title: Case management in primary palliative care is associated more strongly with organisational than with patient characteristics: results from a cross-sectional prospective study.
abstract: BACKGROUND
  Case managers have been introduced in Dutch primary palliative care; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner and home care nurses. This study aims to describe support and investigate what characteristics of patients and the organizational setting are related to the number of contacts and to the number of times topics are discussed between the case manager and patients and/or informal carers.
  
  
  METHODS
  Prospective study following cancer patients (n = 662) receiving support from a palliative care case manager in Dutch primary care, using registration forms filled out by the case manager after contact with the patient and/or informal carer. In backward linear regression, the association was studied between patient or organizational characteristics and the number of contacts and the number of times conversation topics were discussed.
  
  
  RESULTS
  Organizational characteristics add more to explained variability in data than patient characteristics. Case managers provide support in a flexible manner with regard to the number, mode, persons present, and duration of contacts. Support covered all domains of palliative care, with most attention given to physical complaints, life expectancy and psychological aspects.
  
  
  CONCLUSIONS
  Support offered by the case managers is prompted by characteristics of the organization for which they work. This is contradictory to the idea of patient centered care highly valued in palliative care.
authors.affiliation: Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. eol@vumc.nl.|Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. eol@vumc.nl.
authors.forename: Annicka Gm
authors.initials: AG
authors.lastname: van der Plas
authors.affiliation: Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. a.francke@vumc.nl.|Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. a.francke@vumc.nl.|NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands. a.francke@vumc.nl.
authors.forename: Anneke L
authors.initials: AL
authors.lastname: Francke
authors.affiliation: Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Kris.Vissers@radboudumc.nl.
authors.forename: Kris C
authors.initials: KC
authors.lastname: Vissers
authors.affiliation: Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. WJJ.Jansen@vumc.nl.|Department of Anaesthesiology, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. WJJ.Jansen@vumc.nl.
authors.forename: Wim Jj
authors.initials: WJ
authors.lastname: Jansen
authors.affiliation: Vrije Universiteit Brussel and Ghent University, End-of-Life Care Research Group, Laarbeeklaan 103, B-1090, Brussels, Belgium. Luc.deliens@vub.ac.be.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. b.philipsen@vumc.nl.|Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. b.philipsen@vumc.nl.
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D019090:Case Management / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D009426:Netherlands; D010166:Palliative Care / Q000458:organization & administration* / Q000523:psychology*; D011446:Prospective Studies