Case management in primary care among frequent users of healthcare services with chronic conditions: protocol of a realist synthesis

Hudon, Catherine; Chouinard, Maud‐Christine; Aubrey‐Bassler, Kris; Muhajarine, Nazeem; Pluye, Pierre; Bush, Paula Louise; Ramsden, Vivian R.; Guénette, Line; Morin, Paul; Lambert, Mireille; Groulx, A; Couture, Martine; Campbell, Cameron; Baker, Margaret Momot; Edwards, Lynn; Sabourin, Véronique; Spence, Claude; Gauthier, Gilles; Warren, Mike; Godbout, Julie; Davis, Breanna; Rabbitskin, Norma

doi:10.1136/bmjopen-2017-017701

Cited by 15 publications

(13 citation statements)

References 39 publications

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“…As planned in our protocol, 25 we searched for evidence from all of the studies included in our parent systematic review detailing the methods and characteristics of the included studies. 26 The comprehensive search strategy used in our parent systematic review yielded 21 peer-reviewed articles published during the period 1996 to September 2017 and evaluating 19 interventions in primary care settings designed to improve care among adult frequent users of health care services who were affected by at least 1 chronic physical condition.…”

Section: Stage 2 Searching For Evidencementioning

confidence: 99%

Case Management in Primary Care for Frequent Users of Health Care Services: A Realist Synthesis

Hudon¹,

Chouinard²,

Aubrey‐Bassler³

et al. 2020

Ann Fam Med

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PURPOSE Case management (CM) is a promising intervention for frequent users of health care services. Our research question was how and under what circumstances does CM in primary care work to improve outcomes among frequent users with chronic conditions? METHODS We conducted a realist synthesis, searching MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) for articles meeting the following criteria: (1) population: adult frequent users with chronic disease, (2) intervention: CM in a primary care setting with a postintervention evaluation, and (3) primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Academic and gray literature were evaluated for relevance and robustness. Independent reviewers extracted data to identify context, mechanism, and outcome (CMO) configurations. Analysis of CMO configurations allowed for the modification of an initial program theory toward a refined program theory. RESULTS Of the 9,295 records retrieved, 21 peer-reviewed articles and an additional 89 documents were retained. We evaluated 19 CM interventions and identified 11 CMO configurations. The development of a trusting relationship fostering patient and clinician engagement in the CM intervention was recurrent in many CMO configurations. CONCLUSION Our refined program theory proposes that in the context of easy access to an experienced and trusted case manager who provides comprehensive care while maintaining positive interactions with patients, the development of this relationship fosters the engagement of both individuals and yields positive outcomes when the following mechanisms are triggered: patients and clinicians feel supported, respected, accepted, engaged, and committed; and patients feel less anxious, more secure, and empowered to self-manage.

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Section: Stage 2 Searching For Evidencementioning

confidence: 99%

Case Management in Primary Care for Frequent Users of Health Care Services: A Realist Synthesis

Hudon¹,

Chouinard²,

Aubrey‐Bassler³

et al. 2020

Ann Fam Med

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“…[12][13][14][15]19,20 However, CM is a complex intervention, with various characteristics interacting in a nonlinear manner. 21,22 To design and implement effective CM interventions, we need to understand the characteristics of CM that are associated with positive outcomes. The objective of the present study was to conduct a systematic review to identify characteristics of CM that yield positive outcomes among adult frequent users with chronic disease in primary care.…”

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confidence: 99%

Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review

et al. 2019

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PURPOSE Case management (CM) interventions are effective for frequent users of health care services, but little is known about which intervention characteristics lead to positive outcomes. We sought to identify characteristics of CM that yield positive outcomes among frequent users with chronic disease in primary care. METHODS For this systematic review of both quantitative and qualitative studies, we searched MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) and included articles meeting the following criteria: (1) population: adult frequent users with chronic disease, (2) intervention: CM in a primary care setting with a postintervention evaluation, and (3) primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Independent reviewers screened abstracts, read full texts, appraised methodologic quality (Mixed Methods Appraisal Tool), and extracted data from the included studies. Sufficient and necessary CM intervention characteristics were identified using configurational comparative methods. RESULTS Of the 10,687 records retrieved, 20 studies were included; 17 quantitative, 2 qualitative, and 1 mixed methods study. Analyses revealed that it is necessary to identify patients most likely to benefit from a CM intervention for CM to produce positive outcomes. High-intensity intervention or the presence of a multidisciplinary/interorganizational care plan was also associated with positive outcomes. CONCLUSIONS Policy makers and clinicians should focus on their case-finding processes because this is the essential characteristic of CM effectiveness. In addition, value should be placed on high-intensity CM interventions and developing care plans with multiple types of care providers to help improve patient outcomes.

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“…Qualitative data will be coded using MAXQDA software via an analysis framework derived from the initial theory and the literature: participant (patients, practice staffs) descriptions; practices’ components or strategies; proximal outcomes and their associated measures; the inner and outer contexts; and mechanisms triggered by the inner and outer contexts and how they might generate proximal and final outcomes. 43 The middle-range theories (sub-CMOs) aim to explain why the organisational model works (or not) and has positive expected outcomes, and the specific ways in which it works (or not) in each specific practice. The refinement and validation of these middle-range theories will be derived via consensus discussion between the practice staffs (GPs, PCNs and medical assistants) and investigators about the synthesis and interpretation of findings.…”

Section: Methods and Analysismentioning

confidence: 99%

Protocol for an implementation and realist evaluation of a new organisational model for primary care practices in the canton of Vaud, Switzerland

et al. 2020

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IntroductionContinuity of care, especially for patients with complex needs, is a major challenge for healthcare systems in many high-income countries, including Switzerland. Since 2015, a collaborative project between Unisanté-Department of Family Medicine (DMF), some general practitioners (GPs) and canton of Vaud’s public health authorities has sought to develop a new organisational model for the provision of primary care to ensure better care coordination and to provide adapted care deliveries to patients’ healthcare needs. The model’s main component is the addition of a primary care nurse to GPs practices. Three additional tools are individualised patient care plans, electronic medical records and patient empanelment. To assess this model, a 2-year pilot study has begun in nine GPs’ practices in the canton. This paper presents the protocol for an evaluation of the implementation and effectiveness of the new organisational model.Method and analysisWe will conduct a before-and-after study using a mixed-methods and a realist approach. First, we will use quantitative and qualitative data to assess the new organisational model’s implementation (feasibility, fidelity, acceptability and costs) and effectiveness (healthcare services use, patient experience, staff experience and patient-level costs). Combining this data with focus group data will enable a realist evaluation of the pilot project, which will help understand the elements of context and mechanism that affect implementation.Ethics and disseminationThe evaluation will inform the canton of Vaud’s health authorities about the limits of and perspectives for this organisational model. All results will also be made available to the practices and the patients involved. At the end of the project, we will propose organisational adaptations and a sustainable financial model for extending the model to other practices in the canton and potentially to the national level.The canton of Vaud’s Human Research Ethics Committee approved the study, and Data Protection and Information Law Authority gave a favourable opinion concerning data processing procedures.

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Case management in primary care among frequent users of healthcare services with chronic conditions: protocol of a realist synthesis

Cited by 15 publications

References 39 publications

Case Management in Primary Care for Frequent Users of Health Care Services: A Realist Synthesis

Case Management in Primary Care for Frequent Users of Health Care Services: A Realist Synthesis

Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review

Protocol for an implementation and realist evaluation of a new organisational model for primary care practices in the canton of Vaud, Switzerland

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