General Practice and Primary Care - Theses

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    Reconceptualising case management in theory and practice: a front-line perspective
    Yarmo, Deborah ( 1999-12)
    This thesis is a qualitative study exploring the role of case managers in the evolving Australian case management models. It represents the perspectives of front-line case managers based on their first-hand knowledge of the models’ effect on their own role as well as the perceived effects on the clients. A cross-sectional design was chosen for this study involving 51 semi-structured, in-depth interviews with front-line case managers from three different Victorian, Australian long-term care case management models. Informants came from a range of professional disciplines including general practice, nursing, psychology, occupational therapy, social work, and other related fields. Purposive and incidental sampling were employed. The major findings identify the discrepancy between theory and practice in regard to case management being 'client centred'. Instead, case management is concluded to be 'system centred' based on a unilateral approach taken by each of the three models. Case managers had a limited ability to attain necessary services for clients depending on their skills and experience, relationship with the client, degree of job satisfaction, level of influence in the health and social system, and ability to collaborate with relevant professionals. It reviews the relationship between three primary influences (system, model, client) affecting the case managers' pursuit of attaining appropriate client services. A reconceptualised theoretical framework, a 'neo-process centred' case management, is proposed comprising a multidimensional approach, which can be applied to existing and new models in their aspiration of improving client care within existing constraints.