title: Case management for frail older people - a qualitative study of receivers' and providers' experiences of a complex intervention.
abstract: BACKGROUND
  Case management interventions have been widely used in the care of frail older people. Such interventions often contain components that may act both independently of each other and interdependently, which makes them complex and challenging to evaluate. Qualitative research is needed for complex interventions to explore barriers and facilitators, and to understand the intervention's components. The objective of this study was to explore frail older people's and case managers' experiences of a complex case management intervention.
  
  
  METHODS
  The study had a qualitative explorative design and interviews with participants (age 75-95 years), who had received the case management intervention and six case managers who had performed the intervention were conducted. The data were subjected to content analysis.
  
  
  RESULTS
  The analysis gave two content areas: providing/receiving case management as a model and working as, or interacting with, a case manager as a professional. The results constituted four categories: (1 and 2) case management as entering a new professional role and the case manager as a coaching guard, as seen from the provider's perspective; and (3 and 4) case management as a possible additional resource and the case manager as a helping hand, as seen from the receiver's perspective.
  
  
  CONCLUSIONS
  The new professional role could be experienced as both challenging and as a barrier. Continuous professional support is seemingly needed for implementation. Mutual confidence and the participants experiencing trust, continuity and security were important elements and an important prerequisite for the case manager to perform the intervention. It was obvious that some older persons had unfulfilled needs that the ordinary health system was unable to meet. The case manager was seemingly able to fulfil some of these needs and was experienced as a valuable complement to the existing health system.
authors.affiliation: Department of Health Sciences, Faculty of Medicine, Lund University, P,O, Box 157, Lund SE-221 00, Sweden. Magnus.Sandberg@med.lu.se.
authors.forename: Magnus
authors.initials: M
authors.lastname: Sandberg
authors.forename: Ulf
authors.initials: U
authors.lastname: Jakobsson
authors.forename: Patrik
authors.initials: P
authors.lastname: Midlöv
authors.forename: Jimmie
authors.initials: J
authors.lastname: Kristensson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D005260:Female; D016330:Frail Elderly; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D036301:Qualitative Research