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Table 1 Tasks to be undertaken by case managers

From: Understanding the challenges to implementing case management for people with dementia in primary care in England: a qualitative study using Normalization Process Theory

1 Identify people with dementia (PWD) from general practice lists
2 Review medical records of PWD +/- their carer(s), noting any gaps in the record and also the involvement of other possible sources of support
3 Liaise with other professionals who know the PWD to learn their perspectives on individual or family needs
4 Engage with the PWD +/- carer to identify their main concerns or unmet needs
5 Update or fill in gaps in GP medical records and where appropriate update social care records
6 Analyse information obtained with PWD & carers
7 Map support available to and wanted by PWD & carer. Create a personal care or support plan with each PWD & carer, and initiate actions that will provide that support
8 Analyse information obtained with other relevant practitioners
9 Prioritise individual PWD and carers: Assess need for action in terms of `intensive’, `maintenance’ and `holding’
10 Build the care plan into the GP medical records, and share with other professionals and agencies as needed
11 Organise systematic follow-up to review the outcomes of actions taken, meet regularly with the GP or other relevant clinical leads, and act as an advocate for the PWD and carers
12 Meet regularly with his/her mentor, to discuss PWD and carers with whom they are working, to review prioritisation, to resolve any problems that have arisen and to plan the end of their role with the PWD and their carers, as appropriate
13 Undertake professional updating and top-up training, as needed
14 Meet with and communicate with members of the research team to discuss the case manager role as it develops