus low (0-2) service integration. We controlled for demographics, housing history, and needs in comparing H-PACT versus mainstream experiences; and experiences in high versus low integration H-PACTs. Results: Among respondents, 969 (91%) had complete data and 626 (62%) were in H-PACTs. After covariate adjustment, compared to mainstream respondents, H-PACT respondents were more likely (P < .01) to report favorable experiences (AORs = 1.7-2.1) and less likely to report unfavorable experiences (AORs = 0.5-0.6) in all 4 domains. Of 29 H-PACTs, 27.6% had high integration. High integration H-PACT respondents were twice as likely as low integration H-PACT respondents to report favorable access/coordination experiences (AOR = 1.7). Conclusions: Homeless-tailored clinics with highly-integrated services were associated with better care experiences among PEH with SMI. These observational data suggest that tailored primary care with integrated services may improve care perceptions among complex patients.
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Affiliation(s)
- Sonya Gabrielian
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
| | - Audrey L Jones
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - April E Hoge
- Birmingham VA Medical Center, Birmingham, AL, USA
| | | | - Young-Il Kim
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - John R Blosnich
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,University of Southern California, Los Angeles, CA, USA
| | - Adam J Gordon
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lillian Gelberg
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
| | - Erika L Austin
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - David Pollio
- University of Alabama at Birmingham College of Letters and Sciences, Birmingham, AL, USA
| | | | | | - Stefan G Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Béland S, Dumont-Samson O, Hudon C. Case Management and Telehealth: A Scoping Review. Telemed J E Health 2021; 28:11-23. [PMID: 33847524 DOI: 10.1089/tmj.2021.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Case management (CM) is an intervention adapted to the needs of patients with chronic conditions or complex needs. Factors associated with effectiveness of CM, such as high intervention intensity, can represent challenges to its implementation. Telehealth has the potential to help overcome these challenges, but little work has been done to synthesize available evidence on telehealth CM. The purpose of this scoping review was thus to fill this gap and document which telehealth modalities have been used, summarize perspectives of key users, and discuss evidence on effectiveness of telehealth-delivered CM. Methods: A search in MEDLINE, Scopus, and CINAHL for articles published between January 2005 and January 2021 was done. Studies in which telehealth was used for patient-case manager interaction and conducted in a population with complex health needs and/or chronic conditions were included. Articles selected for full-text review were independently screened by two reviewers. Data extraction was conducted once and validated by a second reviewer. Results: Of 3,108 articles, 22 were retained for data extraction. A narrative synthesis was conducted. Most studies evaluated CM interventions delivered over telephone, yet, literature suggests that face-to-face contact is essential to CM success. Results also indicate that telehealth CM is acceptable and effective, associated with better utilization of health services and favorable clinical outcomes. Conclusions: Lack of research evaluating telehealth CM delivered using modalities other than telephone. Further research should evaluate CM interventions that integrate platforms enabling visual information exchange.
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Affiliation(s)
- Sophie Béland
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Olivier Dumont-Samson
- Centre Intégré Universitaire de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Catherine Hudon
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Canada
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