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case management in long-term conditions:

- case management provided a client with psychosocial support, regular monitoring and referral options

- case management had no impact of emergency admission presentations, hospital stay length or mortality

- effective case management requires a multifaceted approach to care

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-          Barriers include: organisation of care including lack of time, priorities of organisations, lack of communication, need more evidence on effectiveness of case management alone
-          Cost effective, innovative ways to coordinate services
-          3 levels of case management dependency including from level 1 selfcare support and management to level 3 high complexity case management

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Case management in Long term Conditions (LTC) -article highlights

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Case management in Long term Conditions (LTC) -article highlights

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The article highlights that the definition of case management can vary in relation to the context of the care environment.

Effective case management requires a multifaceted approach which includes adequate infrastructure, professional development and service evaluation.

Evidence reported that a dedicated key worker was beneficial as the model supported contact, regular monitoring, more holistic support including psychosocial support and broader options and education.

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- Aim of case management is to develop cost effective and efficient ways of coordinating services in order to improve the quality of life

- There is a distinction between disease-specific case managers, case managers and team based approaches
= Disease-specific management: undertaken by a specialist nurse who provides the direct clinical care and patient education/advice
= Case managers:  assessing patients, developing care plans, regularly monitoring patients, coordinating care and responding to crises
= Team-based approach (to case management) includes the delivery of care to service users by a skilled multidisciplinary team

- Despite different organisations using a different model of case management to ensure it is fit for them, the essential features of the model remain the same. These include: identification of eligible patients, Individual assessment and diagnosis,  development of individual care plans, linking patients to required services or coordination of services, implementation, monitoring of outcomes and evaluation.

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-       There is an identified need for support for coordinating clients care when they are living with complex conditions or long term conditions. Some evidence showed the efficacy of an identified person or team coordinating the individuals care.

-       There are gaps in the evidence relating to the correlation between case management and clinical outcomes, satisfaction of clients and use of resources.

-       The models of case management are not currently believed to be transferable between different population groups such as countries and age groups.

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-          The definition of case management appears to differ vastly in each country and healthcare system, as does the healthcare professional providing case management. This disparity can complicate the evaluation of outcomes and create large variation in results.

-          Team based approaches to case management use a multidisciplinary team with a designated key worker, who will co-ordinate care. A key worker will co-ordinate the most appropriate services for the individual.

-          Care co-ordination benefits patients by improving physical care, but also providing health promotion information to both patient and carer.  Psychosocial support is also improved as patients felt they could depend on their care team more.

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1. Intensive on-going personalised and coordinated attention ensures individuals experience a seamless journey through the health and social care systems and in turn has lead to an improvement in quality of life and reduction in unplanned hospital admissions.
2. Benefits of case management include improved physical care, education and advice and psychosocial support
3. Team based and the concept of an identified person to coordinate care was reported as beneficial to patients

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Having one main person assigned to a patient is more preferred

Case management has the focus on providing client-centered care that is specific to the patient. This ultimately improves the trust and communication between all parties

The different levels of case management are; high risk disease, high complexity, and low level.

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Case Management in long term conditions 

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Case Management in long term conditions 

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1. Effective case management relies on a multifaceted approach and aims to improve patient outcomes in a variety of ways, this includes fewer days in hospital and emergency admissions.

2. Case management is beneficial as it provides improved care by coordinating care tasks, providing education, advice and psychological support to cares and patients.

3. Barriers and challenges to effective treatment include: organisations case manager is from (including caseload and research), communication, shifting from traditional to proactive approach, the complexities in patients, limited research on case management alone.

