Case Managers and Physicians: Communication and Perceived Problems

Feltes, Michael; Wetle, Terrie; Clemens, Elizabeth; Crabtree, Benjamin F.; Dubitzky, Deborah; Kerr, Myra

doi:10.1111/j.1532-5415.1994.tb06065.x

Cited by 12 publications

(9 citation statements)

References 17 publications

(26 reference statements)

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“…38,52 Even with clear policy, primary care teams are constrained by a lack of resources or limited budgets. 51,53 Unstable policy and limited resources make it difficult for health care professionals to facilitate care plans and interventions 38 and, by extension, to meet the differing expectations of patients, families, organizations, and governments. 50…”

Section: Policy and Available Resourcesmentioning

confidence: 99%

Understanding Barriers to and Facilitators of Case Management in Primary Care: A Systematic Review and Thematic Synthesis

et al. 2020

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PURPOSE Despite evidence on the benefits of case management for the care of patients with complex needs in primary care, implementing the program-necessary to achieve its benefits-has been challenging worldwide. Evidence on factors affecting implementation remains disparate. Accordingly, the objective of this systematic review was to identify barriers to and facilitators of case management, from the perspectives of health care professionals, in primary care settings around the world. METHODSWe conducted a systematic review and thematic synthesis of qualitative findings. In collaboration with 2 librarians, we searched 3 electronic databases (MEDLINE, CINAHL, EMBASE) for studies related to factors affecting case management function in primary care. Two researchers screened titles, abstracts, and full texts for inclusion, then assessed included studies for quality. Results from included studies were synthesized by thematic synthesis, and a framework was developed. RESULTSOf 1,640 unique records identified, 22 studies, originating from 6 countries, met the inclusion criteria. We identified 9 barriers and facilitators: family context; policy and available resources; physician buy-in and understanding of the case manager role; relationship building; team communication practices; autonomy of case managers; training in technology; relationships with patients; and time pressure and workload. We describe these factors, then present a framework demonstrating the relationships among them.CONCLUSIONS Our study's findings show that multiple factors influence case management implementation. These findings have implications for researchers, clinicians, and policy makers who strive to implement or reform case management programs in local or larger primary care settings.

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Section: Policy and Available Resourcesmentioning

confidence: 99%

Understanding Barriers to and Facilitators of Case Management in Primary Care: A Systematic Review and Thematic Synthesis

et al. 2020

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“…Th is lack of knowledge about case managers' functions and the feeling of being left out of discussions and decisions are two of the reasons for physicians' reservations about case managers. [7][8][9] Because physicians' participation before implementation was limited, their lack of knowledge is unsurprising. According to the implementation analysis, two factors contributed to physicians' absence from the discussions: their fi nancial compensation structure and very limited availability.…”

Section: Discussionmentioning

confidence: 99%

“…6 A few North American studies showed that family physicians were reluctant to introduce a new professional (ie, case manager) who could interfere in patient-doctor relationships. [7][8][9][10] Th e main objective of our study was to document the early perceptions of family physicians regarding ISD networks and case management before and after introduction and to identify obstacles to using case managers.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Integrated service delivery

Daniel

Ward

2006

Business Process Management Journal

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OBJECTIVE To document the early perceptions of family physicians regarding integrated service delivery (ISD) networks a few weeks before and 6 months after establishing these networks and to identify obstacles to using case managers. DESIGN Cross-sectional survey with two questionnaires mailed 6 months apart. SETTING Three regional municipalities (one urban and two rural) in the Eastern Townships of Quebec. PARTICIPANTS All family physicians in the three areas (n = 267). A total of 124 physicians (of 206 eligible; 60% response rate) answered the fi rst questionnaire, and 104 of these the second (86% response rate). MAIN OUTCOME MEASURES The fi rst questionnaire asked what family physicians thought about ISD networks and the emerging case management function, and whether they were interested in participating in ISD networks. The second measured physicians' participation in ISD networks, asked whether their perceptions of case management had changed, and identifi ed obstacles to using case managers. RESULTS Nearly all (98%) respondents to the preimplementation questionnaire believed that family physicians will increasingly have to belong to ISD networks. Very few (8.2%), however, felt involved or consulted in decisions about developing and implementing these networks. More than one quarter (27%) did not know that an ISD network for older people would be established in their area, and 84.3% did not feel suffi ciently informed to be involved. Most family physicians (85.7%) said they were interested in using case managers. Six months after implementation, 70.2% of physicians knew that case managers were available; 35.6% had used a case manager. During implementation, physicians' opinions about case management were slightly less positive than they had been. The three main obstacles to using case managers were forgetting to use them (69.1%), the habit of using social workers instead (63.6%), and not knowing how to contact them (59.4%). CONCLUSION Physicians are interested in participating in ISD networks and working with case managers. They must be better informed, however, about the availability of case managers, how they can reach case managers, case managers' precise role, and the advantages to themselves and their patients of using these services.

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“…2 However, home care case managers often deal with fragmentary information and lack a forum for regular review and communication with the primary care physician. 3,4 For the frail elderly population, there are conflicting results on the value of models of comprehensive follow-up in the community. In Italy, Bernabei and others 5,6 randomized seniors already receiving home care to an integrated case management system.…”

Section: Introductionmentioning

confidence: 99%

South Winnipeg Integrated Geriatric Program (SWING): A Rapid Community-Response Program for the Frail Elderly

Montgomery

Fallis

2003

Can. J. Aging

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The objective of this study was to compare enhanced access to geriatric assessment and case management to usual home care service provision for the frail elderly. This was a demonstration project, with randomized allocation to control or intervention groups of frail elderly persons who had been referred to the Home Care service in Winnipeg. Of the 164 persons who were randomized, 78 intervention and 74 control patients were evaluated. Intervention subjects received a multidimensional assessment as soon as possible by a specially trained coordinator, who had enhanced access to geriatric medical and day-hospital services; intervention patients were case managed for a 3-month period. Control cases received usual care from home care coordinators. The intervention group received significantly faster assessment and deployment of home services, as well as greater utilization of the geriatric day-hospital services. Utilization of emergency room and hospital services was similar for both groups. Control subjects experienced more prolonged hospital stays and a significantly higher proportion (23%) were designated for long-term care than of intervention clients (9%). We conclude that the SWING program, which facilitated access to geriatric services and case management, reduced or delayed the need for long-term care.

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Case Managers and Physicians: Communication and Perceived Problems

Abstract: From the perspective of case managers, gaps in interprofessional communication may hinder the optimal care of frail elderly individuals.

Cited by 12 publications

References 17 publications

Understanding Barriers to and Facilitators of Case Management in Primary Care: A Systematic Review and Thematic Synthesis

Understanding Barriers to and Facilitators of Case Management in Primary Care: A Systematic Review and Thematic Synthesis

Integrated service delivery

South Winnipeg Integrated Geriatric Program (SWING): A Rapid Community-Response Program for the Frail Elderly

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