scholarly journals The care manager meeting the patients’ unique needs using the care manager model—A qualitative study of experienced care managers

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Irene Svenningsson ◽  
Dominique Hange ◽  
Camilla Udo ◽  
Karin Törnbom ◽  
Cecilia Björkelund ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Common Mental Disorders ◽  
Controlled Trial ◽  
Successful Outcome ◽  
Comfort Zone ◽  
Care Manager ◽  
Care Managers ◽  
Care And Support

Abstract Background Implementation of a care manager in a collaborative care team in Swedish primary care via a randomized controlled trial showed successful outcome. As four years have elapsed since the implementation of care managers, it is important to gain knowledge about the care managers’ long-term skills and experiences. The purpose was to examine how long-term experienced care managers perceived and experienced their role and how they related to and applied the care manager model. Method Qualitative study with a focus group and interviews with nine nurses who had worked for more than two years as care managers for common mental disorders. The analysis used Systematic Text Condensation. Results Four codes arose from the analysis: Person-centred; Acting outside the comfort zone; Successful, albeit some difficulties; Pride and satisfaction. The care manager model served as a handrail for the care manager, providing a trustful and safe environment. Difficulties sometimes arose in the collaboration with other professionals. Conclusion This study shows that long-term experience of working as a care manager contributed to an in-depth insight and understanding of the care manager model and enabled care managers to be flexible and act outside the comfort zone when providing care and support to the patient. A new concept emerged during the analytical process, i.e. the Anchored Care Manager, which described the special competencies gained through experience. Trial registration NCT02378272 Care Manager—Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM—CARE).

scholarly journals The experiences of care managers and rehabilitation coordinators of a primary care intervention to promote return to work for patients with common mental disorders: a qualitative study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Eva-Lisa Petersson ◽  
Karin Törnbom ◽  
Dominique Hange ◽  
Shabnam Nejati ◽  
Margareta Jerlock ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Return To Work ◽  
Common Mental Disorders ◽  
Primary Care Centre ◽  
Care Centre ◽  
Care Model ◽  
Rehabilitation Process ◽  
Care Manager ◽  
Care Managers

Abstract Background In an earlier study, PRIM-CARE RCT, a care manager implementation at the primary care centre showed improved return to work and reduced sick leave for patients with CMD. To further improve return to work, the project Co-Work-Care added a person-centered dialogue meeting between the patient, the employer and the rehabilitation coordinator, preceded by an increased collaboration between care manager, rehabilitation coordinator and GP. In this first qualitative study of the Co-Work-Care project, we explored how care managers and rehabilitation coordinators experienced the Co-Work-Care model. The purpose of this study was to explore care managers’ and rehabilitation coordinators’ perceptions and experiences of a close collaboration and the use of the person-centred dialogue meeting. Methods From an ongoing RCT with 20 primary care centres, care managers (CMs) (n = 13) and rehabilitation coordinators (RCs) (n = 12) participated in a qualitative study with focus groups. The study was conducted in the primary health care in a Swedish region. The data was analysed with Systematic Text Condensation by Malterud. Results Seven codes describing the participants’ experiences of the Co-Work-Care model were identified: 1) The importance of collaboration at the primary care centre, 2) Collaboration and division of roles between the RC and the CM, 3) Collaboration with the General practitioner (GP), 4) The person-centred dialogue meeting, 5) Initiating the person-centred dialogue meeting, 6) The person-centred dialogue meeting to improve collaboration with the employer, and 7) The person-centred dialogue meeting to teach about the return to work process. Conclusion The increased collaboration within the Co-Work-Care model created a common picture and understanding of the patient’s situation. The person-centred dialogue meeting in the rehabilitation process became a bridge between the employer and the patient. Trial registration NCT03250026 (registered August 15, 2017).

scholarly journals Implementation of care managers for patients with depression: a cross-sectional study in Swedish primary care

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e035629
Author(s):  
Pia Augustsson ◽  
Anna Holst ◽  
Irene Svenningsson ◽  
Eva-Lisa Petersson ◽  
Cecilia Björkelund ◽  
...  
Keyword(s):  
Primary Care ◽  
Collaborative Care ◽  
Qualitative Content Analysis ◽  
Controlled Trial ◽  
Cross Sectional Study ◽  
Healthcare Management ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Manager ◽  
Care Managers

