プライマリケアの質 オープンアクセス

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Older people with complex long-term health conditions. Their views on the community matron service: a qualitative study

Ken Brown, Karen Stainer, Jane Stewart, Rose Clacy, Sharron Parker

Background The Department of Health in the UK has suggested that older people with complex health problems may benefit from a case-management approach to meet their needs. The NHS has since invested heavily in community matrons as one method of tackling managed care. Matrons are highly trained nurses, able to diagnose, prescribe and manage patients with long-term conditions within primary care. Early evidence suggests that the matron approach does not achieve the government targets of reducing unplanned hospital admissions. Aim To explore the experiences and attitudes of older people who have a community matron so that we may gain an understanding of the successes and failures of this form of case management. Design of study Qualitative study using one-toone interviews with patients and carers. Setting Nottingham and surrounding rural areas during 2006–2007. Method A purposive sample of patients recruited from community matron caseloads. In-depth semistructured interviews were audiotaped and transcribed. Analysis for emergent themes used a template approach andwas validated by discussion with lay advisors and community matrons and by separate analysis of a sample of interviews by an independent researcher. Results Twenty-four participants were recruited. They often valued their matron as a personal friend as well as a professional.Many suggested that matrons improved their global health, reduced the workload of general practitioners, kept them out of residential care, reduced the need for social and psychological care, and supported their carers. Some were unclear why they had been selected for the matron service and knew of others they felt would benefit morethan them. Conclusions Matrons seem to be generally highly valued on a professional and personal level, almost filling the role of family doctor vacated by changing practices in modern primary care. Participants suggested several reasons why matrons could be economically justified, which need further investigation. The methods of case selection for these services also need to be questioned.