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      Effectiveness of a case management model for people with multimorbidity: Mixed methods study

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          Abstract

          Aims

          The aim was to determine the impact of a case management model on indicators of health service utilization, polypharmacy, quality of life and dependency of patients with multimorbidity, and family caregiver overload in a group of patients insured with two insurance companies in the city of Bogotá (Colombia).

          Design

          This was a mixed methods study, which integrated a quantitative and qualitative component.

          Methods

          The study was conducted between July 2019 and March 2020. A quantitative component is based on a pre‐experimental study with a single group and pre‐ and post‐test measurements. Patients with multimorbidity with a medium or high level of complexity were included in the study. A sample of 317 patients and their caregivers was estimated. Following the completion of the intervention, a descriptive study that explored the perspective of nurses, patients and caregivers was developed to better understand the process and results from their own words and experience. A total of 17 dyads of patients and caregivers were interviewed, as well as six nurse managers. The integration strategy was developed based on a comparison made from the perspective of multiple stakeholders.

          Results

          The model's impact on quality of life, particularly in terms of social functioning and mental health, has been documented. Caregiver overload was reduced and an improvement in the adoption of the role was observed, aspects that converge with the experience of the dyads and the caregivers in the support and backing provided by the model.

          Conclusion

          The intervention was structured in five modules: case detection, complexity screening, comprehensive assessment with various instruments, individualized care and follow‐up plan, and plan assessment. The nurse manager role is confirmed as that of a professional with the leadership capacity to articulate disciplines and actors, whilst also dealing with the day‐to‐day needs of people with complex health conditions.

          Impact

          A comprehensive and integrated approach to patients with multiple diseases in a health insurance context marked by access barriers and fragmentation of health services. The study provides quantitative and qualitative evidence of the benefits of the case management model in Colombia for patients with multiple diseases and their family caregivers, particularly in terms of the psychosocial dimensions of health‐related quality of life and dependence assessment. A significant impact on the caregiver role, as well as an improvement in perception and trust in the health system, was observed as a result of the overcoming of administrative barriers achieved by the nurse case manager. The findings are considered to be extremely useful for decision‐makers and insurers in developing a case management model focused on comprehensive and individualized care plans, as well as for individuals with multiple diseases and their caregivers.

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          Most cited references45

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          Naturalistic inquiry

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            Interventions for improving outcomes in patients with multimorbidity in primary care and community settings.

            Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions to improve outcomes for people with multimorbidity.
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              Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS).

              Patients with multimorbidity have complex health needs but, due to the current traditional disease-oriented approach, they face a highly fragmented form of care that leads to inefficient, ineffective, and possibly harmful clinical interventions. There is limited evidence on available integrated and multidimensional care pathways for multimorbid patients. An expert consensus meeting was held to develop a framework for care of multimorbid patients that can be applied across Europe, within a project funded by the European Union; the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). The experts included a diverse group representing care providers and patients, and included general practitioners, family medicine physicians, neurologists, geriatricians, internists, cardiologists, endocrinologists, diabetologists, epidemiologists, psychologists, and representatives from patient organizations. Sixteen components across five domains were identified (Delivery of Care; Decision Support; Self Management Support; Information Systems and Technology; and Social and Community Resources). The description and aim of each component are described in these guidelines, along with a summary of key characteristics and relevance to multimorbid patients. Due to the lack of evidence-based recommendations specific to multimorbid patients, this care model needs to be assessed and validated in different European settings to examine specifically how multimorbid patients will benefit from this care model, and whether certain components have more importance than others.
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                Author and article information

                Contributors
                (View ORCID Profile)
                (View ORCID Profile)
                Journal
                Journal of Advanced Nursing
                Journal of Advanced Nursing
                Wiley
                0309-2402
                1365-2648
                November 2022
                September 14 2022
                November 2022
                : 78
                : 11
                : 3830-3846
                Affiliations
                [1 ] Care Perspectives Group Fundación Universitaria de Ciencias de la Salud – FUCS Bogotá Colombia
                [2 ] Instituto de Evaluación Tecnológica en Salud – IETS Bogotá Colombia
                [3 ] Nursing Faculty Universidad Nacional de Colombia Bogotá Colombia
                [4 ] Compensar Salud Bogotá Colombia
                [5 ] Grupo Hospital de San José Investiga Sociedad de Cirugía de Bogotá – Hospital de San José Bogotá Colombia
                Article
                10.1111/jan.15417
                aa4633e6-97a7-4015-9096-df9234be7eb8
                © 2022

                http://onlinelibrary.wiley.com/termsAndConditions#vor

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