1
|
Hudon C, Chouinard MC, Doucet S, Piccinini-Vallis H, Fairman K, Sampalli T, Zed J, Brodeur M, Chênevert D, Dépelteau A, Dupont M, Karam M, Légaré F, Luke A, Macdonald M, Morvannou A, Ramsden VR, Rodriguez Del Barrio L, Wong ST, Lambert M, Bisson M, Schwarz C, Benoit R, Poirier MD, Rock-Hervieux AL, Rubenstein D, Wilhelm L. Case management in primary healthcare for people with complex needs to improve integrated care: a large-scale implementation study protocol. BMJ Open 2024; 14:e083783. [PMID: 39134438 PMCID: PMC11331999 DOI: 10.1136/bmjopen-2023-083783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/15/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Case management (CM) is among the most studied effective models of integrated care for people with complex needs. The goal of this study is to scale up and assess CM in primary healthcare for people with complex needs. METHODS AND ANALYSIS The research questions are: (1) which mechanisms contribute to the successful scale-up of CM for people with complex needs in primary healthcare?; (2) how do contextual factors within primary healthcare organisations contribute to these mechanisms? and (3) what are the relationships between the actors, contextual factors, mechanisms and outcomes when scaling-up CM for people with complex needs in primary healthcare? We will conduct a mixed methods Canadian interprovincial project in Quebec, New-Brunswick and Nova Scotia. It will include a scale-up phase and an evaluation phase. At inception, a scale-up committee will be formed in each province to oversee the scale-up phase. We will assess scale-up using a realist evaluation guided by the RAMESES checklist to develop an initial programme theory on CM scale-up. Then we will test and refine the programme theory using a mixed-methods multiple case study with 10 cases, each case being the scalable unit of the intervention in a region. Each primary care clinic within the case will recruit 30 adult patients with complex needs who frequently use healthcare services. Qualitative data will be used to identify contexts, mechanisms and certain outcomes for developing context-mechanism-outcome configurations. Quantitative data will be used to describe patient characteristics and measure scale-up outcomes. ETHICS AND DISSEMINATION Ethics approval was obtained. Engaging researchers, decision-makers, clinicians and patient partners on the study Steering Committee will foster knowledge mobilisation and impact. The dissemination plan will be developed with the Steering Committee with messages and dissemination methods targeted for each audience.
Collapse
Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | | | - Kimberly Fairman
- Institute for Circumpolar Health Research, Yellowknife, Northwest Territories, Canada
| | - Tara Sampalli
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Joanna Zed
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Magaly Brodeur
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Denis Chênevert
- Department of Human Resources Management, HEC Montreal, Montreal, Quebec, Canada
| | - Andréa Dépelteau
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mariève Dupont
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marlène Karam
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - France Légaré
- Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adele Morvannou
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Sabrina T Wong
- Centre for Health Services and Policy Research and School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mireille Lambert
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | | | | | | | | | | |
Collapse
|
2
|
Alshowair A, Altamimi S, Alruhaimi FA, Alshahrani S, Alsuwailem F, Alkhaldi M, Abdalla H, Alkhuraiji FH, Alaqeel MS, Almureef SS, Alhawasy S, Abdel-Azeem A. Cost-Savings Associated with Multi-Disciplinary Team Approach for Reducing Macrovascular and Microvascular Complications in Patients with Type 2 Diabetes: A Predictive Model. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:211-223. [PMID: 38596283 PMCID: PMC11001564 DOI: 10.2147/ceor.s451739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Purpose This study aims to predict the expected cost savings associated with implementing a multidisciplinary team (MDT) approach to reduce macrovascular and microvascular complications among patients with type 2 diabetes mellitus (T2DM). Methods This economic evaluation study was conducted in Riyadh First Health Cluster, Saudi Arabia as a predictive model conceptualized by the authors based on models used in previous studies, particularly the CORE Diabetes Model. Our model was designed based on 1) the level of glycemic control among 24,755 T2DM patients served by MDTs; 2) the expected incidence of diabetes-related complications without intervention; 3) the predicted risk reduction of developing diabetes-related complications with MDTs. Costs of complications and cost savings were then calculated and expressed as mean incremental annual cost savings adjusted for a 1% reduction in HbA1c, and a 10 mmHg reduction in systolic blood pressure (SBP). Results Along with the expected reduction in all diabetes-related complications, the average incremental cost savings per diabetic patient is predicted to be ($38,878) with approximately ($11,108) in the year of complication onset and ($27,770) over the subsequent post-index 10-years. On adjustment of cost savings, the average incremental cost savings are predicted to be ($22,869) for each 1% reduction in HbA1c per diabetic patient and ($27,770) for every 10 mmHg reduction in SBP per diabetic patient. Conclusion MDT as a model of care is effective in glycemic control among T2DM patients with a predicted significant reduction of all diabetes-related complications and in turn, a predicted significant cost savings.
Collapse
Affiliation(s)
- Abdulmajeed Alshowair
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Saleh Altamimi
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Faisal A Alruhaimi
- Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Saad Alshahrani
- Academic and Training Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Fatima Alsuwailem
- Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Mona Alkhaldi
- Health Administration Office, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Haiam Abdalla
- Model of Care, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | | | - Montaser Saad Alaqeel
- Financial Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | | | - Salman Alhawasy
- Reporting Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
| | - Amro Abdel-Azeem
- Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine Zagazig University, Zagazig, Egypt
| |
Collapse
|
3
|
Kurteva S, Tamblyn R, Meguerditchian AN. Predictors of frequent emergency department visits among hospitalized cancer patients: a comparative cohort study using integrated clinical and administrative data to improve care delivery. BMC Health Serv Res 2023; 23:887. [PMID: 37608371 PMCID: PMC10464437 DOI: 10.1186/s12913-023-09854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Frequent emergency department (FED) visits by cancer patients represent a significant burden to the health system. This study identified determinants of FED in recently hospitalized cancer patients, with a particular focus on opioid use. METHODS A prospective cohort discharged from surgical/medical units of the McGill University Health Centre was assembled. The outcome was FED use (≥ 4 ED visits) within one year of discharge. Data retrieved from the universal health insurance system was analyzed using Cox Proportional Hazards (PH) model, adopting the Lunn-McNeil approach for competing risk of death. RESULTS Of 1253 patients, 14.5% became FED users. FED use was associated with chemotherapy one-year pre-admission (adjusted hazard ratio (aHR) 2.60, 95% CI: 1.80-3.70), ≥1 ED visit in the previous year (aHR: 1.80, 95% CI 1.20-2.80), ≥15 pre-admission ambulatory visits (aHR 1.54, 95% CI 1.06-2.34), previous opioid and benzodiazepine use (aHR: 1.40, 95% CI: 1.10-1.90 and aHR: 1.70, 95% CI: 1.10-2.40), Charlson Comorbidity Index ≥ 3 (aHR: 2.0, 95% CI: 1.2-3.4), diabetes (aHR: 1.60, 95% CI: 1.10-2.20), heart disease (aHR: 1.50, 95% CI: 1.10-2.20) and lung cancer (aHR: 1.70, 95% CI: 1.10-2.40). Surgery (cardiac (aHR: 0.33, 95% CI: 0.16-0.66), gastrointestinal (aHR: 0.34, 95% CI: 0.14-0.82) and thoracic (aHR: 0.45, 95% CI: 0.30-0.67) led to a decreased risk of FED use. CONCLUSIONS Cancer patients with higher co-morbidity, frequent use of the healthcare system, and opioid use were at increased risk of FED use. High-risk patients should be flagged for preventive intervention.
Collapse
Affiliation(s)
- Siyana Kurteva
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.
- Department of Science, Aetion, Inc, New York, USA.
- Clinical & Health Informatics Research Group, Department of Medicine, McGill University, 2001 McGill College Avenue, Suite 1200, H3A 1G1, Montreal, Canada.
