The experiences of care managers and rehabilitation coordinators of a primary care intervention to promote return to work for patients with common mental disorders: a qualitative study

Abstract Background In an earlier study, PRIM-CARE RCT, a care manager implementation at the primary care centre showed improved return to work and reduced sick leave for patients with CMD. To further improve return to work, the project Co-Work-Care added a person-centered dialogue meeting between the patient, the employer and the rehabilitation coordinator, preceded by an increased collaboration between care manager, rehabilitation coordinator and GP. In this first qualitative study of the Co-Work-Care project, we explored how care managers and rehabilitation coordinators experienced the Co-Work-Care model. The purpose of this study was to explore care managers’ and rehabilitation coordinators’ perceptions and experiences of a close collaboration and the use of the person-centred dialogue meeting. Methods From an ongoing RCT with 20 primary care centres, care managers (CMs) (n = 13) and rehabilitation coordinators (RCs) (n = 12) participated in a qualitative study with focus groups. The study was conducted in the primary health care in a Swedish region. The data was analysed with Systematic Text Condensation by Malterud. Results Seven codes describing the participants’ experiences of the Co-Work-Care model were identified: 1) The importance of collaboration at the primary care centre, 2) Collaboration and division of roles between the RC and the CM, 3) Collaboration with the General practitioner (GP), 4) The person-centred dialogue meeting, 5) Initiating the person-centred dialogue meeting, 6) The person-centred dialogue meeting to improve collaboration with the employer, and 7) The person-centred dialogue meeting to teach about the return to work process. Conclusion The increased collaboration within the Co-Work-Care model created a common picture and understanding of the patient’s situation. The person-centred dialogue meeting in the rehabilitation process became a bridge between the employer and the patient. Trial registration NCT03250026 (registered August 15, 2017).

Download Full-text

How can a care manager at the primary care centre support foreign‐born female patients suffering from common mental disorders? – An interview study

Scandinavian Journal of Caring Sciences ◽

10.1111/scs.13060 ◽

2021 ◽

Author(s):

Shabnam Nejati ◽

Irene Svenningsson ◽

Cecilia Björkelund ◽

Dominique Hange

Keyword(s):

Primary Care ◽

Mental Disorders ◽

Common Mental Disorders ◽

Interview Study ◽

Primary Care Centre ◽

Care Centre ◽

Foreign Born ◽

Care Manager ◽

Female Patients

Download Full-text

The care manager meeting the patients’ unique needs using the care manager model—A qualitative study of experienced care managers

BMC Family Practice ◽

10.1186/s12875-021-01523-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Irene Svenningsson ◽

Dominique Hange ◽

Camilla Udo ◽

Karin Törnbom ◽

Cecilia Björkelund ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Common Mental Disorders ◽

Controlled Trial ◽

Successful Outcome ◽

Comfort Zone ◽

Care Manager ◽

Care Managers ◽

Care And Support

Abstract Background Implementation of a care manager in a collaborative care team in Swedish primary care via a randomized controlled trial showed successful outcome. As four years have elapsed since the implementation of care managers, it is important to gain knowledge about the care managers’ long-term skills and experiences. The purpose was to examine how long-term experienced care managers perceived and experienced their role and how they related to and applied the care manager model. Method Qualitative study with a focus group and interviews with nine nurses who had worked for more than two years as care managers for common mental disorders. The analysis used Systematic Text Condensation. Results Four codes arose from the analysis: Person-centred; Acting outside the comfort zone; Successful, albeit some difficulties; Pride and satisfaction. The care manager model served as a handrail for the care manager, providing a trustful and safe environment. Difficulties sometimes arose in the collaboration with other professionals. Conclusion This study shows that long-term experience of working as a care manager contributed to an in-depth insight and understanding of the care manager model and enabled care managers to be flexible and act outside the comfort zone when providing care and support to the patient. A new concept emerged during the analytical process, i.e. the Anchored Care Manager, which described the special competencies gained through experience. Trial registration NCT02378272 Care Manager—Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM—CARE).

