title: Barriers to implementation of case management for patients with dementia: a systematic mixed studies review.
abstract: OBJECTIVE
  Results of case management designed for patients with dementia and their caregivers in community-based primary health care (CBPHC) were inconsistent. Our objective was to identify the relationships between key outcomes of case management and barriers to implementation.
  
  
  METHODS
  We conducted a systematic mixed studies review (including quantitative and qualitative studies). Literature search was performed in MEDLINE, PsycINFO, Embase, and Cochrane Library (1995 up to August 2012). Case management intervention studies were used to assess clinical outcomes for patients, service use, caregiver outcomes, satisfaction, and cost-effectiveness. Qualitative studies were used to examine barriers to case management implementation. Patterns in the relationships between barriers to implementation and outcomes were identified using the configurational comparative method. The quality of studies was assessed using the Mixed Methods Appraisal Tool.
  
  
  RESULTS
  Forty-three studies were selected (31 quantitative and 12 qualitative). Case management had a limited positive effect on behavioral symptoms of dementia and length of hospital stay for patients and on burden and depression for informal caregivers. Interventions that addressed a greater number of barriers to implementation resulted in increased number of positive outcomes. Results suggested that high-intensity case management was necessary and sufficient to produce positive clinical outcomes for patients and to optimize service use. Effective communication within the CBPHC team was necessary and sufficient for positive outcomes for caregivers.
  
  
  CONCLUSIONS
  Clinicians and managers who implement case management in CBPHC should take into account high-intensity case management (small caseload, regular proactive patient follow-up, regular contact between case managers and family physicians) and effective communication between case managers and other CBPHC professionals and services.
authors.affiliation: Department of Family Medicine, McGill University, Montreal, Canada.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Khanassov
authors.affiliation: Department of Family Medicine, McGill University, Montreal, Canada isabelle.vedel@mcgill.ca.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vedel
authors.affiliation: Department of Family Medicine, McGill University, Montreal, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pluye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000458:organization & administration; D019090:Case Management / Q000458:organization & administration*; D003704:Dementia / Q000175:diagnosis / Q000628:therapy*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D011792:Quebec; D016032:Randomized Controlled Trials as Topic
keywords: case management; community-based primary health care; configurational comparative method; dementia; systematic mixed studies review