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Case management in primary care for frequent users of health care services: A mixed methods study

Hudon Catherine, Chouinard Maud-Christine, Dubois Marie-France, Roberge Pasquale, Loignon Christine, Tchouaket Éric, Lambert Mireille, Hudon Émilie, Diadiou Fatoumata et Bouliane Danielle. (2018). Case management in primary care for frequent users of health care services: A mixed methods study. Annals of Family Medicine, 16, (3), p. 232-239.

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URL officielle: https://doi.org/10.1370/afm.2233

Résumé

PURPOSE This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation.

METHODS We used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. The second phase had a qualitative descriptive design and entailed thematic analysis of in-depth interviews (25 patients, 6 case management nurses, 9 health managers) and focus groups (8 patients’ spouses, 21 family physicians) to understand stakeholders’ perceived effects of the intervention on patients.

RESULTS A total of 247 patients were randomized into the intervention group (n = 126) or the control group (n = 121). Compared with usual care, the intervention reduced psychological distress (odds ratio = 0.43; 95% CI, 0.19–0.95, P = .04), but did not have any significant effect on patient activation (P = .43). Qualitative results suggested that patients and their spouses benefitted from the case management intervention, gaining a sense of security, and stakeholders noted better patient self-management of health.

CONCLUSIONS Together, our study’s quantitative and qualitative results suggest that case management reduces psychological distress, making patients and caregivers feel more secure, whereas impact on self-management is unclear. Case management is a promising avenue to improve outcomes among frequent users of health care with complex needs.

Type de document:Article publié dans une revue avec comité d'évaluation
Volume:16
Numéro:3
Pages:p. 232-239
Version évaluée par les pairs:Oui
Date:2018
Sujets:Sciences de la santé
Sciences de la santé > Sciences infirmières
Sciences de la santé > Sciences médicales
Département, module, service et unité de recherche:Départements et modules > Département des sciences de la santé > Module des sciences infirmières
Mots-clés:frequent users, utilization, case management, outcomes, mixed methods, comorbidity, practice-based research, primary care, usagers fréquents, utilisation, gestion de cas, méthodes mixtes, comorbidité, recherche axée sur la pratique, soins primaires
Déposé le:24 avr. 2019 00:52
Dernière modification:24 avr. 2019 00:52
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