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
- Department of Medicine, McGill University Health Center, Montreal, Canada
- McGill University Health Centre, Montreal, Canada
| | - Ari N Meguerditchian
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
- Department of Surgery, McGill University Health Center, Montreal, Canada
- Center for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, Canada
- St. Mary's Research Centre, Montreal, Canada
| |
Collapse
|
4
|
Nursing Care Coordination in Primary Healthcare for Patients with Complex Needs: A Comparative Case Study. Int J Integr Care 2023; 23:5. [PMID: 36819614 PMCID: PMC9912854 DOI: 10.5334/ijic.6729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Despite nurses' substantial role in care coordination, few education programs exist to better support them in this role. Identification of a set of core care coordination activities across heterogeneous care coordination programs would facilitate the development of a standard of practice. We sought to examine care coordination activities across two care coordination programs in Family Medicine Groups in Quebec, and their relationship to the program design. Methods We performed a comparative case study of two care coordination programs in primary care targeting frequent users of healthcare services and people with Alzheimer's disease and related disorders. Data collection included documents and semi-structured interviews with key informants. Results Several activities were common to both programs, such as patient identification; assessment, development of an individualized service plan; and linking patients and caregivers with professionals and services. However, their components were different due to the impact of the integrated care program design, policy environment, and the target patient populations' complex needs. Discussion The homogeneity or heterogeneity of patients' complex needs shapes their care trajectory and the intensity of their care coordination needs. As the complexity of these needs grows, so does the necessity to build the care coordinators' capacity for integrated care.
Collapse
|
5
|
Alshowair A, Altamimi S, Alshahrani S, Almubrick R, Ahmed S, Tolba A, Alkawai F, Alruhaimi F, Alsafwani E, AlSuwailem F, Abdalla H, Abdel-Azeem A. Effectiveness of Case Manager Led Multi-Disciplinary Team Approach on Glycemic Control Amongst T2DM Patients in Primary Care in Riyadh: A Retrospective Follow-Up Study. J Prim Care Community Health 2023; 14:21501319231204592. [PMID: 37902553 PMCID: PMC10617256 DOI: 10.1177/21501319231204592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/16/2023] [Accepted: 09/13/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES Our study aims to assess the effectiveness of implementing a case manager-led Multidisciplinary Team approach in the primary healthcare setting on improving glycemic control and reducing cardiovascular risks for T2DM patients over a 6-month period. METHODS This retrospective record-based follow-up study was carried out on 3060 uncontrolled T2DM patients in primary healthcare centers in Riyadh First Health Cluster over a period of 6 months. The patient records are investigated and analyzed, including demographic characteristics and measurements of Hemoglobin A1c (HbA1c), Low-Density Lipoprotein Cholesterol (LDL-C), total cholesterol, and BP levels at enrollment and after 6 months of Multi-Disciplinary Team follow-up. The changes in the study variables and their correlations to each other are tested using Statistical Package for the Social Sciences software. RESULTS At enrollment, our patients were characterized by poor glycemic control (HbAIC > 8%). Most of them have high body weight with a mean BMI of (31.2 ± 1.7), and nearly two-thirds are either hypertensive or have dyslipidemia (43.4% and 47.3% respectively). After 6 months of MDT follow-up, there is a significant improvement in glycemic control among 1971 patients (64.4%), with a reduction in the mean level of different outcomes relative to baseline HbA1c (-15%, P < .001), total cholesterol (-9.0%, P < .001), LDL-C (-11.0%, P < .001), systolic BP (-7.7%, P < .001), and diastolic BP (-10.5%, P < .001). The improved glycemic control showed a significant positive correlation with the number of MDT visits but negatively correlated with BMI and the number of comorbidities. In addition, the improvements in secondary outcomes were positively and significantly correlated with such improvements in glycemic control. CONCLUSION Case-manager-led MDT approach significantly improves glycemic control and significantly improves control over dyslipidemia and hypertension, reducing cardiovascular risks, and unfavorable events among such diabetic patients. We highly recommend developing more MDTs, training case managers, and rigorously evaluating the MDT approach.
Collapse
Affiliation(s)
| | - Saleh Altamimi
- Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Saad Alshahrani
- Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Rehab Almubrick
- Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Syed Ahmed
- Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Ali Tolba
- Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Fatimah Alkawai
- Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Faisal Alruhaimi
- Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Eman Alsafwani
- Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Fatima AlSuwailem
- Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Haiam Abdalla
- Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Amro Abdel-Azeem
- Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
6
|
Raubinger S, Allworth S, Carey S. When you are living and dying at the same time: A qualitative exploration of living with gastrointestinal motility disorders. J Hum Nutr Diet 2022; 36:622-631. [PMID: 36420640 DOI: 10.1111/jhn.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND An expanding base of evidence indicates that chronic gastrointestinal disorders not only impact physical wellbeing, but also affect many psychosocial aspects of life. However, less is known about gastrointestinal motility disorders. The present study aimed to explore how individuals experience gastrointestinal motility disorders and their impact on daily living. METHODS Eleven people with a gastrointestinal motility disorder participated in semi-structured interviews face-to-face or via telephone. The interviews explored how participants came to be diagnosed, their experiences with health professionals, as well as the impact of dysmotility on enjoyment of food, socialising, eating out and quality of life (QoL). Interviews were tape-recorded, transcribed and analysed using an inductive thematic analysis approach. RESULTS Analysis revealed an overarching theme of frustration that stemmed from three subthemes: (1) feeling misunderstood, judged and dismissed by health professionals leading to delayed diagnosis, misdiagnosis and multiple diagnoses; (2) severity and unpredictability of undesirable gastrointestinal symptoms; and (3) reduced QoL because of physical and social limitations, impairing their ability to have normal life experiences, including education, work and social activities. CONCLUSIONS Dysmotility is a complex illness that impacts almost all aspects of a person's life. In addition to managing reported physical symptoms, the social and psychological burden associated with dysmotility needs to be addressed to improve outcomes and QoL.
Collapse
Affiliation(s)
- Sian Raubinger
- Department of Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Sarah Allworth
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sharon Carey
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| |
Collapse
|
7
|
Bujold M, Pluye P, Légaré F. Decision-making and related outcomes of patients with complex care needs in primary care settings: a systematic literature review with a case-based qualitative synthesis. BMC PRIMARY CARE 2022; 23:279. [PMID: 36352376 PMCID: PMC9644584 DOI: 10.1186/s12875-022-01879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In primary care, patients increasingly face difficult decisions related to complex care needs (multimorbidity, polypharmacy, mental health issues, social vulnerability and structural barriers). There is a need for a pragmatic conceptual model to understand decisional needs among patients with complex care needs and outcomes related to decision. We aimed to identify types of decisional needs among patients with complex care needs, and decision-making configurations of conditions associated with decision outcomes. METHODS We conducted a systematic mixed studies review. Two specialized librarians searched five bibliographic databases (Medline, Embase, PsycINFO, CINAHL and SSCI). The search strategy was conducted from inception to December 2017. A team of twenty crowd-reviewers selected empirical studies on: (1) patients with complex care needs; (2) decisional needs; (3) primary care. Two reviewers appraised the quality of included studies using the Mixed Methods Appraisal Tool. We conducted a 2-phase case-based qualitative synthesis framed by the Ottawa Decision Support Framework and Gregor's explicative-predictive theory type. A decisional need case involved: (a) a decision (what), (b) concerning a patient with complex care needs with bio-psycho-social characteristics (who), (c) made independently or in partnership (how), (d) in a specific place and time (where/when), (e) with communication and coordination barriers or facilitators (why), and that (f) influenced actions taken, health or well-being, or decision quality (outcomes). RESULTS We included 47 studies. Data sufficiency qualitative criterion was reached. We identified 69 cases (2997 participants across 13 countries) grouped into five types of decisional needs: 'prioritization' (n = 26), 'use of services' (n = 22), 'prescription' (n = 12), 'behavior change' (n = 4) and 'institutionalization' (n = 5). Many decisions were made between clinical encounters in situations of social vulnerability. Patterns of conditions associated with decision outcomes revealed four decision-making configurations: 'well-managed' (n = 13), 'asymmetric encounters' (n = 21), 'self-management by default' (n = 8), and 'chaotic' (n = 27). Shared decision-making was associated with positive outcomes. Negative outcomes were associated with independent decision-making. CONCLUSION Our results could extend decision-making models in primary care settings and inform subsequent user-centered design of decision support tools for heterogenous patients with complex care needs.
