"So at least now I know how to deal with things myself, what I can do if it gets really bad again"-experiences with a long-term cross-sectoral advocacy care and case management for severe multiple sclerosis: a qualitative study.

BACKGROUND: Persons with severe Multiple Sclerosis (PwsMS) face complex needs and daily limitations that make it challenging to receive optimal care. The implementation and coordination of health care, social services, and support in financial affairs can be particularly time consuming and burdensome for both PwsMS and caregivers. Care and case management (CCM) helps ensure optimal individual care as well as care at a higher-level. The goal of the current qualitative study was to determine the experiences of PwsMS, caregivers and health care specialists (HCSs) with the CCM. METHODS: In the current qualitative sub study, as part of a larger trial, in-depth semi-structured interviews with PwsMS, caregivers and HCSs who had been in contact with the CCM were conducted between 02/2022 and 01/2023. Data was transcribed, pseudonymized, tested for saturation and analyzed using structuring content analysis according to Kuckartz. Sociodemographic and interview characteristics were analyzed descriptively. RESULTS: Thirteen PwsMS, 12 caregivers and 10 HCSs completed interviews. Main categories of CCM functions were derived deductively: (1) gatekeeper function, (2) broker function, (3) advocacy function, (4) outlook on CCM in standard care. Subcategories were then derived inductively from the interview material. 852 segments were coded. Participants appreciated the CCM as a continuous and objective contact person, a person of trust (92 codes), a competent source of information and advice (on MS) (68 codes) and comprehensive cross-insurance support (128 codes), relieving and supporting PwsMS, their caregivers and HCSs (67 codes). CONCLUSIONS: Through the cross-sectoral continuous support in health-related, social, financial and everyday bureaucratic matters, the CCM provides comprehensive and overriding support and relief for PwsMS, caregivers and HCSs. This intervention bears the potential to be fine-tuned and applied to similar complex patient groups. TRIAL REGISTRATION: The study was approved by the Ethics Committee of the University of Cologne (#20-1436), registered at the German Register for Clinical Studies (DRKS00022771) and in accordance with the Declaration of Helsinki.

Experiences with long-term care for geriatric patients by an interprofessional outpatient care approach - a qualitative study.

BACKGROUND: Outpatient care for geriatric patients is complex and requires the collaboration of different professions for supporting long-term care. Care and case management (CCM) could provide support with that. The long-term care of geriatric patients could be optimized with an interprofessional, cross-sectoral CCM. Therefore, the aim of the study was to evaluate the experiences and attitudes of those involved in the care with regard to the interprofessional design of the care for geriatric patients. METHODS: A qualitative study design was used. Focus group interviews were conducted with those involved in the care (general practitioners (GP), health care assistants (HCA) as well as care and case managers (CM)). The interviews were digitally recorded, transcribed and analysed by qualitative content analysis. RESULTS: Overall, ten focus groups were conducted in the five practice networks with n = 46 participants (n = 15 GP, n = 14 HCA and n = 17 CM). The participants evaluated the care they received from a CCM positively. The HCA and the GP were the primary points of contact for the CM. The close collaboration with the CM was experienced to be rewarding and relieving. Through their home-visitations, the CM gained a deep insight into the homelives of their patients and were thus able to accurately reflect the gaps in the care back to the family physicians. CONCLUSIONS: The different health care professionals involved in this type of care experience that an interprofessional and cross-sectoral CCM is able to optimally support the long-term care of geriatric patients. The different occupational groups involved in the care benefit from this type of care arrangement as well.

Legal advice and care-effective use of care and case management: limits, risks and need for change (funded by the innovation Fund of the Federal Joint Committee (G-BA) according to §§ 92a and 92b of the fifth book of the German social code (SGB V). Funding code 01NVF17029 (RubiN) regional uninterrupted in the network).

INTRODUCTION: An important dimension of care and case managers is to support geriatric patients in obtaining social services in medical, nursing, therapeutic and social fields. To this, they advise and represent their patients. METHODS: The documentation of patient contacts with case managers of a network of physicians was evaluated. In particular, activities involving legal advice were analysed in detail, compared with the current legal situation in Germany and evaluated. In addition, qualitative expert interviews were conducted. The content and the legal requirements of legal services law were determined by applying legal interpretation methods (esp. wording, telos, systematics). The results of the evaluation of the documentation were compared with legal requirements. RESULTS: Care and case management touches activities in some fields of action without having a legal basis in legal services law. This leads to the fact that these services may not be provided and to - uninsured and uninsurable - liability risks. DISCUSSION: With the introduction of care and case management into standard care, both social law and the Legal Services Act must be adapted to enable the legally compliant use of care and case managers. Otherwise, certain services that are useful for the care of patients may not be provided.

[A case management questionnaire for family caregivers of geriatric patients]. / Ein Case-Management-Fragebogen für Angehörige geriatrischer Patienten.

