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Case managers within general practices in 11 Western countries: repeat cross-sectional studies.

Romane Berret1, Nicolas Senn1, Hubert Maisonneuve2

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The use of case managers in general practitioner practices is increasing across Western countries, particularly in rural and larger practices. Their implementation is linked to practice characteristics, not physician age or sex.

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Area of Science:

  • Primary Care Research
  • Health Services Research
  • Health Policy

Background:

  • Primary care reform is essential due to an aging population and rising healthcare demands.
  • New models, including case managers in general practices, are emerging.
  • Case managers play a role in monitoring and managing care for patients with chronic conditions.

Purpose of the Study:

  • To determine the frequency of case managers in general practices across eleven Western countries from 2012 to 2019.
  • To identify general practitioner and practice characteristics associated with case manager frequency.

Main Methods:

  • Secondary analysis of the Commonwealth Fund International Health Policy Surveys of Primary Care Physicians (2012, 2015, 2019).
  • Inclusion of random samples of general practitioners from 11 Western countries (totaling over 35,000 physicians).
  • Mixed-effects logistic regression analysis to assess the association between practice characteristics and case manager use.

Main Results:

  • Case manager frequency in general practices increased overall between 2012 and 2019, with significant country-level variation.
  • Practices in small towns (OR 1.4) and rural areas (OR 1.9) reported higher case manager use compared to urban settings.
  • Larger practices (higher quartiles of full-time equivalent employees) showed significantly greater use of case managers (Q4 OR 3.8).

Conclusions:

  • Case manager implementation in general practices is a developing and increasing trend in Western countries.
  • Practice location (rural/small town) and size are significantly associated with case manager frequency.
  • Personal characteristics of general practitioners, such as age and sex, were not found to be significant factors in case manager adoption.