How to operationalize the function of case manager at the level of the first aid and care line in Wallonia and Brussels?

Introduction: Too often, the health services user is left to navigate a complex system without the support, tools, resources or knowledge to effectively manage their needs on their own (1). Case managers ensure intensive coordination for patients with complex needs and monitor their care trajectory (2). The case manager’s function has existed for several years in French-speaking Belgium, yet no consensus has been established as to the definition of the role or missions of the case manager. This has led to difficulties in the operationalization of case management and a confusion in the distribution of tasks with other professionals. This study aims to clarify the role of case manager, a sine qua none condition for developing this profession (3) (4) (5).

Methods: Three exploratory focus groups were conducted and included case managers, care coordinators and network partners. The interview guide aimed to identify the participants’ consensual and different perceptions regarding the role of case manager, through their daily collaborative practice.

Preliminary results: The results show a lack of clarity regarding the role and missions of case managers in primary care level, especially when compared to those of care coordinators. Case managers’ partners showed high expectations regarding their function which calls upon a range of advanced skills, knowledge and experience.

Discussion: The lack of a legal framework and the absence of training could be contributing to this role confusion. Working in pairs or teams of case managers could be a relevant approach to meet the expectations. 

Conclusion: Role ambiguity is a setback that ultimately leads to unproductivity. An in-depth description of the details of case mangers activities needs to be developed through the collaborative work of the case mangers themselves, their organization, their health and social care partners, and patients and caregivers.

Lessons learned: The function of case manager, as every other integrated care strategy, tends to adapt to the context where it is implemented.

Limitations: The data collection methods did not include patients nor caregivers.

Future research: Needs to develop a clear role description and competency framework for case managers in French speaking Belgium in order to facilitate the development of a relevant training 

References

1. Case Management Society of America. Standards of Practice for Case Management. 2016;

2. Lukersmith S, Millington M, Salvador-Carulla L. What is case management? A scoping and mapping review. Int J Integr Care. 2016;16(4).

3. Joo JY, Huber DL. Barriers in Case Managers’ Roles: A Qualitative Systematic Review. West J Nurs Res. 2018;40(10):1522‑42.

4. Teper MH, Vedel I, Yang XQ, Margo-Dermer E, Hudon C. Understanding barriers to and facilitators of case management in primary care: A systematic review and thematic synthesis. Ann Fam Med. 2020;18(4):355‑63.

5. Chaire Interdisciplinaire de la Première Ligne. Un livre blanc de la première ligne en Belgique francophone. 2020;116.