Family Practice Based Case Management – Old Wine in New Skins?
DOI: 10.3238/zfa.2011.0324german translation / full article
Introduction: In light of limited human and restricted financial resources there is a call for innovative multi-professional care strategies that take up the challenge of primary care for the chronically ill. Case management is an increasingly discussed approach. This raises the question how family practice teams conceptualize and experience case management as part of their daily work.
Method: As part of a set of exploratory studies for the development of a family practice-based care management programme, 12 family practitioners and 8 health care assistants (HCAs) took part in semi-structured interviews. All family practitioners participated in a primary care centred care contract. The interviews addressed their definition of case management and prior experiences with this concept. All interviews were transcribed verbatim. We performed content analysis supported by the software package atlas.ti in order to analyse and interpret data.
Results: Family practitioners as well as HCAs define case management as individualized, structured and intensified care concept for chronically ill and geriatric patients. For them, case management implies to address medical and social needs. Family practitioners attribute the role of a case manager to either themselves, to specialists, or to HCAs. In contrast, HCAs claim themselves or specialized non-physician health professionals to be case managers. Practice teams experience some core elements of case management as part of their daily work: Gate-keeping and care coordination, social work and monitoring. However, they perceive shortage of physicians and HCAs as main barriers to further implementation of structured case management.
Conclusion: Core elements of case management are already integrated in family practice. Further developments of this concept should take into account pre-existing experiences particularly to address a shortage of staff.