Community case management and unplanned hospital admissions in patients with heart failure: A systematic review and qualitative evidence synthesis

Aims
To describe case management as experienced by patients with heart failure and their health professionals with the aim of understanding why case management might contribute in reducing hospital admissions.

Background
Heart failure is a common cause of unplanned hospital admission. The evidence for case management in patients with heart failure for reducing admissions is promising.

Design
Systematic review and qualitative evidence synthesis.

Data source
Searches were conducted in Medline, Psychinfo, Kings Fund database and Cinahl from inception of each database to February 16th 2017.

Review methods
Robust systematic review methodology was used to identify qualitative studies describing the experiences of patients with heart failure and health care providers of case management. Data were synthesised thematically and analytic themes were developed.

Results
Five studies (six papers) from which nine descriptive themes were used to determine three analytic themes. This synthesis showed that case management provides positive quality of care for patients, increases perceived access to services, and creates more time in which to ask questions and develop trusted relationships. For health professionals, case management enhanced care by improved relationships with both patients and colleagues although concerns remained around resources, training and inter-professional conflict.

Conclusions
This synthesis emphasises the importance of the quality of being cared for as a patient and caring as a health professional. Case management enhances communication between patients and health professionals, supports patient self-care and self-management, and can be an important contributing factor in reducing unplanned admissions for patients with heart failure.