This review has explored five questions relating to nurse case management and self-care support. The principal findings are summarised below in relation to these questions.
2.5.1 How is nurse case management for long-term conditions
implemented?
Nurse case management for people with long-term conditions is variably implemented. Based on the studies reviewed in section one, there was often insufficient detail for us to understand how the core tasks and components were operationalised. Nurse case management was implemented by case managers undertaking key tasks such as assessment, care planning and implementation of the care plan. Some studies also reported a focus on monitoring and reviews. Implementation could also vary in terms of therapeutic interventions, illness management and care co-ordination, in addition to target client groups and available services. The variability between studies reflected different models of care, in addition to local implementation issues such as target client groups and the range of services at the disposal of the case manager.
2.5.2 How are self-care support interventions implemented?
The literature reviewed in section two (part two) showed that self-careinterventions are most commonly delivered using patient education, consisting of a combination of written materials and teaching sessions. Psychological intervention
Queen's Printer and Controller of HMSO 2010 72 was an additional feature aiming to promote relaxation and alleviating anxiety and depression. Delivery can take a multi-disciplinary approach or can use trained volunteers with experiential knowledge and can be condition specific or general for example, the Expert Patient Programme.
2.5.3 What impact do self-care support interventions have for
people with long-term conditions?
The findings of previous reviews section two (part one) showed modest evidence of benefit from self-care interventions. These findings were supported by the UK research evidence, section two (part two) showing that most interventions have modest improvements in at least one self-care related outcome. Improved outcomes tended to be in self efficacy, knowledge of illness and physical
functioning. The use of groups may have unplanned benefits of providing informal social support and shared knowledge.
2.5.4 How is self-care supported within, or as a consequence of,
case management interventions?
Although a feature of most studies reviewed in section three, self-care support within the nurse case management interventions tended to be less formalised, more individualised and delivered one-to-one in the home. The most common activity was that of patient education mostly delivered on an individual basis and supported by some form of curriculum. This education could also include medication and appointment management. Psychological support for both patients and their carers played an additional role in both assessing and providing support.
2.5.5 What impact does case management have upon self-care?
It is not possible to draw firm conclusions from the case management intervention studies reviewed in section three, as few self-care related outcomes weremeasured. Health service usage was measured by nearly all the nurse case management studies with just over a third involving self-care support showing a decrease in service use. A larger proportion of nurse case management studies had significant effects on treatment adherence which may be due to the comprehensive nature of the intervention.
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Chapter 3 Method
This study was commissioned to explore the NHS and social care model for
improving care for people with long-term conditions with a particular focus on the role of self-care support services. As noted in the introduction, it had three aims. First, to map current provision of NHS case management services in primary care for people with long-term conditions. Second, to classify approaches to case
management implementation, focussing on integration of care between primary and secondary care and between health and social care. Third, to identify the extent and nature of self-care initiatives within this service and to investigate their links with entry to and exit from it. An application was made to the National Research Ethics Service for ethical review of the study and it received a favourable opinion on the 7th September 2007 from the Cambridgeshire 4 Research Ethics Committee
(Number: 07H0305/59).
The collection and analysis of the data are described in this chapter. Both qualitative and quantitative approaches were used and the data collection comprised four elements:
A survey of case management for people with long-term conditions and self- care services.
A comparison of this data with previous studies of care management undertaken by the Personal Social Services Research Unit.
Case studies of long-term conditions services in four primary care trusts. Service user perspectives on the relative merits of different approaches to case management and self-care services
This work was informed by the three part literature review reported by Chapter two of which a detailed methodology for each part is described alongside the findings. In developing the methodology two concepts central to the case management literature, integration and differentiation, were important. English policy guidance envisaged that case management for people with long-term conditions would be provided within in an integrated care system, spanning primary and secondary healthcare and local authority social care services. Within this model it was envisaged that there would be a range of services, providing the opportunity to deliver different levels of care to patients a variety of needs. In the context of case management this constitutes a differentiated approach.