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Main topics addressed by the experts on the first draft were: inclusion of informal caregivers (family, partner) in case management, communication and role delineation between the case manager and other health care professionals and the necessity of tailoring care to individual needs and wishes.
Coaching-on-the-job will be executed by the trainer during two consults between the case manager and a patient.
They reported that the relationship between the case manager and the older person was of paramount importance.
Discharge planning is done in collaboration between the case manager, a social worker, the patient, and the nurse and physician in charge at the ward.
Topics discussed between the case manager and the patient and informal carer should cover physical, emotional, and spiritual care needs of the patient.
Previous research [ 3, 16, 21, 23] emphasizes the importance of efficient collaboration between the case manager and other health professionals in the health system.
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Initially, collaboration between the case managers and the primary care physicians (PCPs) was seen more as a hierarchical relationship.
Several factors seemed to contribute to the difficulties case managers experienced in identifying unmet needs including the limited contacts between the case managers and patients and carers.
The studies by JM Nelson and P Arnold-Powers [ 12] and K Brown, K Stainer, J Stewart, R Clacy and S Parker [ 11] found that the relationship between the case managers (CM) and participants was highly valued.
Inclusion criteria: 1) The intervention should meet the criteria for CM which includes multidisciplinary collaboration, care co-ordination, and it should include in-person meetings between patient and the case manager aimed at supporting, informing and educating the patient.
We included papers on CM-like interventions that fulfilled all of the following inclusion criteria: 1) The intervention should meet the criteria for CM which includes multidisciplinary collaboration, care co-ordination, and it should include in-person meetings between patient and the case manager aimed at supporting, informing and educating the patient.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com