Case management by nurses in primary care: analysis of 73 'success stories'

There is interest as to whether case management reduces unplanned patient admission to hospital. However, very little is known about how the intervention is delivered and what the most salient outcome measures are.

Qualitative study embedded in a wider evaluation.

Primary health care.

Analysis of case manager case reports in a service innovation evaluation study.

Case management provides home-based care to frail elderly patients using a process of assessment and medication review. This often leads to new diagnoses, to the co-ordination of further care and the tailoring of services to suit the needs of individuals. The benefits reported are complex and relate to improving a patient's quality of life more than the prevention or otherwise of admission to hospital. The type of attention provided by these roles seems to be absent from current NHS arrangements. The role enables time to be spent assessing the individual needs of patients who live at the margins of independent living.

The case managers describe having the time and the skills to assess a mix of clinical and social problems, and then accessing the correct networks to help elderly people with multiple illnesses navigate a complex system of providers. More weight should be given to the ability of this intervention to result in improved quality of life for patients, and to the investigation of costs and benefits.