Nurse-led case management for community dwelling older people: an explorative study of models and costs.

Autor: Gage H; Department of Economics, University of Surrey, Guildford, UK. h.gage@surrey.ac.uk, Ting S, Williams P, Drennan V, Goodman C, Iliffe S, Manthorpe J, Davies SL, Masey H
Jazyk: angličtina
Zdroj: Journal of nursing management [J Nurs Manag] 2013 Jan; Vol. 21 (1), pp. 191-201. Date of Electronic Publication: 2012 May 07.
DOI: 10.1111/j.1365-2834.2012.01379.x
Abstrakt: Aim:   To compare community matrons with other nurses carrying out case management for impact on service use and costs.
Background:   In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions.
Methods:   Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries.
Results:   Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors.
Conclusion:   Further research on cost-effectiveness of case management models is required.
Implications for Nursing Management:   The case for continued investment in community matrons remains to be proven.
(© 2012 Blackwell Publishing Ltd.)
Databáze: MEDLINE
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