ObjectivesTo perform an analysis of collaborative care with a care manager implementation in a primary healthcare setting. The study has a twofold aim: (1) to examine clinicians’ and directors’ perceptions of implementing collaborative care with a care manager for patients with depression at the primary care centre (PCC), and (2) to identify barriers and facilitators that influenced this implementation.DesignA cross-sectional study was performed in 2016–2017 in parallel with a cluster-randomised controlled trial.Setting36 PCCs in south-west Sweden.ParticipantsPCCs’ directors and clinicians.OutcomeData regarding the study’s aims were collected by two web-based questionnaires (directors, clinicians). Descriptive statistics and qualitative content analysis were used for analysis.ResultsAmong the 36 PCCs, 461 (59%) clinicians and 36 (100%) directors participated. Fifty-two per cent of clinicians could cooperate with the care manager without problems. Forty per cent regarded to their knowledge of the care manager assignment as insufficient. Around two-thirds perceived that collaborating with the care manager was part of their duty as PCC staff. Almost 90% of the PCCs’ directors considered that the assignment of the care manager was clearly designed, around 70% considered the priority of the implementation to be high and around 90% were positive to the implementation. Facilitators consisted of support from colleagues and directors, cooperative skills and positive attitudes. Barriers were high workload, shortage of staff and extensive requirements and demands from healthcare management.ConclusionsOur study confirms that the care manager puts collaborative care into practice. Facilitators and barriers of the implementation, such as time, information, soft values and attitudes, financial structure need to be considered when implementing care managers at PCCs.

scholarly journals Implementation of a care manager organisation and its association with antidepressant medication patterns: a register-based study of primary care centres in Sweden

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044959
Author(s):  
Christine Sandheimer ◽  
Cecilia Björkelund ◽  
Gunnel Hensing ◽  
Kirsten Mehlig ◽  
Tove Hedenrud
Keyword(s):  
Primary Care ◽  
Treatment Guidelines ◽  
Common Mental Disorders ◽  
Common Mental Disorder ◽  
Antidepressant Medication ◽  
Linear Mixed Effects ◽  
Care Manager ◽  
Defined Daily Doses ◽  
Number Of Patients ◽  
Mental Disorder Diagnosis

ObjectiveTo evaluate the implementation of a care manager organisation for common mental disorders and its association with antidepressant medication patterns on primary care centre (PCC) level, compared with PCCs without this organisation. Moreover, to determine whether a care manager organisation is associated with antidepressant medication patterns that is more in accordance with treatment guidelines.DesignRegister-based study on PCC level.SettingPrimary care in Region Västra Götaland, Sweden.ParticipantsAll PCCs in the region. PCCs were analysed in three subgroups: PCCs with a care manager organisation during 2015 and 2016 (n=68), PCCs without the organisation (n=92) and PCCs that shifted to a care manager organisation during 2016 (n=42).Outcome measuresProportion of inadequate medication users, defined as number of patients >18 years with a common mental disorder diagnosis receiving care at a PCC in the region during the study period and dispensed 1–179 defined daily doses (DDD) of antidepressants of total patients with at least 1 DDD. The outcome was analysed through generalised linear regression and a linear mixed-effects model.ResultsOverall, all PCCs had about 30%–34% of inadequate medication users. PCCs with a care manager organisation had significantly lower proportion of inadequate medication users in 2016 compared with PCCs without (−6.4%, p=0.02). These differences were explained by higher proportions in privately run PCCs. PCCs that shifted to a care manager organisation had a significant decrease in inadequate medication users over time (p=0.01).ConclusionsPublic PCCs had a more consistent antidepressant medication pattern compared with private PCCs that gained more by introducing a care manager organisation. It was possible to document a significant decrease in inadequate medication users, notwithstanding that PCCs in the region followed the guidelines to a comparatively high extent regardless of present care manager organisation.

scholarly journals Creating a safety net for patients with depression in primary care; a qualitative study of care managers’ experiences

2018 ◽  
Vol 36 (4) ◽  
pp. 355-362 ◽  
Author(s):  
Irene Svenningsson ◽  
Camilla Udo ◽  
Jeanette Westman ◽  
Shabnam Nejati ◽  
Dominique Hange ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Safety Net ◽  
Care Managers

scholarly journals Improving the Care of People with Long-Term Conditions in Primary Care: Protocol for the Enhance Pilot Trial

2015 ◽  
Vol 5 (1) ◽  
pp. 135-149 ◽  
Author(s):  
Emma L. Healey ◽  
Clare Jinks ◽  
Valerie A. Tan ◽  
Carolyn A. Chew-Graham ◽  
Sarah A. Lawton ◽  
...  
Keyword(s):  
Primary Care ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Pilot Trial ◽  
Integrated Approach ◽  
Long Term Conditions ◽  
Delivery Of Care ◽  
Care Protocol ◽  
Engagement Assessment

Background Long-term conditions (LTCs) are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. Objective To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. Design The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENAHNCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes) will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. Discussion Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418.

