Vladimir Khanassov1, Isabelle Vedel2, Pierre Pluye1. 1. Department of Family Medicine, McGill University, Montreal, Canada. 2. Department of Family Medicine, McGill University, Montreal, Canada isabelle.vedel@mcgill.ca.
Abstract
PURPOSE: Results of case management designed for patients with dementia and their caregivers in community-based primary health care (CBPHC) were inconsistent. Our objective was to identify the relationships between key outcomes of case management and barriers to implementation. METHODS: We conducted a systematic mixed studies review (including quantitative and qualitative studies). Literature search was performed in MEDLINE, PsycINFO, Embase, and Cochrane Library (1995 up to August 2012). Case management intervention studies were used to assess clinical outcomes for patients, service use, caregiver outcomes, satisfaction, and cost-effectiveness. Qualitative studies were used to examine barriers to case management implementation. Patterns in the relationships between barriers to implementation and outcomes were identified using the configurational comparative method. The quality of studies was assessed using the Mixed Methods Appraisal Tool. RESULTS: Forty-three studies were selected (31 quantitative and 12 qualitative). Case management had a limited positive effect on behavioral symptoms of dementia and length of hospital stay for patients and on burden and depression for informal caregivers. Interventions that addressed a greater number of barriers to implementation resulted in increased number of positive outcomes. Results suggested that high-intensity case management was necessary and sufficient to produce positive clinical outcomes for patients and to optimize service use. Effective communication within the CBPHC team was necessary and sufficient for positive outcomes for caregivers. CONCLUSIONS: Clinicians and managers who implement case management in CBPHC should take into account high-intensity case management (small caseload, regular proactive patient follow-up, regular contact between case managers and family physicians) and effective communication between case managers and other CBPHC professionals and services.
PURPOSE: Results of case management designed for patients with dementia and their caregivers in community-based primary health care (CBPHC) were inconsistent. Our objective was to identify the relationships between key outcomes of case management and barriers to implementation. METHODS: We conducted a systematic mixed studies review (including quantitative and qualitative studies). Literature search was performed in MEDLINE, PsycINFO, Embase, and Cochrane Library (1995 up to August 2012). Case management intervention studies were used to assess clinical outcomes for patients, service use, caregiver outcomes, satisfaction, and cost-effectiveness. Qualitative studies were used to examine barriers to case management implementation. Patterns in the relationships between barriers to implementation and outcomes were identified using the configurational comparative method. The quality of studies was assessed using the Mixed Methods Appraisal Tool. RESULTS: Forty-three studies were selected (31 quantitative and 12 qualitative). Case management had a limited positive effect on behavioral symptoms of dementia and length of hospital stay for patients and on burden and depression for informal caregivers. Interventions that addressed a greater number of barriers to implementation resulted in increased number of positive outcomes. Results suggested that high-intensity case management was necessary and sufficient to produce positive clinical outcomes for patients and to optimize service use. Effective communication within the CBPHC team was necessary and sufficient for positive outcomes for caregivers. CONCLUSIONS: Clinicians and managers who implement case management in CBPHC should take into account high-intensity case management (small caseload, regular proactive patient follow-up, regular contact between case managers and family physicians) and effective communication between case managers and other CBPHC professionals and services.
Authors: Peter M Aupperle; Edward R MacPhee; Andrew C Coyne; Jonathan Blume; Betty Sanchez Journal: J Geriatr Psychiatry Neurol Date: 2003-03 Impact factor: 2.680
Authors: Matthew Parsons; Hugh Senior; Ngaire Kerse; Mei-Hua Chen; Stephen Jacobs; Stephen Vanderhoorn; Craig Anderson Journal: J Am Geriatr Soc Date: 2012-01 Impact factor: 5.562
Authors: Janet Specht; Ann Bossen; Geri Richards Hall; Bridget Zimmerman; Jane Russell Journal: Am J Alzheimers Dis Other Demen Date: 2009-02-26 Impact factor: 2.035
Authors: Erik Jedenius; Kristina Johnell; Johan Fastbom; Jan Strömqvist; Bengt Winblad; Niels Andreasen Journal: Scand J Prim Health Care Date: 2011-07-11 Impact factor: 2.581
Authors: Aaltje P D Jansen; Hein P J van Hout; Harm W J van Marwijk; Giel Nijpels; Martine C de Bruijne; Judith E Bosmans; Anne-Margriet Pot; Wim A B Stalman Journal: BMC Public Health Date: 2005-12-12 Impact factor: 3.295
Authors: Catherine Hudon; Maud-Christine Chouinard; Pierre Pluye; Reem El Sherif; Paula Louise Bush; Benoît Rihoux; Marie-Eve Poitras; Mireille Lambert; Hervé Tchala Vignon Zomahoun; France Légaré Journal: Ann Fam Med Date: 2019-09 Impact factor: 5.166
Authors: Noreen Khan; Nelda Garcia; Roshanak Mehdipanah; Emily M Briceño; Steven G Heeringa; Deborah A Levine; Xavier F Gonzales; Kenneth M Langa; Ruth Longoria; Lewis B Morgenstern Journal: J Alzheimers Dis Date: 2022 Impact factor: 4.472
Authors: Vladimir Khanassov; Pierre Pluye; Sarah Descoteaux; Jeannie L Haggerty; Grant Russell; Jane Gunn; Jean-Frederic Levesque Journal: Int J Equity Health Date: 2016-10-10