Community case managers' challenges collaborating with primary care when managing complex patients in the community: A qualitative study in Singapore

Abstract

Community case managers (CCMs) play a crucial role in the continuity of care for complex patients in the community. However, they are often considered as non-members of the healthcare team and not actively engaged by the primary care team because of the unique landscape of social services in Singapore. Given that these two distinct professional groups had minimal collaboration previously, integrating CCMs as partners of patient care within the primary care team may pose many challenges. The objective of this qualitative study was to understand the challenges encountered by CCMs when collaborating with primary care services. This exploratory qualitative descriptive study used individual in-depth interviews. CCMs were selected using convenience and snowball sampling. The interviews were semi-structured, guided by a topic guide. Fourteen CCMs were interviewed within a period of 12 weeks (October-December 2018). Thematic analysis was used to analyse the transcripts. Two researchers coded each transcript independently, and a coding framework was agreed upon. Potential themes were then independently developed based on the coding framework. Fourteen individual in-depth interviews were conducted. Six themes emerged from the data, i.e., self-identity, patient factor, inter-professional factor, collaborative culture, confidentiality and organisational structure. Challenges that resonated with previous studies were self-identity, inter-professional factors and confidentiality, whereas other challenges such as patient factors, collaborative culture and organisational structure were unique to Singapore's healthcare landscape. Significant challenges were encountered by CCMs when collaborating with primary care services. Understanding these challenges is key to refining intervention in current models of comprehensive community care between medical and non-medical professionals.

Keywords: Singapore; challenges; collaboration; collaborative care; community care; community case managers; complex patients; primary care services.