Introducing case management for people with dementia in primary care: a mixed-methods study.
Steve Iliffe, Louise Robinson, Claire Bamford, Amy Waugh, Chris Fox, Gill Livingston, Jill Manthorpe, Pat Brown, Barbara Stephens, Katie Brittain, Carolyn Chew-Graham, Cornelius Katona, CAREDEM research team
Author Information
Steve Iliffe: Department of Primary Care & Population Health, University College London, London.
Louise Robinson: University of Newcastle Institute for Ageing, Newcastle upon Tyne.
Claire Bamford: University of Newcastle Institute for Ageing, Newcastle upon Tyne.
Amy Waugh: Mental Health Sciences Unit, University College London, London.
Chris Fox: Norwich Medical School, University of East Anglia, Norwich.
Gill Livingston: Mental Health Sciences Unit, University College London, London.
Jill Manthorpe: Social Care Workforce Research Unit, King's College London, London.
Pat Brown: Dementia UK, London.
Barbara Stephens: Dementia UK, London.
Katie Brittain: University of Newcastle Institute for Ageing, Newcastle upon Tyne.
Carolyn Chew-Graham: Primary Care and Health Sciences, Keele University, Keele.
Cornelius Katona: Mental Health Sciences Unit, University College London, London.
BACKGROUND: Case management may be a feasible solution to the problem of service fragmentation for people with dementia. AIM: To adapt a US model of primary care-based case management for people with dementia and test it in general practice. DESIGN AND SETTING: Mixed-methodology case studies of case management implementation in four general practices: one rural, one inner-city, and two urban practices. Practice nurses undertook the case manager role in the rural and inner-city practices, and were allocated one session per week for case management by their practices. A seconded social worker worked full time for the two urban practices. METHOD: Participants were community-dwelling patients with dementia who were living at home with a family carer, and who were not receiving specialist care coordination. Case study methods included analysis of case loads and interviews with patients, carers, local NHS and other stakeholders, and case managers. Measures included numbers of patients with dementia and their carers, number of unmet needs identified, and actions taken to meet needs. Case manager records were compared with findings from interviews with patients and carers, and with other stakeholders. RESULTS: The number of eligible patients was smaller than expected. No practice achieved its recruitment target. Researchers identified more unmet needs than case managers. The practice nurse case managers reported lack of time and found research documentation burdensome. Patients and carers were positive about case management as a first point of contact with the practice, as a 'safety net', and for creating a one-to-one therapeutic relationship. CONCLUSION: Further investigation is required before case management for people with dementia and their carers can be implemented in primary care.
