Table 4 Mixed Methods Study Design – Case Manager Roles

Iliffe et al., (2014) [27]

United Kingdom

N = 29 dyads (people with dementia-carer) who were not receiving care coordination from specialist services

• Study aimed to adapt a United States model of primary care-based case management for people with dementia and test it in four general practices: one rural, one inner-city, and two urban practices (CAREDEM study)

• The CARDEM intervention consisted of training and mentoring based on an educational needs assessment in conjunction with a learning manual

• The trainer and mentor for the case mangers was an experienced Admiral Nurse who visited each workplace and was available by phone and email

• The case managers were practice nurses in the rural and inner-city practices and a social worker in the other urban practices

N/A

• Mixed methodology case studies

• Quantitative data: numbers identified, eligibility for case management, number and types of needs and number of contacts

• In-depth interviews with stakeholders including people with dementia, carers, case managers and their mentor, health and social care professionals and researchers

• Case manger records were compared with findings from the interviews

• Sixty-three case manager contacts were recorded and the median number of contacts and type of contacts varied significantly between case managers

• The proportion of needs for which actions were recorded varied significantly by type of need for carers but not patients

• Researchers identified more unmet needs than case managers

• Perceived benefits of case managers identified from carers and people with dementia were: first point of contact, a safety net and creating a one-to-one therapeutic relationship. Some suggested the care managers take a more active role in negotiating with local services

• Health care professionals stated the case manager provided continuity of care and was seen as complementary to existing services

• Case managers perceived the advantages as the continuity of care and flexibility in responsiveness to needs but wished they had more time to develop their work and show concrete benefits

This mixed methods study showed that case management offered potential benefit to people with dementia, their carers and community based professionals through continuity of care by a named trust individual that could act proactively to prevent a crisis. However, it was also shown that needs may be overlooked. It is suggested that further development work is need to establish the best approaches to meeting the needs of people with dementia and their cares before case management can be implemented in primary care.

Verkade et al., (2010) [28]

The Netherlands

N = 30 experts in the field of case management (14 practising professionals nine case managers for people with dementia, three team managers, one geriatrician, one psychiatrist)

• N = 30

• Modified four-phase Delphi design to build consensus on the essential components that form part of case management programmes for people with dementia and the preconditions needed for effective implementation

N/A

• Literature Review

• Focus Group Interview (N = 8)

• First Delphi survey round to validate the pre-selected items

• Second and third Delphi surveys designed to score items with a view to reaching consensus

• Consensus was reached on 61 out of 75 statements.

• Essential components were: information, support and counselling, coordination of the care provided, and to a lesser extent practical help. A patient centred approach was found to be one of the key aspects.

• Essential preconditions were: vision, care relationship, structured methodology, integration of case management into the health care chain, and the case manager’s level of training/expertise.

It is recommended that the essential components and preconditions be used as a basis for developing minimum quality criteria for case management in people with dementia to enhance quality of care and reduce undesirable differences.