Patients’ and carers’ experiences of a multidisciplinary team-led community case management programme
A system for optimising disease management and offering care planning and care coordination is beneficial for an increasingly elderly population with complex care needs. Case management is one model for providing this. Case management is often delivered by an individual designated case manager, however its implementation by a multidisciplinary team with heavy involvement from GPs has recently been incentivised by the introduction of the Avoiding Unplanned Admissions Enhanced Service to the NHS GP contract in 2014.
This qualitative study aimed to explore the experiences of patients and their carers on the care they have received whilst enrolled on the Northumberland High Risk Patient Programme (NHRPP), a multidisciplinary team-led community case management programme.
Patients enrolled on the NHRPP were purposively sampled on the basis of age, gender, whether they lived alone and their GP practice characteristics (rurality, size, deprivation score). Recruitment continued until data saturation was reached. Semi-structured interviews were conducted with each participant in their own home. Patients were invited to have a carer present at the interview if they wished. Thematic analysis of the data was conducted to identify conceptual themes.
16 patients and 7 carers were interviewed (5 men and 11 women, aged 48-90 years, median age 81.5 years).
Participants lacked knowledge of the NHRPP with no one recalling receiving a thorough introduction to it from a healthcare professional. Despite this, participants were satisfied with their care overall. This satisfaction was driven by a number of factors including close relationships with healthcare professionals, good access, provision of proactive support, productive care planning and support for self-management.
Some issues were highlighted regarding the execution of the programme with some participants feeling that it appeared more of a process-driven “box-ticking exercise” than something that was delivered with any serious intent from their GP. This was the result of brief and ad-hoc care planning episodes, care plans being inadequately reviewed and poor professional engagement. Concerns also related to the overall aims of the programme with participants misunderstanding these, or finding conflict between their motivations and those of the programme.
Evaluations of case manager-led programmes have shown high degrees of patient satisfaction as a result of the role this individual plays in providing personal support and coordination. This study shows a programme implemented by a multidisciplinary team and GPs can be successful in providing patients with support and involvement in their own care. However, the programme was poorly introduced to patients and appeared bureaucratic rather than patient-centred, which may be due to a lack of professional time.