title: Introducing case management for people with dementia in primary care: a mixed-methods study.
abstract: BACKGROUND
  Case management may be a feasible solution to the problem of service fragmentation for people with dementia.
  
  
  OBJECTIVE
  To adapt a US model of primary care-based case management for people with dementia and test it in general practice.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Further investigation is required before case management for people with dementia and their carers can be implemented in primary care.
authors.affiliation: Department of Primary Care & Population Health, University College London, London.
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.affiliation: University of Newcastle Institute for Ageing, Newcastle upon Tyne.
authors.forename: Louise
authors.initials: L
authors.lastname: Robinson
authors.affiliation: University of Newcastle Institute for Ageing, Newcastle upon Tyne.
authors.forename: Claire
authors.initials: C
authors.lastname: Bamford
authors.affiliation: Mental Health Sciences Unit, University College London, London.
authors.forename: Amy
authors.initials: A
authors.lastname: Waugh
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich.
authors.forename: Chris
authors.initials: C
authors.lastname: Fox
authors.affiliation: Mental Health Sciences Unit, University College London, London.
authors.forename: Gill
authors.initials: G
authors.lastname: Livingston
authors.affiliation: Social Care Workforce Research Unit, King's College London, London.
authors.forename: Jill
authors.initials: J
authors.lastname: Manthorpe
authors.affiliation: Dementia UK, London.
authors.forename: Pat
authors.initials: P
authors.lastname: Brown
authors.affiliation: Dementia UK, London.
authors.forename: Barbara
authors.initials: B
authors.lastname: Stephens
authors.affiliation: University of Newcastle Institute for Ageing, Newcastle upon Tyne.
authors.forename: Katie
authors.initials: K
authors.lastname: Brittain
authors.affiliation: Primary Care and Health Sciences, Keele University, Keele.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.affiliation: Mental Health Sciences Unit, University College London, London.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Katona
mesh_terms: D019090:Case Management / Q000458:organization & administration*; D003704:Dementia / Q000628:therapy*; D058006:General Practice; D006801:Humans; D020380:Needs Assessment; D011320:Primary Health Care; D006113:United Kingdom
keywords: carers; case management; case studies; dementia; general practice; nursing, practice