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1. The aim of case management is to coordinate health services efficiently and cost effectively, for people living with long term health conditions, with the aim of increasing quality of life for these individuals (Offredy et al. 2016). This is done by identifying eligible patients, performing appropriate assessments, linking patients to the services they require, implementing, monitoring and evaluating outcomes (Offredy et al. 2016).
2. There are three levels of case management dependency.
- Level 1: Patients are provided with supported self care through education, skill development and support from appropriate health care professionals (Offredy et al. 2016).
- Level 2: The use of multidisciplinary teams and specialist services for patients with high risk due to having a complex single condition or multiple medical conditions (Offredy et al. 2016).
- Level 3: This is for the management of cases with high complexity, where patients have extremely high use of services and may require unplanned secondary care. These cases are managed by a community matron who develops plans to coordinate health and social care (Offredy et al. 2016).
3. Barriers to implementing  case management models effectively include:
- Caseloads becoming over-burdoned, which increases patient wait times for service connection and reduces the amount of time available for professional development for health providers.
- the lack of availability of funding/financial resources.

Offredy, M., Bunn, F. & Morgan, J. (2016). Case management in long term conditions: an inconsistent journey. British Journal of Community Nursing, 14(6), 252-257. DOI: 10.12968/bjcn.2009.14.6.42593

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- Effective case management relays good communication and deciding on the right form of communication for your client that is getting case managed. If this is lacking this can make the client feel like their needs are not being met (Offredy et al., 2009).

- The definition of what case management is seem to issue in this report as there lack a clear guidelines through the study that where look at (Offredy et al., 2009).

- Multidisciplinary team approach seemed to yield better results them single nursing approach to continuation of care  (Offredy et al., 2009).

This article has highlighted that there is potential benefits for the clients long term health and wellbeing. There just needs to be better strategies that have clearly defines what case management is and how it is best implemented to see better results.

Offredy, M., Bunn, F. & Morgan, J. (2009). Case management in long term conditions: an inconsistent journey? British Journal of Community Nursing, 14(6), 252-257. https://doi.org/10.12968/bjon.2009.14.6.42593

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- Due to the differing models, definitions and settings, evaluation of the case managemnt models are difficult to evaluate

- Effective case management involves an approach that addresses infrastructure, professional development and service evaluation

- Qualitative data found improved service to frail old people, while quantitative data found no real change in hospital admissions, bed days or mortality.

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- Psychosocial support is important for clients when receiving care. Having a case manager is considered to be someone the patients and carers can depend on which resulted in reports of enhanced care.
- can management significantly benefits individuals and that having a single point of contact was considered preferable when navigating services.
- In order for case management to be effective, it requireds a multifaceted approach when considering a patients care

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There were inconsistent findings in regard to the effects of case management. This may have been in relation to the variations of case management models used across research.

Qualitative data found that clients appreciated the extra care – psychosocial support, education and advice.

The effectiveness of case management may depend on the size of clinician's caseload.

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1.  Case management aims to improve patient outcomes in a variety of ways, such as fewer days in a hospital bed, fewer emergency admissions, more relevant and less duplication of supports.

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1.  Case management aims to improve patient outcomes in a variety of ways, such as fewer days in a hospital bed, fewer emergency admissions, more relevant and less duplication of supports.

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2.  Studies to test the effectiveness of case management end up obtaining wildly different results due to a lack of standard measurments.
3. Qualitative studies and overall patients satisfaction seems to show positive results, quantitative studies show no improvements in outcomes such as days admitted or overall money spent.

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·      Previous literature focused on patient preferences emphasised a strong preference for one dedicated key worker who would act as the point of contact.

·      Case management programs have been found to improved frequency of contact, psychosocial support and avoidance of hospital admissions for frail older people.

·      The model of case management used in one country may not demonstrate effectiveness in another.