Download Full-text

Qualitative study of high-cost patients in an urban primary care centre

Chronic Illness ◽

10.1177/1742395310388673 ◽

2011 ◽

Vol 7 (2) ◽

pp. 107-119 ◽

Cited By ~ 4

Author(s):

William H Sledge ◽

Melissa Wieland ◽

David Sells ◽

David Walden ◽

Christine Holmberg ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Primary Care Centre ◽

Care Centre

Download Full-text

ABS66: Management of asthma in a primary care centre in Singapore based on the Chronic Care Model

Primary Care Respiratory Journal ◽

10.1016/j.pcrj.2006.04.160 ◽

2006 ◽

Vol 15 (3) ◽

pp. 203-203

Author(s):

Ngiap-Chuan Tan ◽

Mun Hong Chow

Keyword(s):

Primary Care ◽

Chronic Care Model ◽

Chronic Care ◽

Primary Care Centre ◽

Care Centre ◽

Care Model

Download Full-text

Implementation of a care manager organisation and its association with antidepressant medication patterns: a register-based study of primary care centres in Sweden

BMJ Open ◽

10.1136/bmjopen-2020-044959 ◽

2021 ◽

Vol 11 (3) ◽

pp. e044959

Author(s):

Christine Sandheimer ◽

Cecilia Björkelund ◽

Gunnel Hensing ◽

Kirsten Mehlig ◽

Tove Hedenrud

Keyword(s):

Primary Care ◽

Treatment Guidelines ◽

Common Mental Disorders ◽

Common Mental Disorder ◽

Antidepressant Medication ◽

Linear Mixed Effects ◽

Care Manager ◽

Defined Daily Doses ◽

Number Of Patients ◽

Mental Disorder Diagnosis

ObjectiveTo evaluate the implementation of a care manager organisation for common mental disorders and its association with antidepressant medication patterns on primary care centre (PCC) level, compared with PCCs without this organisation. Moreover, to determine whether a care manager organisation is associated with antidepressant medication patterns that is more in accordance with treatment guidelines.DesignRegister-based study on PCC level.SettingPrimary care in Region Västra Götaland, Sweden.ParticipantsAll PCCs in the region. PCCs were analysed in three subgroups: PCCs with a care manager organisation during 2015 and 2016 (n=68), PCCs without the organisation (n=92) and PCCs that shifted to a care manager organisation during 2016 (n=42).Outcome measuresProportion of inadequate medication users, defined as number of patients >18 years with a common mental disorder diagnosis receiving care at a PCC in the region during the study period and dispensed 1–179 defined daily doses (DDD) of antidepressants of total patients with at least 1 DDD. The outcome was analysed through generalised linear regression and a linear mixed-effects model.ResultsOverall, all PCCs had about 30%–34% of inadequate medication users. PCCs with a care manager organisation had significantly lower proportion of inadequate medication users in 2016 compared with PCCs without (−6.4%, p=0.02). These differences were explained by higher proportions in privately run PCCs. PCCs that shifted to a care manager organisation had a significant decrease in inadequate medication users over time (p=0.01).ConclusionsPublic PCCs had a more consistent antidepressant medication pattern compared with private PCCs that gained more by introducing a care manager organisation. It was possible to document a significant decrease in inadequate medication users, notwithstanding that PCCs in the region followed the guidelines to a comparatively high extent regardless of present care manager organisation.

Download Full-text

Creating a safety net for patients with depression in primary care; a qualitative study of care managers’ experiences

Scandinavian Journal of Primary Health Care ◽

10.1080/02813432.2018.1529018 ◽

2018 ◽

Vol 36 (4) ◽

pp. 355-362 ◽

Cited By ~ 7

Author(s):

Irene Svenningsson ◽

Camilla Udo ◽

Jeanette Westman ◽

Shabnam Nejati ◽

Dominique Hange ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Safety Net ◽

Care Managers

Download Full-text

Implementation of care managers for patients with depression: a cross-sectional study in Swedish primary care

BMJ Open ◽

10.1136/bmjopen-2019-035629 ◽

2020 ◽

Vol 10 (5) ◽

pp. e035629

Author(s):

Pia Augustsson ◽

Anna Holst ◽

Irene Svenningsson ◽

Eva-Lisa Petersson ◽

Cecilia Björkelund ◽

...

