RT Journal Article
SR Electronic
T1 Understanding Barriers to and Facilitators of Case Management in Primary Care: A Systematic Review and Thematic Synthesis
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 355
OP 363
DO 10.1370/afm.2555
VO 18
IS 4
A1 Matthew Hacker Teper
A1 Isabelle Vedel
A1 Xin Qiang Yang
A1 Eva Margo-Dermer
A1 Catherine Hudon
YR 2020
UL http://www.annfammed.org/content/18/4/355.abstract
AB PURPOSE Despite evidence on the benefits of case management for the care of patients with complex needs in primary care, implementing the program—necessary to achieve its benefits—has been challenging worldwide. Evidence on factors affecting implementation remains disparate. Accordingly, the objective of this systematic review was to identify barriers to and facilitators of case management, from the perspectives of health care professionals, in primary care settings around the world.METHODS We conducted a systematic review and thematic synthesis of qualitative findings. In collaboration with 2 librarians, we searched 3 electronic databases (MEDLINE, CINAHL, EMBASE) for studies related to factors affecting case management function in primary care. Two researchers screened titles, abstracts, and full texts for inclusion, then assessed included studies for quality. Results from included studies were synthesized by thematic synthesis, and a framework was developed.RESULTS Of 1,640 unique records identified, 22 studies, originating from 6 countries, met the inclusion criteria. We identified 9 barriers and facilitators: family context; policy and available resources; physician buy-in and understanding of the case manager role; relationship building; team communication practices; autonomy of case managers; training in technology; relationships with patients; and time pressure and workload. We describe these factors, then present a framework demonstrating the relationships among them.CONCLUSIONS Our study’s findings show that multiple factors influence case management implementation. These findings have implications for researchers, clinicians, and policy makers who strive to implement or reform case management programs in local or larger primary care settings.