Abstract
Patient education and self-management support are two important principles of care management. Where these principles help individuals to become more independent, the principle of care coordination seems to result in the opposite.
It is not to say that care coordination is redundant. The opposite is true. Many, if not all countries, have systems where patients would be much worse off without care managers helping them to navigate the system. But if the call for more case managers is rooted in the lack of efforts to make fundamental changes to our social and health care systems, I am worried that care management is not a sustainable strategy after all.
To put it differently, if care management connects the multiple silos in our systems, we will end up with the same fragmented systems as we are dealing with today. Connecting dots now means we still have to deal with dots in the future. To improve this situation, an important step is to ask care managers what challenges they are dealing with in making connections and how they think these challenges should be overcome. Only when care managers get to spend most of their time on patient education and self-management support, the power to change systems from within becomes stronger.
This double issue of the International Journal of Care Coordination provides useful insights in changing health-care systems from within. Vehko et al. provide three clear conditions that need to be met for patients with complex needs to become actively involved in making treatment plans. 1 Another study that challenges the current practice of coordinating care for patients with complex needs comes from Hoyem et al. 2 They expose the variety and intensity of activities care coordinators are dealing with and discuss how continuity of care for patients with complex needs could be secured.
According to Balasubramanian et al., new models of care clearly delineating roles for oncologists and primary care physicians are needed to improve colorectal cancer survivorship care in the United States. 3 By looking at the experience of older adults with a care coordination programme in the United States, Scholz Mellum et al. emphasize that the delivery of care coordination services and the attitude of the provider delivering those services are equally important. 4
In their letter, Seys et al. discuss the need for hospitals to continuously improve the care process for patients with a chronic obstructive pulmonary disease exacerbation whilst stressing the importance of behavioural changes by both patients and health-care providers. 5 Starling discusses the main findings from the evaluation of a three-year long national programme to develop new care models in England. From this impressive work, 10 lessons to support providers and commissioners to adopt local co-creation and testing of care models to better coordinate care for people with complex health and social care needs were derived. In brief, there are no simple fixes to overcome service fragmentation. 6
Finally, we gratefully thank our reviewers for supporting us in optimizing the transfer of knowledge between authors and readers of the International Journal of Care Coordination.