Collapse
Affiliation(s)
- Mathieu Bujold
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, Canada.
- Department of Family Medicine, McGill University, Montreal, Canada.
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| |
Collapse
|
8
|
Drovandi A, Seng L, Crowley B, Fernando ME, Evans R, Golledge J. Health Professionals' Opinions About Secondary Prevention of Diabetes-Related Foot Disease. Sci Diabetes Self Manag Care 2022; 48:349-361. [PMID: 35837980 DOI: 10.1177/26350106221112115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to explore the perceptions of health professionals regarding the ideal design of a remotely delivered diabetes-related foot disease (DFD) secondary prevention program. METHODS A qualitative study involving 33 semistructured phone interviews was conducted with health professionals with experience managing DFD. Interviews discussed the role of health professionals in managing DFD, their experience in using telehealth, perceived management priorities, preferences for a secondary prevention management program, and perceived barriers and facilitators for such a program. Interviews were audio-recorded and transcribed, and inductive thematic analysis was used to derive key themes. RESULTS Three themes were derived: (1) barriers in current model of DFD care, (2) facilitators and ideas for a remotely delivered secondary prevention program, and (3) potential challenges in implementation. DFD care remains acute-care focused, with variability in access to care and a lack of "clinical ownership." Patients were perceived as often having poor knowledge and competing priorities, meaning engagement in self-care remains poor. Participants felt a remote secondary prevention program should be simple to follow and individualized to patients' context, with embedded support from a case manager and local multidisciplinary service providers. Challenges to implementation included limited DFD awareness, poor patient motivation, patient-related issues with accessing and using technology, and the inability to accurately assess and treat the foot over telehealth. CONCLUSIONS Health professionals felt that an ideal remotely delivered secondary prevention program should be tailored to patients' needs with embedded support from a case manager and complemented with multidisciplinary collaboration with local service providers.
Collapse
Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Benjamin Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Malindu E Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
| | | | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD, Australia
| |
Collapse
|
9
|
Community-Based Advanced Case Management for Patients with Complex Multimorbidity and High Medical Dependence: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137807. [PMID: 35805465 PMCID: PMC9265887 DOI: 10.3390/ijerph19137807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
This longitudinal study aimed to evaluate a community-based and nurse-led advanced case management model centered on disease management. Participants were chronically ill patients aged 20 years and older who were highly dependent on medical care. The case management group (CMG) received nurse-led advanced case management, and the comparison group (CG) was selected by matching estimated propensity scores with the CMG. We compared the changes in medico-economic indicators between the two groups and analyzed the physical and psychological indicators of the CMG over time. The CMG comprised 51 participants, of which eight dropped out by 12 months after registration. After 1:1 propensity score matching, there were 40 participants in the CMG and CG, respectively. At 12 months after the registration, there was no significant difference between the two groups and no change in the CMG. At 24 months after the registration, the CMG’s medical and long-term care costs decreased significantly, while the CG’s costs increased. Moreover, there was a significant reduction in the number of hospital days and hospital admissions in the CMG. Our findings revealed that nurse-led advanced case management could be useful for patients with complex needs to avoid hospitalization due to exacerbations.
Collapse
|
10
|
Carlsson KS, Brommels M. Integrated Health and Social Services for People With Chronic Mental Health Problems: People Are More Important Than Processes. Insights From a Multiple Case Study in Swedish Psychiatry. Front Public Health 2022; 10:845201. [PMID: 35812519 PMCID: PMC9257072 DOI: 10.3389/fpubh.2022.845201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
Three mental health organizations, one merged with, one formally cooperating with, and one without formal links to social services were analyzed through the experience of staff, patients and relatives in order to elucidate what approaches best promoted service coordination. Seventeen staff and eight patients or relatives, recruited from the three organizations, participated in semi-structured interviews, guided by pre-selected categories derived from previous research about coordination and care processes. Directed content analysis was used to identify and categorize meaning units. Both staff and patients raised the same concerns. Organized collaboration between psychiatric care and social services addressed only some of patients' challenges. More important was patient access to financial and social assistance. The organizational arrangements were not referred to, whereas case management was seen as crucial. In many instances relatives have to act as case managers. Service integration in mental health has to include, in addition to social services, other authorities like social insurance and employment agencies. A case manager knowledgeable about all welfare services is best positioned to promote that “extended integration”. Relatives often have to take this responsibility to support this fragile group of patients. This observed importance of case management is supported by previous research in mental health and primary care. The role of relatives should be acknowledged and supported by those services.
Collapse
|
11
|
Chang E, Ali R, Berkman ND. Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review. BMJ Open 2022; 12:e058539. [PMID: 35680272 PMCID: PMC9185578 DOI: 10.1136/bmjopen-2021-058539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Payers, providers and policymakers in the USA are interested in developing interventions that reduce preventable or modifiable healthcare use among high-need, high-cost (HNHC) patients. This study seeks to describe how and why complex interventions for HNHC patients lead to more appropriate use of healthcare services. DESIGN A realist review which develops programme theories from causal explanations generated and articulated through the creation of context-mechanism-outcome configurations. METHODS Electronic databases (including PubMed and Embase) and gray literature from January 2000 to March 2021 were searched. All study designs were included if the article provided data to develop our programme theories. Included studies were conducted in the USA and focused on interventions for adult, HNHC patients. RESULTS Data were synthesised from 48 studies. Identifying HNHC patients for inclusion in interventions requires capturing a combination of characteristics including their prior use of healthcare services, complexity of chronic disease(s) profile, clinician judgment and willingness to participate. Once enrolled, engaging HNHC patients in interventions requires intervention care providers and patients to build a trusting relationship. Tailored, individualised assistance for medical and non-medical needs, emotional support and self-management education empowers patients to increase their participation in managing their own care. Engagement of care providers in interventions to expand support of HNHC patients is facilitated by targeted outreach, adequate staffing support with shared values and regular and open communication. CONCLUSIONS Building relationships with HNHC patients and gaining their trust is a key component for interventions to successfully change HNHC patients' behaviors. Identifying HNHC patients for an intervention can be best achieved through a multipronged strategy that accounts for their clinical and psychosocial complexity and prior experiences with the healthcare system. Successful interventions recognise that relationships with HNHC patients require the sustained engagement of care providers. To succeed, providers need ongoing emotional, financial, logistical and practical resources. PROSPERO REGISTRATION NUMBER CRD42020161179.
Collapse
Affiliation(s)
- Eva Chang
- RTI-University of North Carolina Evidence-Based Practice Center, RTI International, Research Triangle Park, North Carolina, USA
- Advocate Aurora Research Institute, Advocate Aurora Health Inc, Downers Grove, Illinois, USA
| | - Rania Ali
- RTI-University of North Carolina Evidence-Based Practice Center, RTI International, Research Triangle Park, North Carolina, USA
| | - Nancy D Berkman
- RTI-University of North Carolina Evidence-Based Practice Center, RTI International, Research Triangle Park, North Carolina, USA
| |
Collapse
|
12
|
Teaming in Interdisciplinary Chronic Pain Management Interventions in Primary Care: a Systematic Review of Randomized Controlled Trials. J Gen Intern Med 2022; 37:1501-1512. [PMID: 35239110 PMCID: PMC9086072 DOI: 10.1007/s11606-021-07255-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/28/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Current pain management recommendations emphasize leveraging interdisciplinary teams. We aimed to identify key features of interdisciplinary team structures and processes associated with improved pain outcomes for patients experiencing chronic pain in primary care settings. METHODS We searched PubMed, EMBASE, and CINAHL for randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (e.g., BPI total pain, GCPS pain intensity, RMDQ pain-related disability), include primary care as an intervention setting, and demonstrate some evidence of teamwork or teaming; specifically, they needed to involve at least two clinicians interacting with each other and with patients in an ongoing process over at least two timepoints. We assessed study quality with the Cochrane Risk of Bias tool. We narratively synthesized intervention team structures and processes, comparing among interventions that reported a clinically meaningful improvement in patient-reported pain outcomes defined by the minimal clinically important difference (MCID). RESULTS We included 13 total interventions in our review, of which eight reported a clinically meaningful improvement in at least one patient-reported pain outcome. No included studies had an overall high risk of bias. We identified the role of a care manager as a common structural feature of the interventions with some clinical effect on patient-reported pain. The team processes involving clinicians varied across interventions reporting clinically improved pain outcomes. However, when analyzing team processes involving patients, six of the interventions with some clinical effect on pain relied on pre-scheduled phone calls for continuous patient follow-up. DISCUSSION Our review suggests that interdisciplinary interventions incorporating teamwork and teaming can improve patient-reported pain outcomes in comparison to usual care. Given the current evidence, future interventions might prioritize care managers and mechanisms for patient follow-up to help bridge the gap between clinical guidelines and the implementation of interdisciplinary, team-based chronic pain care.
