Case Management
Another model for providing integrated primary health care
and rehabilitation is case management. According to this
model, a case manager, on the basis of a referral and intake
assessment, marshals and coordinates the necessary services,
including family medicine and rehabilitation services, either in
the patient’s home or other community location. Case managers
are usually specialized health professionals who act not
within their usual scope of practice, but rather as coordinators,
brokers, or liaisons. The scoping review identified 2 articles
with a rehabilitation/primary care case management perspective.
The focus was on complex, high-needs groups, such as
those with severe disabilities, the frail elderly, or injured workers.
It was observed that these are populations with special
needs beyond standard primary care that required an advanced
coordinating function.
Case management has the advantage of tracking and coordinating
multiple service providers and organizations. The effective
use of case management reduces the number of visits to
the primary care physician and instead links the patient with
more appropriate service providers who can meet many of the
social and functional needs of patients with complex conditions.
It is efficient from the patient’s perspective because all
services and communications are coordinated through one portal,
and there is some assurance that information is being
efficiently shared among those who need it.
The disadvantage of the case management approach arises if
various involved professionals do not acknowledge the case
management role and do not cooperate by furnishing information
in an accurate and timely fashion. The resources needed to
offer a case management approach within a primary health care
organization include therapists, clerical staff and information
technology, office space, meeting space, liaison with community
resources, and transportation.
Both self-management and case management are components
of a more general model of primary care termed chronic
disease management, usually represented by the Wagner
Chronic Care Model.