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Open Access Research article

Case management for frail older people – a qualitative study of receivers’ and providers’ experiences of a complex intervention

Magnus Sandberg12*, Ulf Jakobsson34, Patrik Midlöv34 and Jimmie Kristensson12

Author Affiliations

1 Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, Lund SE-221 00, Sweden

2 The Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, P.O. Box 187, Lund SE-221 00, Sweden

3 Center for Primary Health Care Research, Faculty of Medicine, Lund University, Malmö SE-205 02, Sweden

4 Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, Malmö SE-205 02, Sweden

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BMC Health Services Research 2014, 14:14  doi:10.1186/1472-6963-14-14

Published: 10 January 2014

Abstract

Background

Case management interventions have been widely used in the care of frail older people. Such interventions often contain components that may act both independently of each other and interdependently, which makes them complex and challenging to evaluate. Qualitative research is needed for complex interventions to explore barriers and facilitators, and to understand the intervention’s components. The objective of this study was to explore frail older people's and case managers’ experiences of a complex case management intervention.

Methods

The study had a qualitative explorative design and interviews with participants (age 75-95 years), who had received the case management intervention and six case managers who had performed the intervention were conducted. The data were subjected to content analysis.

Results

The analysis gave two content areas: providing/receiving case management as a model and working as, or interacting with, a case manager as a professional. The results constituted four categories: (1 and 2) case management as entering a new professional role and the case manager as a coaching guard, as seen from the provider’s perspective; and (3 and 4) case management as a possible additional resource and the case manager as a helping hand, as seen from the receiver’s perspective.

Conclusions

The new professional role could be experienced as both challenging and as a barrier. Continuous professional support is seemingly needed for implementation. Mutual confidence and the participants experiencing trust, continuity and security were important elements and an important prerequisite for the case manager to perform the intervention. It was obvious that some older persons had unfulfilled needs that the ordinary health system was unable to meet. The case manager was seemingly able to fulfil some of these needs and was experienced as a valuable complement to the existing health system.

Keywords:
Case management; Frail elderly; Intervention studies; Qualitative evaluation