Nurse-led case management for community dwelling older people: an explorative study of models and costs |
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| Authors: | HEATHER GAGE PhD SHARLENE TING PhD PETER WILLIAMS MSc VARI DRENNAN PhD CLAIRE GOODMAN PhD STEVEN ILIFFE FRCGP JILL MANTHORPE MA SUE L. DAVIES MSc HELEN MASEY MSc |
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| Affiliation: | 1. Reader in Health Economics;2. Research Fellow, Department of Economics;3. Statistical Consultant, Department of Mathematics, University of Surrey, Guildford;4. Professor of Health Policy and Service Delivery, Faculty of Health and Social Care Sciences, Kingston University and St George’s University of London, London;5. Professor of Health Care Research, Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield;6. Professor of Primary Care for Older People, University College London, Royal Free Campus, London;7. Professor of Social Work, King’s College London, London;8. Research Fellow, Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield;9. Research Fellow, School of Health Sciences and Social Care, Brunel University, Uxbridge, London, UK |
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| Abstract: | Aim To compare community matrons with other nurses carrying out case management for impact on service use and costs. Background In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. Methods Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. Results Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. Conclusion Further research on cost-effectiveness of case management models is required. Implications for Nursing Management The case for continued investment in community matrons remains to be proven. |
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| Keywords: | case management community matrons costs nurses older people |
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