·         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. 

·      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 

-       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.

 

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.

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 

 

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. 

 

 

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.

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

 

 

 

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 

·      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. 

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.

-          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.

-       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. 

- 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