Collapse
|
13
|
Sarabia-Cobo C, Taltavull JM, Lladó-Jordan G, González S, Molina-Mula J, Ortego-Mate C, Fernández-Peña R. Comparison between attention and experiences of chronic complex patients: A multicentric study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:976-987. [PMID: 33453131 DOI: 10.1111/hsc.13269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/25/2020] [Accepted: 11/11/2020] [Indexed: 02/05/2023]
Abstract
The aim of this research is to explore and analyse the functional status and experiences of complex patients located at levels 3-4 of the risk pyramid of the chronic care model in primary care, within the hospital system of two regions in Spain. The design was a mixed design (COREQ). The participants were enrolled in programs for chronic complex patients and their caregivers. Sociodemographic variables were gathered, together with the following measures: the Barthel test, the Mini mental test, the Zarit questionnaire, the IEXPAC scale and the Braden scale. A semi-structured interview was conducted individually with patients in order to explore their experiences and narrative on the process of their illness and the support they had received. The sample comprised 206 chronic pluripathological patients, of whom 103 were from Cantabria and a further 103 were from Mallorca. The patient profile in both regions was very similar. There was an equal distribution across both gender and the patients were over 78 years old. They all had a basic (primary) education, an average income and required moderate physical dependence, receiving assistance primarily from their children. The qualitative analysis highlighted patients' awareness of the illness and their concern for the future, noting that, overall, patients were satisfied with the care provided by their caregivers and the health system. We can conclude that is the first multicentric study of these characteristics conducted in Spain, despite it being the country with the second largest ageing population in the world. It is important to test new organisational models with differentiating areas of advanced clinical practice in primary care, whereby both patients and their caregivers can be co-responsible within the care process.
Collapse
Affiliation(s)
- Carmen Sarabia-Cobo
- Faculty of Nursing, University of Cantabria, Santander, Spain
- Nursing Research Group IDIVAL, Santander, Spain
| | - J M Taltavull
- Gerencia de Atención Primaria de Mallorca. Servicio Balear de Salud, Islas Baleares, Spain
| | | | | | - Jesús Molina-Mula
- Nursing and Physiotherapy Department, University of Illes Balears, Santander, Spain
| | - Carmen Ortego-Mate
- Faculty of Nursing, University of Cantabria, Santander, Spain
- Nursing Research Group IDIVAL, Santander, Spain
| | - Rosario Fernández-Peña
- Faculty of Nursing, University of Cantabria, Santander, Spain
- Nursing Research Group IDIVAL, Santander, Spain
- SALBIS Research Group, León, Spain
| |
Collapse
|
14
|
Silva E Lima SG, Spagnuolo RS, Juliani CMCM, Colichi RMB. Nursing consultation in the Family Health Strategy and the nurse's perception: Grounded Theory. Rev Bras Enferm 2022; 75:e20201105. [PMID: 35352778 DOI: 10.1590/0034-7167-2020-1105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/03/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to understand the experience of nurses with nursing consultations in the context of the Family Health Strategy and propose a representative model. METHODS qualitative research using Grounded Theory, with 14 nurses working through non-directive interviews. For data analysis, three stages were used: open, axial and selective coding, which originated phenomena, themes, categories and subcategories, which supported the construction of the central category and, consequently, the theoretical model. RESULTS the interrelation of phenomena emerged from the essence of the nurse's experience, revealing the central category: From nursing education to the practice of Nursing Consultation, unveiling learning, challenges and autonomy as intervening components. Final Considerations: the nurse's experience is positive and, despite numerous challenges in daily life, the nurse has been performing it based on comprehensive care. New studies may add new understandings that enable the expansion of working conditions, valuing the nursing consultation.
Collapse
|
15
|
Jepma P, Latour CHM, Ten Barge IHJ, Verweij L, Peters RJG, Scholte Op Reimer WJM, Buurman BM. Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention - a qualitative study. BMC Health Serv Res 2021; 21:786. [PMID: 34372851 PMCID: PMC8353821 DOI: 10.1186/s12913-021-06719-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/29/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients' participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients. METHODS A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed. RESULTS Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants' recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention. CONCLUSION Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients' needs, considering their frailty, self-management skills and existing formal and informal caregiver networks.
Collapse
Affiliation(s)
- Patricia Jepma
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Corine H M Latour
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Iris H J Ten Barge
- Nursing Sciences, Program of Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lotte Verweij
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- HU University of Applied Sciences Utrecht, Research Group Chronic Diseases, Utrecht, The Netherlands
| | - Bianca M Buurman
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Putra ADM, Sandhi A. Implementation of nursing case management to improve community access to care: A scoping review. BELITUNG NURSING JOURNAL 2021; 7:141-150. [PMID: 37469339 PMCID: PMC10353612 DOI: 10.33546/bnj.1449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/24/2021] [Accepted: 06/02/2021] [Indexed: 07/21/2023] Open
Abstract
Background Case management is an approach used to help patients locate and manage health resources as well as to enhance effective communication among patients, families, and health systems. Nurses' role as case managers has been proven effective in reducing healthcare costs among patients with chronic diseases. However, little is known about its implementation in improving access to care in community-based settings. Objectives This scoping review aimed to examine the components of nursing case management in improving access to care within community settings and to identify the issues of community-based nursing case management for future implications. Design This study was conducted following the framework of scoping review. Data Sources The authors systematically searched five electronic databases (CINAHL, PubMed, Science Direct, Scopus, and Google Scholar) for relevant studies published from January 2010 to February 2021. Only original studies involving nurses as one of the professions performing case management roles in the community-based settings, providing 'access to care' as the findings, were included. Review Methods The article screening was guided by a PRISMA flowchart. Extraction was performed on Google Sheet, and synthesis was conducted from the extraction result. Results A total of 19 studies were included. Five components of nursing case management to improve access to care were identified: 1) Bridging health systems into the community, 2) Providing the process of care, 3) Delivering individually-tailored health promotion and prevention, 4) Providing assistance in decision making, and 5) Providing holistic support. In addition, three issues of nursing case management were also identified: 1) Regulation ambiguity, 2) High caseloads, and 3) Lack of continuing case management training. Conclusion Care coordination and care planning were the most frequent components of nursing case management associated with access to care. These findings are substantial to improve nurses' ability in performing the nursing process as well as to intensify nurses' advocacy competence for future implications.
