Case management of individuals with long-term conditions by community matrons: report of qualitative findings of a mixed method evaluation

• Published in: Primary health care research & development 2014-01, Vol.15 (1), p.26-37
• Main Authors: Randall, Sue, Daly, Guy, Thunhurst, Colin, Mills, Natalie, Guest, David A., Barker, Annette
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Caregivers - psychology; Case management; Case Management - organization & administration; Case Management - standards; Case Management - trends; Community Health Nursing - organization & administration; Community Health Nursing - standards; Community Health Nursing - trends; Comorbidity; Demography; Hospitals; Humans; Interviews as Topic; Long-Term Care - organization & administration; Long-Term Care - standards; Long-Term Care - trends; Nurse's Role; Nurse-Patient Relations; Patient admissions; Patient Readmission - trends; Patient Satisfaction; Program Evaluation; Qualitative Research; Quality of Health Care; Quality of Life; Studies; United Kingdom; Working hours
• ISSN: 1463-4236; 1477-1128
• DOI: 10.1017/S1463423612000667

To consider findings from a study that evaluated case management of individuals with long-term conditions (LTCs) by a community matron (CM) service. The paper highlights issues related to the implementation of a new role and the impact this had on the experience of care across hospital and community settings for patients and their carers. The introduction of the role of CM was intended to increase effective management of patients with complex comorbid LTCs through the introduction of case management, thereby reducing unplanned hospital admissions. The overall methodological approach was one of mixed methods. This paper reports the qualitative findings from CMs (n = 15); patients (n = 13); family carers (n = 8); and secondary care staff who interface with the CM service (n = 7). Data were collected between October 2009 and May 2010. A thematic analysis resulted in the identification of four themes: (1) visibility; (2) interpersonal relationships; (3) leadership; and (4) systems/professional boundaries. Patients enjoyed being seen as a whole and family carers appreciated the coordination aspect of the role. Difficulties arose from the limited understanding of the CM role and from a lack of a shared vision across healthcare professionals concerning the role and its goals.