Experiences of case managers in providing person-centered and integrated care based on the Chronic Care Model: A qualitative study on embrace

PLoS One. 2018 Nov 15;13(11):e0207109. doi: 10.1371/journal.pone.0207109. eCollection 2018.

Abstract

Background: Due to the rise in the number of older adults within the population, healthcare demands are changing drastically, all while healthcare expenditure continues to grow. Person-centered and integrated-care models are used to support the redesigning the provision of care and support. Little is known, however, about how redesigning healthcare delivery affects the professionals involved.

Objectives: To explore how district nurses and social workers experience their new professional roles as case managers within Embrace, a person-centered and integrated-care service for community-living older adults.

Methods: We performed a qualitative study consisting of in-depth interviews with case managers (district nurses, n = 6; social workers, n = 5), using a topic-based interview guide. Audiotaped interviews were transcribed verbatim and analyzed using qualitative content analysis.

Results: The experiences of the case managers involved four major themes: 1) the changing relationship with older adults, 2) establishing the case-manager role, 3) the case manager's toolkit, and 4) the benefits of case management. Within these four themes, subthemes addressed the shift to a person-centered approach, building a relationship of trust, the process of case management, knowledge and experience, competencies of and requirements for case managers, and the differences in professional background.

Discussion: We found that this major change in role was experienced as a learning process, one that provided opportunities for personal and professional growth. Case managers felt that they were able to make a difference, and found their new roles satisfying and challenging, although stressful at times. Ongoing training and support were found to be a prerequisite in helping to shift the focus towards person-centered and integrated care.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aging
  • Attitude of Health Personnel
  • Case Managers* / education
  • Case Managers* / psychology
  • Delivery of Health Care, Integrated* / methods
  • Humans
  • Interviews as Topic
  • Learning
  • Long-Term Care / psychology
  • Middle Aged
  • Models, Theoretical
  • Nurses* / psychology
  • Patient Care Team
  • Patient-Centered Care* / methods
  • Professional Role
  • Qualitative Research
  • Social Workers* / education
  • Social Workers* / psychology

Grants and funding

This study was part of the Dutch National Care for the Elderly Program and funded by The Netherlands Organization for Health Research (ZonMw), file number 314010201, and the Dutch Healthcare Authority (NZA), file number 300-1021 that funded the professionals. ZonMw and NZA had no role in study design, data collection, data analysis, data interpretation, writing of the manuscript, or the decision to submit the manuscript for publication.