Implementing a Case Management Program Designed to Enhance Primary Care Physician Practice With Older Persons

Abstract

A qualitative analysis of the implementation of a case management program is presented. This collaborative research design uses semistructured interviews and observational field methods. Nested within a changing health care environment and a corporation that is restructuring, three physician practices form the intervention sites. During the course of the project there is high turnover among project staff and physicians. This analysis begins with the intervention in which case managers mobilize resources, monitor medication and health care compliance, educate elderly participants and physicians, counsel participants, and provide caregiver support and follow-up. Adjusting to and defining the case management role, structuring supervision and nurturing the intervention, and communicating (both written and face-to-face) with diverse physicians are ongoing tasks throughout project development. The importance of clear communication, the need for great flexibility, and the search to maintain project integrity (keeping sight of the intervention) emerge as critical themes.

Get full access to this article

View all access options for this article.

References

Abramson, J. S. ,& Mizrahi, T. (1996). When socialworkers and physicians collaborate: Positive and negative interdisciplinary experiences. Social Work, 41(3), 270-281.

Anker-Unnever, L. , & Netting, F. E. (1995). Coordinated care partnership: Case management with physician practices. Journal of Case Management, 49(1), 3-8.

Applebaum, R. ,& Austin, C. (1990). Long-term care case management: Design and evaluation. New York: Springer.

Azzarto, J. (1993). The socioemotional needs of elderly family practice patients: Can social workers help? Health and Social Work, 18, 40-48.

Capitman, J. A. , Haskins, B. , & Bernstein, J. (1986). Case management approaches in coordinated community-oriented long-term care demonstrations. The Gerontologist, 26(4), 398-404.

Gerber, L. S. (1994). Case management models: Geriatric nursing prototypes for growth. Journal of Gerontological Nursing, 20, 18-24.

Geron, S. M. ,& Chassler, D. (1994). Guidelines for case management practice across the longterm care continuum. Bristol, CT: Connecticut Community Care, Inc.

Institute of Medicine . (1996). Primary care: America's health in a new era. Washington, DC: National Academy Press.

Kane, R. A. , Penrod, J. D. ,& Kivnick, H. Q. (1994). Case managers discuss ethics: Dilemmas of an emerging occupation in long-term care in the United States. Journal of Case Management, 3(1), 3-12.

10.

Kaufman, S. R. (1995). Decision making, responsibility, and advocacy in geriatric medicine: Physician dilemmas with elderly in the community. The Gerontologist, 35(4), 481-488.

11.

Lamb, G. S. , & Stempel, J. E. (1994). Nurse case management from the client's view: Growing as insider-expert. Nursing Outlook, 42, 7-13.

12.

Like, R. C. (1988). Primary care case management: A family physician's perspective. ORB, 14, 174-178.

13.

Loomis, J. F. (1987). Case management in health care. Health and Social Work, 13, 219-225.

14.

Mark, D. M. , Gottlieb, M. S. , Zellner, B. B. , Chetty, V. K. , & Midtling, J. E. (1996). Medicare costs in urban areas and the supply of primary care physicians. Journal of Family Practice, 43, 33-39.

15.

Miles, M. B. , & Huberman, A. M. (1994). Qualitative data analysis(2nd ed.). Thousand Oaks, CA: Sage.

16.

Mizrahi, T. ,& Abramson, J. S. (1994). Collaboration between socialworkers and physicians: An emerging typology. In E. Sherman & W. J. Reid (Eds.), Qualitative research in social work (pp. 135-151). New York: Columbia University Press.

17.

Netting, F. E. ,& Williams, F. G. (1996). Case manager-physician collaboration: Implications for professional identity, roles, and relationships. Health and Social Work, 21(3), 216-224.

18.

Norris, M.K.G. , & Hill, C. (1991). The clinical nurse specialist: Developing the case manager role. Dimensions of Critical Care Nursing, 10(6), 346-353.

19.

Radecki, S. E. , Kane, R. L. , Solomon, D. H. , Mendenhall, R. C. ,& Beck, J. C. (1988). Are physicians sensitive to the special problems of older patients? Journal of the American Geriatrics Society, 36, 719-725.

20.

Weiss, L. J. , & Blustein, J. (1996). Faithful patients: The effects of long-term physician-patient relationships on the cost and use of health care by older Americans. American Journal of Public Health, 86, 1742-1747.

21.

White, M. , Gundrum, G. , Shearer, S. , & Simmons, W. J. (1994). A role for case managers in the physician office. Journal of Case Management, 3(2), 62-68.