Collapse
Affiliation(s)
- Alenda Dwiadila Matra Putra
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ayyu Sandhi
- Department of Pediatrics and Maternity Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| |
Collapse
|
17
|
Brunner L, Canepa Allen M, Malebranche M, Hudon C, Senn N, Hugli O, Vu F, Akré C, Bodenmann P. Qualitative evaluation of primary care providers' experiences caring for frequent users of the emergency department. BMJ Open 2021; 11:e044326. [PMID: 34172545 PMCID: PMC8237725 DOI: 10.1136/bmjopen-2020-044326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Many interventions have been developed over the years to offer frequent users of the emergency department (FUEDs) better access to quality coordinated healthcare. Despite recognising the role primary care physicians (PCPs) play in FUEDs' care, to date their perceptions of case management, the most studied intervention, have rarely been assessed. Furthermore, a gap regarding PCPs' experience of caring for FUEDs persists. Thus, this study aimed to explore PCPs' perceptions of the care provided to FUEDs in emergency and primary care settings, their views on the local case management team (CMT), and their suggestions to improve FUEDs' care. DESIGN Qualitative study using in-depth semistructured interviews and inductive thematic analysis. SETTING Canton of Vaud, Switzerland. PARTICIPANTS Thirty PCPs participated, 16 in private practice (PP-PCPs) and 14 based at the Lausanne University Centre of General Medicine and Public Health (Unisanté-U-PCPs). RESULTS U-PCPs and PP-PCPs thought that most FUEDs' emergency department (ED) visits were legitimate, but questioned ED adequacy to meet FUEDs' needs. Yet, both PCP groups reported encountering many challenges in FUEDs' care themselves. In this context, PP-PCPs seemed more satisfied of the care they provided to FUEDs than U-PCPs. Generally, U-PCPs seemed to find more value in the CMT to help them care for FUEDs than PP-PCPs. To enhance FUEDs' care, U-PCPs and PP-PCPs suggested enhancing collaboration with other healthcare providers. U-PCPs also wished to increase their availability, and some PP-PCPs considered outpatient clinics, larger group practices or medical centres most appropriate to handle FUEDs' needs. CONCLUSIONS This study highlights the many challenges PCPs face in caring for FUEDs, that a CM intervention has the potential to mitigate, and provides ways forward in improving FUEDs' care, including reinforced communication with the CMT and ED physicians, and structural changes to their own way of delivering care to FUEDs.
Collapse
Affiliation(s)
- Laureline Brunner
- Department of Vulnerabilities and Social Medicine, Unisanté, Lausanne, Vaud, Switzerland
| | - Marina Canepa Allen
- Department of Vulnerabilities and Social Medicine, Unisanté, Lausanne, Vaud, Switzerland
| | - Mary Malebranche
- Department of Medicine, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Catherine Hudon
- Family Medicine and Emergency Medicine Department, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nicolas Senn
- Department of Family Medicine, Unisanté, Lausanne, Vaud, Switzerland
| | - Olivier Hugli
- Emergency Department, University Hospital of Lausanne, Lausanne, Vaud, Switzerland
| | - Francis Vu
- Department of Vulnerabilities and Social Medicine, Unisanté, Lausanne, Vaud, Switzerland
| | - Christina Akré
- Department of Epidemiology and Health Systems-University of Lausanne, Unisanté, Lausanne, Vaud, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Unisanté, Lausanne, Vaud, Switzerland
| |
Collapse
|
18
|
Kurteva S, Tamblyn R, Khosrow-Khavar F, Meguerditchian AN. Postoperative duration of opioid use and acute healthcare services use in cancer patients hospitalized for thoracic surgery. J Surg Oncol 2021; 124:431-440. [PMID: 33893741 DOI: 10.1002/jso.26504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/25/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postoperative pain control is an important cancer care component. However, opioid consumption has resulted in a surge of adverse events, with thoracic surgery patients having the highest rate of persistent use. The effect of opioid duration post-discharge and the risk of increased acute healthcare use in this population remains unclear. METHODS A prospective cohort of non-metastatic cancer patients was assembled from an academic health center in Montreal (Canada). Clinical data linked to administrative claims from the universal healthcare program was used to determine the association between time-varying opioid patterns and emergency department (ED) visits/re-admissions/death 3 months following thoracic surgery. RESULTS Of the 610 patients, 77% had at least one opioid dispensed post-discharge. Compared to non-opioid users, <15 days of use was associated with a 42% decreased risk of acute healthcare events, adjusted HR 0.58, 95% CI (0.40-0.85); longer durations were not associated with an increased risk. Compared to short-term use (<15 days), use of >30 days was associated with a 72% increased risk of the outcome, aHR: 1.72, 95% CI (1.01-2.93). CONCLUSION There was a variation in the risk of acute healthcare use associated with postsurgical opioid use. Findings from this study may be used to inform postoperative prescribing practices.
Collapse
Affiliation(s)
- Siyana Kurteva
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Farzin Khosrow-Khavar
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Ari N Meguerditchian
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.,St. Mary's Research Institute, Montreal, Quebec, Canada
| |
Collapse
|
19
|
Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: A Scoping Review. Int J Integr Care 2021; 21:16. [PMID: 33776605 PMCID: PMC7977020 DOI: 10.5334/ijic.5518] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Millions of people worldwide have complex health and social care needs. Care coordination for these patients is a core dimension of integrated care and a key responsibility for primary healthcare. Registered nurses play a substantial role in care coordination. This review draws on previous theoretical work and provides a synthesis of care coordination interventions as operationalized by nurses for complex patient populations in primary healthcare. Methodology: We followed Arksey and O’Malley’s methodological framework for scoping reviews. We carried out a systematic search across CINAHL, MEDLINE, Scopus and ProQuest. Only empirical studies were included. We performed a thematic analysis using deductive (the American Nurses Association Framework) and inductive approaches. Findings were discussed with a group of experts. Results: Thirty-four articles were included in the synthesis. Overall, nursing care coordination activities were synthesized into three categories: those targeting the patient, family and caregivers; those targeting health and social care teams; and those bringing together patients and professionals. Interpersonal communication and information transfer emerged as cross-cutting activities that support every other activity. Our results also brought to light the nurses’ contribution to care coordination efforts for patients with complex needs as well as critical components that should be present in every care coordination intervention for this clientele. These include an increased intensity and frequency of activities, relational continuity of care, and home visits. Conclusion: With the growing complexity of patient’s needs, efforts must be directed towards enabling the primary healthcare level to effectively play its substantial role in care coordination. This includes finding primary care employment models that would facilitate multidisciplinary teamwork and the delivery of integrated care, and guarantee the delivery of intensive yet efficient coordinated care.
Collapse
|
20
|
Fraze TK, Beidler LB, Briggs ADM, Colla CH. Translating Evidence into Practice: ACOs' Use of Care Plans for Patients with Complex Health Needs. J Gen Intern Med 2021; 36:147-153. [PMID: 33006083 PMCID: PMC7858720 DOI: 10.1007/s11606-020-06122-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 04/23/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Care plans are an evidence-based strategy, encouraged by the Centers for Medicare and Medicaid Services, and are used to manage the care of patients with complex health needs that have been shown to lead to lower hospital costs and improved patient outcomes. Providers participating in payment reform, such as accountable care organizations, may be more likely to adopt care plans to manage complex patients. OBJECTIVE To understand how Medicare accountable care organizations (ACOs) use care plans to manage patients with complex clinical needs. DESIGN A qualitative study using semi-structured interviews with Medicare ACOs. PARTICIPANTS Thirty-nine interviews were conducted across 18 Medicare ACOs with executive-level leaders and associated clinical and managerial staff. APPROACH Development, structure, use, and management of care plans for complex patients at Medicare ACOs. KEY RESULTS Most (11) of the interviewed ACOs reported using care plans to manage care of complex patients. All care plans include information about patient history, current medical needs, and future care plans. Beyond the core elements, care plans included elements based on the ACO's planned use and level of staff and patient engagement with care planning. Most care plans were developed and maintained by care management (not clinical) staff. CONCLUSIONS ACOs are using care plans for patients with complex needs, but their use of care plans does not always meet the best practices. In many cases, ACO usage of care plans does not align with prescribed best practices: ACOs are adapting use of care plans to better fit the needs of patients and providers.
