The role of case managers in Lithuanian primary healthcare: Associations between healthcare visits and emotional well-being of multimorbid patients

Abstract

Background. The evolution of primary healthcare teams in Lithuania has been significant through the last ten years. Recently, the case managers’ specialty was included in the family physicians’ team. Their aim is to identify the patient’s need for complex services, to organise and manage such services, with the recommendations given by other team members and medical specialists and specific needs of the patient and (or) the patient’s family members. Aim. The aim of this study was to assess the associations of a case manager’s role in primary healthcare focusing on the associations between healthcare visits frequency and emotional well-being of the patients with multimorbidity. Methods. The study was conducted in seven Lithuanian primary health care centers (five urban, two rural) within the framework of the TELELISPA project “Improved Healthcare Quality for Patients with Multimorbidity in Lithuania” (project number 08.4.2-ESFA-K-616-01-0003). The study used a case management approach with the support of a multidisciplinary team. Participants were aged 40 to 85 years and had two or more long-term health conditions. General Anxiety Disorder-7 (GAD) scale and Patient Health Questionnaire-9 (PHQ-9) were used to estimate the emotional wellbeing of patients over the 15-month study period. Chi square test for homogeneity implemented in the statistical software package SPSS for Windows 29.0 was used for data analysis. p values < 0.05 indicate statistically significant differences. Results. There were two groups of patients in the study: a case manager-supervised study group: n = 388 (51.3%) and a control group: n = 369 (48.7%). Both groups were homogeneous with respect to gender, age, living place and number of diseases. Statistically significantly more patients from study group compared to control group had visits to medical specialist (86.6% vs 76.1%, p < 0.001), the study group had more than two consultations with nurses or case managers (84.9% vs 35.6%, p < 0.001), and indicated that their depression symptoms (45.7% vs 31.7%, p < 0.001) and anxiety level (47.8% vs 29.0%, p < 0.001) decreased over the study period. Conclusion. Research data shows that the inclusion of a case manager in the family physician team improved the quality of patient care and the patient’s emotional well-being.