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Case management shifts the traditional way of reactive care to proactive interventions of personalised coordinated care with the client at the centre. KEY POINT - (The primary reason for case management  is improve care and drive cost effective and efficient service provision that improves the quality of the clients life and reduces hospital admissions) The literature reviewed in this article showed that for case management to be effective, there must be a multifaceted approach which includes adequate infrastructure, well trained case managers or care coordinators and a continual evaluation of services to ensure outcomes are gained and it is cost effective.  Case Management has been found to benefit patients because of the information and advice they frequently receive, helps them make better informed decisions.  Patients also saw the psychosocial support as beneficial to their care.  KEY POINT 2 - (But to date case management effects been difficult to measure because the models that demonstrate effectiveness in one country are not successful in another and the evidence is inconsistent regarding the effects of case management on long term health, improved functioning and patient satisfaction). The article identified a number of barriers and challenges to effective case management as well.  For example, the lack of practice guides, training and organisational leadership to support the types of interventions, further hindered by limited financial resources available to them.   Studies also noted that the difficulty case managers have in providing regular monitoring of clients and providing timely services due to high volumes of paperwork required in order  to access services.  The effects of coordinated care on long term health and quality of life need to be quantified and understand how cultural, education and socio-economic factors affect these outcomes. However the authors agreed that the breakdown in communication would have contributed to the unmet needs and poorer outcomes. However KEY POINT 3. (Whilst there is a strong preference for a key person coordinating care plans, the inconsistency of evidence for Case management is probably due to the variation between the models studied and the lack of a clear definition for service coordination has made quantifying the impacts of case management extremely difficult). So further study and the development of a map for service is required.

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Qualitatively, case management has been found to benefit individuals, with patients showing strong preference for a single point of contact to coordinate services.

Quantitively, it has been difficult to evaluate the effects of case management on clinical outcomes, physical function, patient satisfaction and healthcare resource use.  This is due to the variations in the models in use and the lack of a clear definition of case management.

Models of case management used to demonstrate effectiveness in one country may not prove successful in another country

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1.     From a patient perspective the provision of a Case Manager has a positive impact because it gives them a dedicated person to liaise with more regularly who is focused on their health care requirements

2.     There’s still no clearly defined outcome on the true effectiveness of case management due to differences between the various health care models and settings which make it difficult to provide a consistent analysis and comparison.

3.     Case management doesn’t appear to show any improvement in reducing emergency admissions, bed days or mortality amongst the high risk patients

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1.       Introducing case management models into the care of people with long term health conditions aims to improve quality of care, prevent hospital admissions, and improve health outcomes.

2.       Barriers to effective implementation of case management models include unavailability of financial resources (E.g. a focus on making an organisation financially stable, rather than a focus on improving patient health outcomes). Furthermore, large caseloads mean case managers have limited time for professional development. Client care needs often go unmet due to delays in accessing services (services have long waiting lists). Finally, there are unclear boundaries between clients and case managers (no clear scope of role responsibilities).

3.       Evidence showed that there were inconsistencies in the positive outcomes achieved by implementing case management processes. For example, in some countries, hospital admissions reduced, but in others there was no change.

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The aim of the case management approach to care of individuals with long term conditions is to improve a clients quality of life and to reduce hospital admissions. This involves a coordinated approach to planning, managing and reviewing individuals care by a dedicated case manager supported by a multi-disciplinary team.

Perceived benefits to patients included improved physical care through examination, assessments and enhanced communication between patients and health care providers. In addition, was the optimisation of coordinated services, products and medical professional treatment. With both patients and carers further advantaged by enhanced education, advise, health promotion and additional support services.

Some of the barriers to effective case management were a deficiency in organisational leadership, lack of financial resources, insufficient time allocation for case managers in addition to a lack of effective communication in some circumstances.

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Key points - Article CM & LTC's

1. - models of case management includes ; identifying and assessing eligible patients
- development of care plans and linking/coordinating of services
- Implementation
-monitoring and evaluation of care plans

2. Case management have different levels;
- High complexity ( to be managed by a community professional )
-High risk disease ( specific case management using multidisciplinary teams)
-Low level( supported self care )

3. Case management benefits include; care coordination of tasks, education and advice, psychosocial support,   and barriers  include - organisation ( lack of practice guidelines) , communication (lengthy paper work-red tape) , Case load redesign due to, patient related health lifestyle issues, research issues (limitation of evidence).

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- The patient benefits when there is a person of reference ( case manager ) coordinating their care, resulting in improved physical care, strong preference for one dedicated worker.

- Qualitative evidence found that case management programmes improved
frequency of contact, provided regular monitoring, psychosocial support,
avoidance of hospital admission.