Collapse
Affiliation(s)
- Taressa K Fraze
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA. .,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
| | - Laura B Beidler
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Adam D M Briggs
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.,The Health Foundation, London, UK
| | - Carrie H Colla
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| |
Collapse
|
21
|
Brodeur M, Margo-Dermer E, Chouinard MC, Hudon C. Experience of being a frequent user of primary care and emergency department services: a qualitative systematic review and thematic synthesis. BMJ Open 2020; 10:e033351. [PMID: 32912938 PMCID: PMC7482492 DOI: 10.1136/bmjopen-2019-033351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Frequent users of healthcare services are often categorised as 'heavy-cost patients'. In the recent years, many jurisdictions have attempted to implement different public policies to optimise the use of health services by frequent users. However, throughout this process, little attention has been paid to their experience as patients. OBJECTIVE To thematically synthesise qualitative studies that explore the experience of frequent users of primary care and emergency department services. DESIGN Qualitative systematic review and thematic synthesis. SETTING Primary care and emergency department. PARTICIPANTS Frequent users of primary care and emergency department services. METHODS A qualitative systematic review was conducted using three online databases (MEDLINE with full text, CINAHL with full text and PsycINFO). This search was combined to an extensive manual search of reference lists and related citations. A thematic synthesis was performed to develop descriptive themes and analytical constructs. STUDY SELECTION Twelve studies were included. All included studies met the following inclusion criteria: qualitative design; published in English; discussed frequent users' experiences from their own perspectives and users' experiences occurred in primary care and/or emergency departments. RESULTS The predominant aspects of frequent users' experiences were: (1) the experience of being ill and (2) the healthcare experience. The experience of being ill encompassed four central themes: physical limitations, mental suffering, impact on relationships and the role of self-management. The healthcare experience embraced the experience of accessing healthcare and the global experience of receiving care. CONCLUSION This synthesis sheds light on potential changes to healthcare delivery in order to improve frequent users' experiences: individualised care plans or case management interventions to support self-management of symptoms and reduce psychological distress; and giving greater importance on the patient-providers relationship as a central facet of healthcare delivery. This synthesis also highlights future research directions that would benefit frequent users.
Collapse
Affiliation(s)
- Magaly Brodeur
- Département de Médecine de Famille et de Médecine d'urgence, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Eva Margo-Dermer
- Département de Médecine de Famille, Université McGill, Montreal, Quebec, Canada
| | - Maud-Christine Chouinard
- Département des Sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Catherine Hudon
- Département de Médecine de Famille et de Médecine d'urgence, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| |
Collapse
|
22
|
"Not Alone Anymore": The Experiences of Adults With Diabetes in New York's Medicaid Health Home Program. Med Care 2020; 58 Suppl 6 Suppl 1:S60-S65. [PMID: 32412954 DOI: 10.1097/mlr.0000000000001296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND New York State Medicaid's Health Home program is an example of a natural experiment that could affect individuals with diabetes. While evaluations of interventions such as the Health Home program are generally based solely on clinical and administrative data and rarely examine patients' experience, patients may add to the understanding of the intervention's implementation and mechanisms of impact. OBJECTIVE The objective of this study was to qualitatively examine the health and nonmedical challenges faced by Medicaid-insured patients with diabetes and their experiences with the services provided by New York's Health Homes to address these challenges. RESEARCH DESIGN We performed 10 focus groups and 23 individual interviews using a guide developed in collaboration with a stakeholder board. We performed a thematic analysis to identify cross-cutting themes. SUBJECTS A total of 63 Medicaid-insured individuals with diabetes, 31 of whom were enrolled in New York's Health Home program. RESULTS While participants were not generally familiar with the term "Health Home," they described and appreciated services consistent with Health Home enrollment delivered by care managers. Services addressed challenges in access to care, especially by facilitating and reminding participants about appointments, and nonmedical needs, such as transportation, housing, and help at home. Participants valued their personal relationships with care managers and the psychosocial support they provided. CONCLUSIONS From the perspective of its enrollees, the Health Home program primarily addressed access to care, but also addressed material and psychosocial needs. These findings have implications for Health Home entities and for research assessing their impact.
Collapse
|
23
|
Teper MH, Vedel I, Yang XQ, Margo-Dermer E, Hudon C. Understanding Barriers to and Facilitators of Case Management in Primary Care: A Systematic Review and Thematic Synthesis. Ann Fam Med 2020; 18:355-363. [PMID: 32661038 PMCID: PMC7358023 DOI: 10.1370/afm.2555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/30/2019] [Accepted: 11/29/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Despite evidence on the benefits of case management for the care of patients with complex needs in primary care, implementing the program-necessary to achieve its benefits-has been challenging worldwide. Evidence on factors affecting implementation remains disparate. Accordingly, the objective of this systematic review was to identify barriers to and facilitators of case management, from the perspectives of health care professionals, in primary care settings around the world. METHODS We conducted a systematic review and thematic synthesis of qualitative findings. In collaboration with 2 librarians, we searched 3 electronic databases (MEDLINE, CINAHL, EMBASE) for studies related to factors affecting case management function in primary care. Two researchers screened titles, abstracts, and full texts for inclusion, then assessed included studies for quality. Results from included studies were synthesized by thematic synthesis, and a framework was developed. RESULTS Of 1,640 unique records identified, 22 studies, originating from 6 countries, met the inclusion criteria. We identified 9 barriers and facilitators: family context; policy and available resources; physician buy-in and understanding of the case manager role; relationship building; team communication practices; autonomy of case managers; training in technology; relationships with patients; and time pressure and workload. We describe these factors, then present a framework demonstrating the relationships among them. CONCLUSIONS Our study's findings show that multiple factors influence case management implementation. These findings have implications for researchers, clinicians, and policy makers who strive to implement or reform case management programs in local or larger primary care settings.
Collapse
Affiliation(s)
- Matthew Hacker Teper
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Xin Qiang Yang
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Eva Margo-Dermer
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine, Univer-sité de Sherbrooke, Sherbrooke, Québec, Canada
| |
Collapse
|
24
|
Danish A, Chouinard MC, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Bisson M, Cassidy M, Condran B, Lambert M, Penney C, Sabourin V, Warren M, Hudon C. Protocol for a mixed-method analysis of implementation of case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs. BMJ Open 2020; 10:e038241. [PMID: 32487584 PMCID: PMC7265033 DOI: 10.1136/bmjopen-2020-038241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Case management (CM) in a primary care setting is a promising approach to integrating and improving healthcare services and outcomes for patients with chronic conditions and complex care needs who frequently use healthcare services. Despite evidence supporting CM and interest in implementing it in Canada, little is known about how to do this. This research aims to identify the barriers and facilitators to the implementation of a CM intervention in different primary care contexts (objective 1) and to explain the influence of the clinical context on the degree of implementation (objective 2) and on the outcomes of the intervention (objective 3). METHODS AND ANALYSIS A multiple-case embedded mixed-methods study will be conducted on CM implemented in ten primary care clinics across five Canadian provinces. Each clinic will represent a subunit of analysis, detailed through a case history. Cases will be compared and contrasted using multiple analytical approaches. Qualitative data (objectives 1 and 2) from individual semistructured interviews (n=130), focus group discussions (n=20) and participant observation of each clinic (36 hours) will be compared and integrated with quantitative (objective 3) clinical data on services use (n=300) and patient questionnaires (n=300). An evaluation of intervention fidelity will be integrated into the data analysis. ETHICS AND DISSEMINATION This project received approval from the CIUSSS de l'Estrie - CHUS Research Ethic Board (project number MP-31-2019-2830). Results will provide the opportunity to refine the CM intervention and to facilitate effective evaluation, replication and scale-up. This research provides knowledge on how to resp ond to the needs of individuals with chronic conditions and complex care needs in a cost-effective way that improves patient-reported outcomes and healthcare use, while ensuring care team well-being. Dissemination of results is planned and executed based on the needs of various stakeholders involved in the research.
