title: Case managers and physicians: communication and perceived problems.
abstract: OBJECTIVE
  To describe case managers' perceptions of the physician-case manager relationship.
  
  
  METHODS
  A qualitative field study using in-depth open-ended interviews was used to elicit case managers' experiences and practices. A multidisciplinary team analyzed transcripts using an adaptation of the "grounded theory" approach of Glaser and Strauss.
  
  
  METHODS
  Case managers were selected for interview using a maximum variation sampling strategy within an established state-wide case management agency.
  
  
  METHODS
  Transcript analysis allowed for the organization of observations into themes, which were merged across interviews to generate theses.
  
  
  RESULTS
  Case managers report that: (1) The case manager role is poorly understood by physicians. (2) Physicians lack insight into the social and environmental aspects of home-bound elderly people. (3) Access to physician services is often difficult to obtain. (4) Power struggles occasionally surface in care planning. (5) Decisions by physicians and case managers regarding the care of frail elderly are often made from different agenda.
  
  
  CONCLUSIONS
  From the perspective of case managers, gaps in interprofessional communication may hinder the optimal care of frail elderly individuals.
authors.affiliation: Uncas on Thames Hospital, Norwich, CT.
authors.forename: M
authors.initials: M
authors.lastname: Feltes
authors.forename: T
authors.initials: T
authors.lastname: Wetle
authors.forename: E
authors.initials: E
authors.lastname: Clemens
authors.forename: B
authors.initials: B
authors.lastname: Crabtree
authors.forename: D
authors.initials: D
authors.lastname: Dubitzky
authors.forename: M
authors.initials: M
authors.lastname: Kerr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D003153:Community Health Services / Q000458:organization & administration; D003220:Conflict, Psychological; D003237:Connecticut; D005260:Female; D016330:Frail Elderly; D006297:Health Services Accessibility; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000592:standards*; D010344:Patient Advocacy; D010347:Patient Care Planning / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D010820:Physicians / Q000523:psychology*; D011209:Power, Psychological; D012380:Role; D012494:Sampling Studies; D012947:Social Work / Q000592:standards*