scholarly journals What are the opportunities for cancer care and related research in primary care? A qualitative study of the views of patients, carers, and practice staff

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703505
Author(s):  
Joseph Clark ◽  
Elvis Amoakwa ◽  
John Blenkinsopp ◽  
Florence Reedy ◽  
Miriam Johnson
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Cancer Care ◽  
Information Needs ◽  
Controlled Trial ◽  
Unmet Need ◽  
Care Staff ◽  
Trial Participation

BackgroundResearch to identify the role of primary care in cancer care is important. However, trials in primary care are difficult.AimTo understand how patients, families, and primary care clinicians view their role in cancer care and identify opportunities for cancer primary care research.MethodQualitative study embedded within a feasibility cluster randomised controlled trial of a primary care based needs assessment intervention. The Supportive Cancer Needs Survey (SCNS) was the main outcome. In-depth interviews with patients/carers and focus groups with primary care staff explored views on cancer care and trial participation. Data were recorded, transcribed verbatim, and analysed thematically by three independent researchers.ResultsFifteen cancer patients and three carers were interviewed and four focus groups (n = 11) were conducted. Three themes were generated satisfaction with current care; key time-points for improved cancer care; and information and research. Satisfaction with current care among patients was high in spite of 72% reporting at least one moderate-high unmet need at baseline. Most patients undergoing cancer treatment were unsure when to access primary care. Patients and carers highly valued proactive contact from their practice following diagnosis though this was uncommon. Post-oncology discharge was a key time-point for information needs and support for patients. Patients were reluctant to consider palliative care in spite of palliative care needs. Some felt therapeutic benefit from completing study measures.ConclusionPatients are satisfied with cancer primary care despite unmet needs. Palliative care is poorly understood by many who may benefit. Research participation may benefit some patients.

Should Care Managers for Older Adults Be Located in Primary Care? A Randomized Controlled Trial

2012 ◽  
Vol 60 (1) ◽  
pp. 86-92 ◽  
Author(s):  
Matthew Parsons ◽  
Hugh Senior ◽  
Ngaire Kerse ◽  
Mei-hua Chen ◽  
Stephen Jacobs ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Care Managers

scholarly journals Long-term antidepressant use: a qualitative study on perspectives of patients and GPs in primary care

2016 ◽  
Vol 66 (651) ◽  
pp. e708-e719 ◽  
Author(s):  
Renske C Bosman ◽  
Klaas M Huijbregts ◽  
Peter FM Verhaak ◽  
Henricus G Ruhé ◽  
Harm WJ van Marwijk ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Antidepressant Use

scholarly journals Physicians’ experiences of SBIRT training and implementation for SUD management in primary care in the UAE: a qualitative study

2017 ◽  
Vol 19 (04) ◽  
pp. 344-354
Author(s):  
Christiane Pflanz-Sinclair ◽  
Catriona Matheson ◽  
Christine M. Bond ◽  
Amna Almarzouqi ◽  
Amanda J. Lee ◽  
...  
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Qualitative Study ◽  
Primary Care Physicians ◽  
Substance Misuse ◽  
Care Pathway ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Successful Implementation ◽  
Cultural Issues

AimThe objective of this paper is to present a qualitative study of introducing substance misuse screening using the Screening Brief Intervention and Referral to Treatment (SBIRT) model, in primary care in Abu Dhabi.BackgroundSubstance misuse in the UAE is an increasing problem. However religious beliefs and fear of legal consequences have prevented this topic from being openly discussed, risk levels identified through screening and treatment options offered.MethodsA controlled trial was undertaken which included a qualitative process study which is reported here. Qualitative interviews with primary care physicians from two intervention clinics were undertaken to explore their views, experiences and attitudes towards substance misuse management in their clinic. Physicians were trained on SBIRT and on the research project process and documentation. At completion of the project, 10 months after the training, physicians (n=17) were invited to participate in an interview to explore their experiences of training and implementation of SBIRT. Interviews were recorded and transcribed. Inductive thematic coding was applied.FindingsIn total, 11 physicians were interviewed and three main themes emerged: (1) The SBIRT screening project, (2) cultural issues and (3) patient follow-up. Findings revealed a general willingness toward the concept of screening and delivering brief interventions in primary care although increased workload and uncertainties about remuneration for the service may be a barrier to future implementation. There was a perceived problem of substance misuse that was not currently being met and a strong perception that patients were not willing to reveal substance use due cultural barriers and fear of police involvement. In conclusion this qualitative process evaluation provided essential insight into implementing SBIRT in the Middle East. In conclusion, despite physician willingness and a clinical need for a substance misuse care pathway, the reluctance among patients to admit to substance use in this culture needs to be addressed to enable successful implementation.

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