Collapse
Affiliation(s)
- Alya Danish
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Monique Cassidy
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Brian Condran
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada
| | | | - Mike Warren
- NL-SPOR Suppport Unit, St-John's, Newfoundland and Labrador, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre hospitalier universitaire de Sherbrooke Research Centre, Sherbrooke, Québec, Canada
| |
Collapse
|
25
|
HUGHES GEMMA, SHAW SARAE, GREENHALGH TRISHA. Rethinking Integrated Care: A Systematic Hermeneutic Review of the Literature on Integrated Care Strategies and Concepts. Milbank Q 2020; 98:446-492. [PMID: 32436330 PMCID: PMC7296432 DOI: 10.1111/1468-0009.12459] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Policy Points Integrated care is best understood as an emergent set of practices intrinsically shaped by contextual factors, and not as a single intervention to achieve predetermined outcomes. Policies to integrate care that facilitate person-centered, relationship-based care can potentially contribute to (but not determine) improved patient experiences. There can be an association between improved patient experiences and system benefits, but these outcomes of integrated care are of different orders and do not necessarily align. Policymakers should critically evaluate integrated care programs to identify and manage conflicts and tensions between a program's aims and the context in which it is being introduced. CONTEXT Integrated care is a broad concept, used to describe a connected set of clinical, organizational, and policy changes aimed at improving service efficiency, patient experience, and outcomes. Despite examples of successful integrated care systems, evidence for consistent and reproducible benefits remains elusive. We sought to inform policy and practice by conducting a systematic hermeneutic review of literature covering integrated care strategies and concepts. METHODS We used an emergent search strategy to identify 71 sources that considered what integrated care means and/or tested models of integrated care. Our analysis entailed (1) comparison of strategies and concepts of integrated care, (2) tracing common story lines across multiple sources, (3) developing a taxonomy of literature, and (4) generating a novel interpretation of the heterogeneous strategies and concepts of integrated care. FINDINGS We identified four perspectives on integrated care: patients' perspectives, organizational strategies and policies, conceptual models, and theoretical and critical analysis. We subdivided the strategies into four framings of how integrated care manifests and is understood to effect change. Common across empirical and conceptual work was a concern with unity in the face of fragmentation as well as the development and application of similar methods to achieve this unity. However, integrated care programs did not necessarily lead to the changes intended in experiences and outcomes. We attribute this gap between expectations and results, in part, to significant misalignment between the aspiration for unity underpinning conceptual models on the one hand and the multiplicity of practical application of strategies to integrate care on the other. CONCLUSIONS Those looking for universal answers to narrow questions about whether integrated care "works" are likely to remain disappointed. Models of integrated care need to be valued for their heuristic rather than predictive powers, and integration understood as emerging from particular as well as common contexts.
Collapse
Affiliation(s)
- GEMMA HUGHES
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
| | - SARA E. SHAW
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
| | - TRISHA GREENHALGH
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
| |
Collapse
|
26
|
Hudon C, Chouinard MC, Aubrey-Bassler K, Muhajarine N, Burge F, Bush PL, Danish A, Ramsden VR, Légaré F, Guénette L, Morin P, Lambert M, Fick F, Cleary O, Sabourin V, Warren M, Pluye P. Case Management in Primary Care for Frequent Users of Health Care Services: A Realist Synthesis. Ann Fam Med 2020; 18:218-226. [PMID: 32393557 PMCID: PMC7213991 DOI: 10.1370/afm.2499] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 11/09/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Maud-Christine Chouinard
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Kris Aubrey-Bassler
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Nazeem Muhajarine
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Fred Burge
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Paula Louise Bush
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Alya Danish
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Vivian R Ramsden
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - France Légaré
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Line Guénette
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Paul Morin
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Mireille Lambert
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Fiona Fick
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Olivia Cleary
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Véronique Sabourin
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Mike Warren
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Pierre Pluye
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| |
Collapse
|
27
|
A "Behind-the-Scenes" Look at Interprofessional Care Coordination: How Person-Centered Care in Safety-Net Health System Complex Care Clinics Produce Better Outcomes. Int J Integr Care 2020; 20:5. [PMID: 32405282 PMCID: PMC7207252 DOI: 10.5334/ijic.4734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction: While the effectiveness of team-based care and wrap-around services for high utilizers is clear, how complex care clinics deliver effective, person-centered care to these vulnerable populations is not well understood. This paper describes how interactions among interprofessional team members enabled individualized, rapid responses to the complex needs of vulnerable patients at the Virginia Commonwealth University Health System’s Complex Care Clinic. Methods: Researchers attended twenty weekly care coordination meetings, audio-recorded the proceedings, and wrote brief observational field notes. Researchers also qualitatively interviewed ten clinic team members. Emergent coding based on grounded theory and a consensus process were used to identify and describe key themes. Results: Analysis resulted in three themes that evidence the structures, processes, and interactions which contributed to the ability to provide person-centred care: team-based communication strategies, interprofessional problem-solving, and personalized patient engagement efforts. Conclusion: Our study suggests that in care coordination meetings team members were able to strategize, brainstorm, and reflect on how to better care for patients. Specifically, flexible team leadership opened an inter-disciplinary communicative space to foster conversations, which revealed connections between the physical, and socio-emotional components of patients’ lives and hidden factors undermining progress, while proactive strategies prevented patient’s rapid deterioration and unnecessary use of inappropriate health services.
Collapse
|
28
|
Peart A, Barton C, Lewis V, Russell G. A state-of-the-art review of the experience of care coordination interventions for people living with multimorbidity. J Clin Nurs 2020; 29:1445-1456. [PMID: 32043672 DOI: 10.1111/jocn.15206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/18/2019] [Accepted: 02/03/2020] [Indexed: 11/27/2022]
Abstract
AIM To explore recent research on care coordination interventions for people living with multimorbidity, from the perspective of the person receiving care. BACKGROUND Care coordination interventions for people living with multimorbidity show some effectiveness in improving management of their health and reducing potentially preventable hospitalisations. The experience of people enrolled in care coordination interventions requires further exploration. DESIGN State-of-the-art review. METHODS A review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist where five databases (The Cochrane Library, PsycINFO, Scopus, CINAHL and MEDLINE) were searched for qualitative sources published from January 2008-March 2019. Two additional databases focused on multimorbidity and integrated care were included in the search. Titles, abstracts and full texts were screened using inclusion criteria. Reference lists of the included articles were hand-searched. Summary tables were developed for data extraction, and the data were mapped to the research question. RESULTS Eighteen primary research articles were included. Three themes of participant experience were identified: (a) relationships built on trust, (b), a sense of safety and security and (c) feeling cared for and respected. CONCLUSION The contribution of qualitative approaches to evaluating the experiences of care for people living with multimorbidity is growing. Participants' describe a focus on relationships formed with healthcare professionals during care coordination. Further research incorporating lived experiences of participants could illuminate these concepts further. RELEVANCE TO CLINICAL PRACTICE People living with multimorbidity who require assistance via care coordination value trusting relationships with healthcare professionals, who respect their needs and provide a sense of security. Understanding participant experiences is important to shape care coordination interventions that incorporate person-centred approaches.
Collapse
Affiliation(s)
- Annette Peart
- Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Chris Barton
- Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Bundoora, Victoria, Australia
| | - Grant Russell
- Department of General Practice, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
29
|
Ngangue PA, Forgues C, Nguyen T, Sasseville M, Gallagher F, Loignon C, Stewart M, Belle Brown J, Chouinard MC, Fortin M. Patients, caregivers and health-care professionals' experience with an interdisciplinary intervention for people with multimorbidity in primary care: A qualitative study. Health Expect 2020; 23:318-327. [PMID: 32035012 PMCID: PMC7104629 DOI: 10.1111/hex.13035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Multimorbidity challenges the health‐care system and requires innovative approaches. In 2015, a 4‐month patient‐centred interdisciplinary pragmatic intervention was implemented in primary care with the aim of supporting self‐management for patients with multimorbidity. Objective To explore the perceptions and experiences of health‐care professionals, patients and their caregivers with a 4‐month patient‐centred interdisciplinary pragmatic intervention in primary care. Design A descriptive, qualitative study using semi‐structured interviews was conducted. Setting and participants A purposive sample of 30 participants was recruited from seven family medicine groups including patients, caregivers and health‐care professionals (HCPs). Interviews were analysed using Thorne's interpretive description approach. Results Findings were grouped into the benefits and challenges of participating in the intervention. The programme allowed patients to adopt realistic and adapted objectives; to customize interventions to the patient's reality; and to help patients gain confidence, improve their knowledge, skills and motivation to manage their condition. Interprofessional collaboration eased the exchange of information via team meetings and electronic medical records. Challenges were related to collaboration, communication, coordination of work and integration of newly relocated HCPs mainly due to part‐time assignments and staff turnover. HCPs part‐time schedules limited their availability and hindered patients’ follow‐up. Discussion and conclusion This intervention was useful and rewarding from the HCPs, patients and caregivers’ perspective. However, to ensure the success of this complex interdisciplinary intervention, implementers and managers should anticipate organizational barriers such as availability and time management of relocated HCPs.
