Patients' Reactions to being Selected by a Computerised Risk Tool for Case Management by a Community Matron in the UK

Friday, 26 July 2013: 8:50 AM

Belinda J. Wigmore, RN, MSc
Virtual Community wards, Croydon Community Health services, Surrey, United Kingdom
Sylvie Marshall-Lucette, PhD, MSc, RN, RNT
Faculty of Health & Social Care Sciences, Kingston University & St George's University of London, London, United Kingdom

Learning Objective 1: The learner will be able to discuss the implications of using a ‘computerised’ predictive risk tool in the selection of patients for case management assessment.

Learning Objective 2: The learner will be able to appreciate the importance of involving long term patients as collaborators to acquire evidence for practice.

Purpose: In the UK, 15 million people have at least one long-term condition and represent 70% of the healthcare expenditure. Evidence suggests that improved management of long-term conditions can reduce care costs.  Case Management, by Community Matrons, was established using a predictive risk tool to predict the likelihood of an acute admission within the following six months.  Potential patients are sent a letter offering an assessment before being admitted to the Virtual Community Ward.  Some patients decline the service or find this approach unusual.   This study aimed to explore the reactions of patients who have been selected by a ‘computerised’ risk tool for case management.

Methods: A qualitative study was considered appropriate to answer the research question. A purposive selection of eight patients, newly admitted to the Community Matron’s caseload, was interviewed and an interpretative phenomenological analytical model was used to interpret the data.

Results: Four themes emerged from the data: surveillance of health; dimensions of trust; dimensions of health guidance and dynamic perception of ill health.  Patients were not particularly concerned about the use of predictive modelling, in many cases it was perceived as the promotion of engagement in health care and intuitive to their health belief systems.  A linear model of reactions was thus developed from these findings. 

Conclusion: The findings suggest that to gain a true sense of reaction to the use of risk tools further research is required, specifically targeting those who have refused case management, yet could potentially benefit from it the most.  Such a care approach will become particularly important, as risk tools become more widely used and hard to reach individuals are required to engage in pro-active case management to prevent the rising cost of chronic ill health.