Self care and case management in long term conditions: the effective management of critical interfaces

The purpose of the proposed research is to explore the role of self care within the NHS and social care model for improving care for people with long term conditions. A number of issues related to the effective implementation of self care and case management (subsequently referred to as NHS case management) are evident in the literature and integral to the proposed study. These include: method of patient identification; case mix and case load size; patient education; the skill mix and qualifications of case managers; their location; links with general practitioners; patient education; and the interface with other components of the care system. This study seeks to investigate these areas further and has four aims. - To map current provision of NHS case management services in primary care for people with long term conditions; - To identify the extent and nature of self care initiatives within this service; - To classify programmes on observable features of case management implementation with particular focus upon the integration of care between primary and secondary care and between health and social care; - To investigate the role of self care initiatives as determinants of entry and, particularly, exit to the services. A mixed method approach to data collection will be employed comprising a literature review, postal questionnaire and interviews by staff based in the PSSRU at the University of Manchester. In addition to the stakeholder involvement described below a number of consultant / advisors, including a number of patient representatives, will be involved at key stages in the research process. A national survey of NHS case management arrangements and self care support arrangements will be undertaken covering all Primary Care Trusts in England. Key characteristics of this service will be identified from the literature and their relevance confirmed or not with managers within the service, prior to development of the questionnaires. Analysis of the findings will permit variations in NHS case management arrangements to be identified, links with self care clarified and services compared with existing data on care management arrangements, care co-ordination for vulnerable adults and older people living at home provided by local authorities. Services that undertake NHS case management in demonstrably different ways will be explored further by interviews with service managers. These will be selected by the characteristics of the service they provide, its potential to contribute to the understanding of NHS case management arrangements and the role of self care within this process. Not only will this approach permit checking of the validity and relevance of the empirical data collected on these two important new initiatives relating to the care of people with long term conditions, but will permit a detailed understanding of the nature of different approaches to the relationship between case management and self care support. User evaluation of the perceived merits and demerits of the different approaches will be sought. It is anticipated that this research will contribute to the development of NHS case management by providing new information about the arrangements which are developing and how they mesh with self care initiatives and other allied services. It is expected that these findings will assist in service design and re-configuration thereby helping to achieve cost savings on inappropriate hospital admissions and improve the patient experience.