- Barriers of effective case management include lack of organisation,  communication, caseload and redesign issues, patient related issues and research related issues.

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1.     The aim of case management is to develop efficient methods of healthcare/service delivery, reduce associated costs and improve quality of life

2.     Barriers to effective treatment include: communication, shifting from traditional to proactive approach & the case manager’s caseload, complex conditions, organisational support and limited research

3.     Evidence found that case management has no direct impact on the rates of emergency admission to hospital

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1.     Case management has been defined as ‘the process of planning, coordinating, managing and reviewing the care of an individual. The broad aim is to ‘develop cost-effective and efficient ways of coordinating services in order to improve the quality of life’

2.     Two significant differences between intensive case management and general case management are provided: the emphasis on team management and medication compliance.

3.     Effective case management relies on a multifaceted approach including adequate infrastructure, continual professional development and involvement in service evaluation.

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-       From a patient perspective, having one key person assigned as a point of contact was strongly preferred.

-       The variation in models of case management and the lack of a clear definition have made it very difficult to rigorously evaluate the overall impact.

-       Qualitative benefits of this method of care are significant but the quantitative benefits are much harder to establish.

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case management in long-term conditions:

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case management in long-term conditions:

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- case management provided a client with psychosocial support, regular monitoring and referral options

- case management had no impact of emergency admission presentations, hospital stay length or mortality

- effective case management requires a multifaceted approach to care

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·      Research conducted on the efficacy of case management has produced mixed results, particularly surrounding its effect on clinical outcomes, patient physical function, patient satisfaction and recourse use across healthcare services. This may be attributed to use of the same models across different countries, variation in service models, lack of a unanimous case management definition, differences in health-care settings, outcome measures used, and potential communication issues leading to unmet client needs (Offredy et al., 2009).

·      Potential benefits of case management include; improved physical care of clients, improved coordination of care tasks with individuals and across organisations, provision of client and carer education and advice, and psychosocial support for carers and clients from a central point of contact (Offredy et al., 2009).

·      Potential barriers and challenges of case management arise in relation to; organisation of leadership, finances, practice guidelines, and time; communication with social care services and role boundary issues; making the shift away from traditional service provision and managing an appropriately sized case load; the complexity of client’s conditions and their needs; and research issues, whereby interventions need clearer articulation (Offredy et al., 2009).

Offredy, M., Bunn, F. & Morgan, J. (2009). Case management in long term conditions: an inconsistent journey? British Journal of Community Nursing, 14(6), 252-257. https://doi.org/10.12968/bjon.2009.14.6.42593

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1. Case management aims to provide personalised ongoing support to patients with LTC, improve communication between patients and healthcare professionals, reduce costs and hospitalisations and integrate care.
2. Effective case management has the potential to improve trust between the patient and healthcare system, optimise healthcare resources, improve health literacy, improve self-management of chronic conditions and provide a sense of support and care to the patient.
3. However, these outcomes are not achieved when there is a lack of organisation, difficulties with communication and boundaries, excessive case management caseloads or non-adherence to treatment. The research is therefore still unclear about the efficacy of case-management as an isolated strategy, the optimal intensity of case management treatment, patient's perceptions and the long-term health outcomes.

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·         Case management is an important aspect in the coordination of patients care, involving key role such as individual care planning, referrals, appointments, facilitating access to clinics, and maintaining therapeutic relationships.

·         Benefits of case management include improved physical care of the patient that focus on examinations, assessments, and treatments, providing importance education and advice about support services, and being able to provide effective psychosocial support to patients and carers.

·         However, literature concluded several key barriers of case management, including level of organisation, lacking effective communication, inability to manage caseloads that don’t prioritise clients care, and complex medical conditions.

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Effective case management relies on a multifaceted approach. Including adequate infrastructure, continual professional development and involvement in service evaluation.

Benefits of case management:  improved frequency of contact, regular monitoring, improved physical care, increased psychosocial support and increased education and advice to patient and carers

Barriers and challenges: poor organisation leadership and resources, insufficient time allocation, role boundary issues, high caseloads, difficulty shifting from the traditional way of care