Doctors' assistants' views of case management to improve chronic heart failure care in general practice: a qualitative study.
OBJECTIVE
This paper is a report of a study to explore the views, concerns and experiences of doctors' assistants of case management for patients with chronic heart failure, while experiencing the new role of being a case manager within the Heidelberg Integrated Case Management trial.


BACKGROUND
Case management is being investigated as part of a randomised controlled trial aiming to improve care for patients with chronic systolic heart failure. In a complex, multifaceted intervention, trained doctors' assistants (equivalent to a nursing role) adopted new tasks using standardised case management involving telephone monitoring, home visits and diagnostic screening.


METHODS
In April 2007, 3 months after implementation of the intervention programme, 27 doctors' assistants participated in four focus group interviews discussing their views on, and experiences of, case management. Thematic analysis of the data was undertaken.


RESULTS
Participants believed that the most positive factors in case management were about interaction with patients, including opportunities for identifying disease and psychosocial problems. However, barriers included lack of time allocated to perform case management in addition to their normal role and poor cooperation within the practice team. According to the doctors' assistants, the routine implementation of case management was acceptable, feasible and effective in improving the management of patients with chronic systolic heart failure.


CONCLUSIONS
Case management enhanced the role of doctors' assistants, leading to increased awareness of the perspective of patients with chronic disease. In the wider international primary care practice nursing context, the orchestrated delegation of tasks using specific case management may be a promising strategy for improving the quality of care of chronically ill patients and enabling patient self-management.
Olbort
Rebecca
R
Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany.
Mahler
Cornelia
C
Campbell
Stephen
S
Reuschenbach
Bernd
B
Müller-Tasch
Thomas
T
Szecsenyi
Joachim
J
Peters-Klimm
Frank
F
D000328:Adult; D001291:Attitude of Health Personnel; D019090:Case Management / Q000458:organization & administration / Q000592:standards*; D002908:Chronic Disease; D005194:Family Practice; D005260:Female; D017144:Focus Groups; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D010823:Physician Assistants / Q000458:organization & administration*; D036301:Qualitative Research; D011788:Quality of Life; D055815:Young Adult