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Doctors' assistants' views of case management to improve chronic heart failure care in general practice: a qualitative study |
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| Authors: | Rebecca Olbort,Cornelia Mahler,Stephen Campbell,Bernd Reuschenbach,Thomas Mü ller-Tasch,Joachim Szecsenyi,& Frank Peters-Klimm |
| Affiliation: | Rebecca Olbort Medical Student and Doctoral Candidate Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany; Cornelia Mahler MA RN Research Fellow Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany; Stephen Campbell PhD Senior Research Fellow Department of General Practice and Health Services Research and National Primary Care Research and Development Centre, University of Manchester, UK; Bernd Reuschenbach MA RN Research Fellow Department of General Practice and Health Services Research, Institute of Psychology, University Hospital Heidelberg, Germany; Thomas Müller-Tasch MD Research Fellow Department of Psychosomatic and General Internal Medicine, University Hospital Heidelberg, Germany; Joachim Szecsenyi MA MSc MD Professor and Director Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany; Frank Peters-Klimm MD Research Fellow Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany |
| Abstract: | Title. Doctors’ assistants’ views of case management to improve chronic heart failure care in general practice: a qualitative study. Aim. This paper is a report of a study to explore the views, concerns and experiences of doctors’ assistants of case management for patients with chronic heart failure, while experiencing the new role of being a case manager within the Heidelberg Integrated Case Management trial. Background. Case management is being investigated as part of a randomised controlled trial aiming to improve care for patients with chronic systolic heart failure. In a complex, multifaceted intervention, trained doctors’ assistants (equivalent to a nursing role) adopted new tasks using standardised case management involving telephone monitoring, home visits and diagnostic screening. Method. In April 2007, 3 months after implementation of the intervention programme, 27 doctors’ assistants participated in four focus group interviews discussing their views on, and experiences of, case management. Thematic analysis of the data was undertaken. Findings. Participants believed that the most positive factors in case management were about interaction with patients, including opportunities for identifying disease and psychosocial problems. However, barriers included lack of time allocated to perform case management in addition to their normal role and poor cooperation within the practice team. According to the doctors’ assistants, the routine implementation of case management was acceptable, feasible and effective in improving the management of patients with chronic systolic heart failure. Conclusion. Case management enhanced the role of doctors’ assistants, leading to increased awareness of the perspective of patients with chronic disease. In the wider international primary care practice nursing context, the orchestrated delegation of tasks using specific case management may be a promising strategy for improving the quality of care of chronically ill patients and enabling patient self‐management. |
| Keywords: | case management chronic heart failure doctors' assistants focus groups general practice practice nursing qualitative research |