Keyword(s):

Primary Care ◽

Collaborative Care ◽

Qualitative Content Analysis ◽

Controlled Trial ◽

Cross Sectional Study ◽

Healthcare Management ◽

Sectional Study ◽

Cross Sectional ◽

Care Manager ◽

Care Managers

ObjectivesTo perform an analysis of collaborative care with a care manager implementation in a primary healthcare setting. The study has a twofold aim: (1) to examine clinicians’ and directors’ perceptions of implementing collaborative care with a care manager for patients with depression at the primary care centre (PCC), and (2) to identify barriers and facilitators that influenced this implementation.DesignA cross-sectional study was performed in 2016–2017 in parallel with a cluster-randomised controlled trial.Setting36 PCCs in south-west Sweden.ParticipantsPCCs’ directors and clinicians.OutcomeData regarding the study’s aims were collected by two web-based questionnaires (directors, clinicians). Descriptive statistics and qualitative content analysis were used for analysis.ResultsAmong the 36 PCCs, 461 (59%) clinicians and 36 (100%) directors participated. Fifty-two per cent of clinicians could cooperate with the care manager without problems. Forty per cent regarded to their knowledge of the care manager assignment as insufficient. Around two-thirds perceived that collaborating with the care manager was part of their duty as PCC staff. Almost 90% of the PCCs’ directors considered that the assignment of the care manager was clearly designed, around 70% considered the priority of the implementation to be high and around 90% were positive to the implementation. Facilitators consisted of support from colleagues and directors, cooperative skills and positive attitudes. Barriers were high workload, shortage of staff and extensive requirements and demands from healthcare management.ConclusionsOur study confirms that the care manager puts collaborative care into practice. Facilitators and barriers of the implementation, such as time, information, soft values and attitudes, financial structure need to be considered when implementing care managers at PCCs.

Download Full-text

216 Integrated Day Hospital for Older Persons in a Primary Care Centre

Age and Ageing ◽

10.1093/ageing/afz103.131 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Fiona McGrath ◽

Sarah Ronayne ◽

Karen McHugh ◽

Mary McDonnell ◽

Elnsari Muataz ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Older Persons ◽

Blood Pressure Monitoring ◽

Rapid Assessment ◽

Population Data ◽

Shared Vision ◽

Primary Care Centre ◽

Day Hospital ◽

Care Centre

Abstract Background To progress with integrated care, for older persons, it was proposed to establish a Day Hospital in a Primary Care Centre. Population data for Co Mayo shows the percentage of those over 65 years, (17.6%), to be significantly higher than the national average In 2018 there were 39,092 attendances to the Emergency Department and approximately 500, per month, were over 75 years. The aim was to develop a pathway from the Emergency Department to the Day Hospital for those 75 years and over who had experienced a fall. Additionally, this included an Early Supported Discharge for hip fracture patients. Methods The Day Hospital was operational 1 day per week with an allocation of funding for a Consultant, Occupational Therapist and assigned Project Manager. Holter and Blood pressure monitoring equipment was purchased. The Home First Team were reassigned to the front door of the hospital and worked with a cANP and a Medical Registrar. A weekly multi-disciplinary forum, inclusive of all stakeholders, developed working relationships, built a shared vision and standardised the approach for the patient cohort. Frailty training was provided specifically to Emergency Department staff. Results The Home First Team saw 541 patients (Jan-Apr 2019) and in collaboration with the Geriatrician streamed those suitable for management to primary care. The Integrated Day Hospital, 1 day per week (Jan-Apr 2019) delivered 55 new assessments plus follow-up appointments. Patient feedback is very positive and specifically highlights ease of access in primary care. Conclusion Establishing a Day Hospital in a Primary Care Centre is an innovative approach and shifts the focus of intervention from acute to primary care. The location is ideal due to a range of disciplines on site, PHN, Dietetics, Psychiatry This is the initial phase, with some pathways in place, and the overall aim is to provide GP access to rapid assessment in Primary Care and thus ensure hospital avoidance where possible.

Download Full-text