BACKGROUND: To ease the burden for family caregivers healthcare concepts are urgently needed. The healthcare concept continuous care in a regional network (RubiN) offers a care and case management in physician networks for geriatric patients and aims to relieve family caregivers. The aim of the study was to develop and to test the psychometric properties of a questionnaire that evaluates the satisfaction and acceptance of the healthcare provided by case management (CM) from the perspective of family caregivers. METHODS: A mixed methods design was used to develop the questionnaire based on qualitative interviews, a literature search and own project experiences. After a pilot run the subsequent data acquisition took place in the participating RubiN physician networks from May to August 2020. Each of the 5 participating networks received a set of 50 questionnaires for family caregivers. The psychometric properties of the questionnaire were evaluated. RESULTS: The questionnaire consisted of 11 items. A total of 137 family caregivers participated in the survey (response rate 55%). Overall, the family caregivers were very satisfied (78.1%) with the care offered. There were only a few missing values in the data. The 11 items in the questionnaire loaded on 2 factors. The first factor called effects from coordination showed an internal consistency of 0.843 and for the second factor called accessibility an internal consistency of 0.683 was observed. CONCLUSION: The questionnaire with 11 items is characterized by its brevity and includes the acceptance and satisfaction of the care elements offered for family caregivers in a geriatric CM.

How Do Health Care Professionals Perceive a Holistic Care Approach for Geriatric Patients? A Focus Group Study.

BACKGROUND: Geriatric patients require holistic care in order to meet their complex care needs. The project RubiN (Continuous Care in a Regional Network) provides case and care management (CCM) for older people to address these needs in a primary care setting in Germany. This study aimed to explore the experiences of health care professionals who provided CCM for geriatric patients. METHODS: Focus group interviews with general practitioners (GPs), health care assistants (HCAs), and case managers (CMs) were conducted. Transcribed data were analyzed by using qualitative content analysis. RESULTS: Ten focus group discussions (n = 15 GPs, n = 14 HCAs, n = 17 CMs) were conducted. The different health care professionals emphasized the importance of a holistic care approach to geriatric care. Moreover, the GPs stated that the CMs supported the patients in organizing their care. A CCM could help encourage patients to remain at their own homes, which would have an effect on patients' quality of life and satisfaction. CONCLUSION: A well-functioning and effective cooperation between those health professionals involved is a prerequisite for a trustful relationship in the holistic care of older people. This creates a feeling of security for all people involved in the care process.

Experiences of family caregivers regarding a community-based care- and case-management intervention. A qualitative study.

Family caregivers play an essential role in healthcare for elderly people in primary care settings. The complexity of geriatric patients as well as the fragmentation of healthcare systems can lead to a burden for family caregivers, which can affect their physical and psychological health as well as social relationships, economic productivity and quality of caregiving. Care- and case-management offers a possibility to support, empower and navigate family caregivers through healthcare systems in order to reduce their own burden. The project RubiN (Continuous care in a regional network) was developed to provide regional care- and case-management for outpatient care of the elderly (age >70 years) in a primary care setting in Germany. The aim of this qualitative study was to explore experiences and attitudes of family caregivers of geriatric patients regarding the community-based care- and case-management intervention RubiN. Telephone interviews with a purposeful sample of 21 family caregivers enlisted in all RubiN networks were conducted between March and May 2020 and were followed by qualitative content analysis. The main categories, which emerged were namely: (1) current healthcare situation and (2) experiences with RubiN. Main findings suggest that participants in this study valued the provided support and experienced a sense of relief. However, some participants were disappointed with RubiN and the included support by care- and case-managers. A care- and case-management affected caregiving per se as well as the patient's and family caregiver's well-being. Important aspects contributing to these findings were a continuous relationship, training and expertise of the care- and case-managers. Establishing networks between the patients, family caregivers, care- and case-managers and healthcare providers were key components as well as a good explanation about RubiN itself for family caregivers. Therefore, a community-based care- and case-management can play an important role in detecting, facilitating and preventing family caregiver burden.

"We are the patients' advocates": Care and case managers' reasons to participate in a geriatric health care project - A qualitative study.

INTRODUCTION: Healthcare provision for the multimorbid elderly is complex. Care and Case Managers (CCMs) can help to coordinate and structure outpatient care for these patient groups. This approach will be realized in the project RubiN ("Continuous Care in Regional Networks"), which is funded by the Federal Joint Committee. The aim of the present qualitative study was to explore the motivation to work as a CCM. METHODS: As part of the qualitative study framework, semi-structured interviews with CCMs were conducted as part of a joint kick-off event. The interviews were focused on the reasons and motivation for participating in the RubiN project. The transcribed interviews were analyzed using qualitative content analysis. RESULTS: Eight of 20 CCMs agreed to take part in the interviews. One of the main motivations for taking part in RubiN was to shift away from working conditions that were perceived as stressful and towards an activity that was experienced as appreciative. The CCMs felt that their professional expertise was recognized by other service providers, and that appreciation of their role increased through their active involvement in the care of geriatric patients. CONCLUSIONS: Care and Case Management as a practical application with extensive coordination services for geriatric patients may contribute to an increase in appreciation and recognition through establishing a separate area of responsibility and scope as well as working in an interdisciplinary team.