The work of case managers as experienced by older persons (75+) with multi-morbidity - a focused ethnography.

Markus Hjelm,Jimmie Kristensson,Doris Bohman,Göran Holst,Ania Willman

doi:10.1186/s12877-015-0172-3

Markus Hjelm, Jimmie Kristensson + Show 3 more

Open Access

https://doi.org/10.1186/s12877-015-0172-3

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Abstract

BackgroundComplex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care. Case management could be one way to address this difficulty. Currently, there is a need to extend the knowledge regarding case management as experienced by those utilising the services, namely older persons (75+) with multi-morbidity. The study aimed to explore older persons’ (75+) with multi-morbidity experiences of case managers.MethodsThe study design was qualitative and used a focused ethnographic approach. Data was collected through individual interviews with 13 older persons and by participant observations with accompanying field notes, all conducted in 2012–2013.ResultsThe data revealed four themes illustrating the older persons’ experiences of case managers:1) Someone providing me with a trusting relationship; 2) Someone assisting me; 3) Someone who is on my side; and 4) Someone I do not need at present.ConclusionsThis study illustrates the importance of establishing trusting relationships between older persons and their case managers in order to truly provide assistance. The older persons valued the case managers acting as informed but unbiased facilitators. The findings could be of help in the development of case management interventions better designed for older persons with multi-morbidity.

Highlights

Complex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care
Case management aims to improve the coordination of health and social care, with the case management interventions being performed by case managers [6]
The findings originate from the ethnographic analysis describing how older persons (75+) with multi-morbidity experienced case managers

Summary

Introduction

Complex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care. Older persons with multi-morbidity i.e. multiple independent diseases, are at risk of receiving fragmented care because of complex health systems [1,2,3,4,5]. Studies suggest that older persons with multimorbidity can experience difficulty feeling involved in their own care because of poor care coordination and a high waiting time [16, 17]. They are at risk of experiencing difficulties when coordinating care efforts, which could lead to a lack of continuity of care [1, 4]. To reduce the fragmentation of care, it has become increasingly important to develop, evaluate and gain knowledge about different models aimed at improving continuity of care [2], with one such example being case management

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