Collapse
Affiliation(s)
- Patrice Alain Ngangue
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Catherine Forgues
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Tu Nguyen
- Westmead Applied Research Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Maxime Sasseville
- Department of health sciences, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Frances Gallagher
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Christine Loignon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | | | - Martin Fortin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| |
Collapse
|
30
|
Garnett D, Hardy L, Fitzgerald E, Fisher T, Graham L, Overcash J. Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer. Clin J Oncol Nurs 2020; 24:65-74. [PMID: 31961839 DOI: 10.1188/20.cjon.65-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.
Collapse
Affiliation(s)
- Doris Garnett
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | | | | | - Taylor Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Lisa Graham
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | | |
Collapse
|
31
|
Chambers D, Cantrell A, Booth A. Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BackgroundIn 2012, a series of systematic reviews summarised the evidence regarding interventions to reduce preventable hospital admissions. Although intervention effects were dependent on context, the reviews revealed a consistent picture of reduction across different interventions targeting cardiovascular and respiratory conditions. The research reported here sought to provide an in-depth understanding of how interventions that have been shown to reduce admissions for these conditions may work, with a view to supporting their effective implementation in practice.ObjectivesTo map the available evidence on interventions used in the UK NHS to reduce preventable admissions for cardiovascular and respiratory conditions and to conduct a realist synthesis of implementation evidence related to these interventions.MethodsFor the mapping review, six databases were searched for studies published between 2010 and October 2017. Studies were included if they were conducted in the UK, the USA, Canada, Australia or New Zealand; recruited adults with a cardiovascular or respiratory condition; and evaluated or described an intervention that could reduce preventable admissions or re-admissions. A descriptive summary of key characteristics of the included studies was produced. The studies included in the mapping review helped to inform the sampling frame for the subsequent realist synthesis. The wider evidence base was also engaged through supplementary searching. Data extraction forms were developed using appropriate frameworks (an implementation framework, an intervention template and a realist logic template). Following identification of initial programme theories (from the theoretical literature, empirical studies and insights from the patient and public involvement group), the review team extracted data into evidence tables. Programme theories were examined against the individual intervention types and collectively as a set. The resultant hypotheses functioned as synthesised statements around which an explanatory narrative referenced to the underpinning evidence base was developed. Additional searches for mid-range and overarching theories were carried out using Google Scholar (Google Inc., Mountain View, CA, USA).ResultsA total of 569 publications were included in the mapping review. The largest group originated from the USA. The included studies from the UK showed a similar distribution to that of the map as a whole, but there was evidence of some country-specific features, such as the prominence of studies of telehealth. In the realist synthesis, it was found that interventions with strong evidence of effectiveness overall had not necessarily demonstrated effectiveness in UK settings. This could be a barrier to using these interventions in the NHS. Facilitation of the implementation of interventions was often not reported or inadequately reported. Many of the interventions were diverse in the ways in which they were delivered. There was also considerable overlap in the content of interventions. The role of specialist nurses was highlighted in several studies. The five programme theories identified were supported to varying degrees by empirical literature, but all provided valuable insights.LimitationsThe research was conducted by a small team; time and resources limited the team’s ability to consult with a full range of stakeholders.ConclusionsOverall, implementation appears to be favoured by support for self-management by patients and their families/carers, support for services that signpost patients to consider alternatives to seeing their general practitioner when appropriate, recognition of possible reasons why patients seek admission, support for health-care professionals to diagnose and refer patients appropriately and support for workforce roles that promote continuity of care and co-ordination between services.Future workResearch should focus on understanding discrepancies between national and international evidence and the transferability of findings between different contexts; the design and evaluation of implementation strategies informed by theories about how the intervention being implemented might work; and qualitative research on decision-making around hospital referrals and admissions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
32
|
Becker RM, Heidemann ITSB. HEALTH PROMOTION IN CARE FOR PEOPLE WITH CHRONIC NON-TRANSMITABLE DISEASE: INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2018-0250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to analyze the health promotion practices developed by nurses in the care of people with non-transmittable chronic disease in primary health care, in scientific publications, between 2007 and 2017. Method: an integrative literature review of a qualitative approach, conducted in five databases, in which was read and critical analysis of the studies in order to know the practices of health promotion. Results: 40 articles were selected and organized according to the fields of the Ottawa Charter: public policies, reorientation of health services, creation of personal skills, reinforcement of community action and favorable environments. Thus, most of the experiments were mainly related to two fields of action: development of personal skills and reorientation of the health system. There is a movement towards the development of a health promotion in which the collective, the social determinants of health and multidisciplinarity are advocated. Conclusion: some limits were identified that need to be overcome, among which stands out the inter-sectoral work that needs to grow beyond the health sector.
Collapse
|
33
|
Kriegel J, Rissbacher C, Pölzl A, Tuttle-Weidinger L, Reckwitz N. Levers for integrating social work into primary healthcare networks in Austria. Health Policy 2019; 124:75-82. [PMID: 31810579 DOI: 10.1016/j.healthpol.2019.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND The integrated healthcare of patients with support needs in primary healthcare in Austria has insufficient structural and procedural features in terms of the quality and security of care. The aim is therefore to develop solution- and patient-oriented services that take into account both the patients' requirements as well as the medical, nursing, therapeutic and economic perspectives. The question arises: What relevant levers can support the active participation of social work in the primary healthcare of patients with support needs in Austria? METHODS An adapted Analytic Hierarchy Process (AHP) was used to investigate the levers for integrating social work into primary healthcare networks in Austria. In addition to a semi-structured literature search, subjective expert and user priorities were surveyed, cause-and-effect relationships were visualized, an extended cycle of success was developed and relevant control levers were identified by means of a pair comparison matrix and an effectiveness front. RESULTS This results in the targeted development and optimization of the complex integration of social work into primary healthcare in Austria, the relevant levers being the professionalization of social work, competences of social work, communication and cooperation of stakeholders. CONCLUSION The identified levers have to be processed conceptually and operationally. For this purpose, an integrated concept has to be developed, which, in addition to innovative organizational instruments, includes special communication approaches as well as inter-professional process and knowledge management.
Collapse
Affiliation(s)
- Johannes Kriegel
- Institute for Management and Economics in Healthcare, UMIT - University for Health Sciences, Medical Informatics & Technology, 6060, Hall i.T., Austria; University of Applied Sciences Upper Austria, School of Applied Health and Social Sciences, Linz, Austria.
| | - Clemens Rissbacher
- Institute of Integrated Healthcare, tirol kliniken, Innrain 98, 6020, Innsbruck, Austria
| | - Alois Pölzl
- Austrian Association of Social Workers, Mariahilferstraße 81/I/14, 1060, Wien, Austria
| | - Linda Tuttle-Weidinger
- University of Applied Sciences Upper Austria, School of Applied Health and Social Sciences, Linz, Austria
| | - Nanni Reckwitz
- Emergency Department, St. Willibrord Hospital, Willibrordstraße 9, 46446, Emmerich, Germany
| |
Collapse
|
34
|
Hudon C, Chouinard MC, Pluye P, El Sherif R, Bush PL, Rihoux B, Poitras ME, Lambert M, Zomahoun HTV, Légaré F. Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review. Ann Fam Med 2019; 17:448-458. [PMID: 31501208 PMCID: PMC7032902 DOI: 10.1370/afm.2419] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/28/2019] [Accepted: 03/29/2019] [Indexed: 11/09/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Québec, Canada
| | | | - Pierre Pluye
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Reem El Sherif
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Paula Louise Bush
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Benoît Rihoux
- Institut de Sciences Politiques Louvain-Europe (ISPOLE), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marie-Eve Poitras
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Québec, Canada
| | - Mireille Lambert
- Centre Intégré Universitaire de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | | | - France Légaré
- Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Canada
| |
Collapse
|
35
|
De Almeida Lima C, Souto Moreira K, Silva Barbosa BC, De Souza Junior RL, De Quadros Coelho Pinto M, De Melo Costa S. Atenção integral à comunidade: autoavaliação das equipes de saúde da família. AVANCES EN ENFERMERÍA 2019. [DOI: 10.15446/av.enferm.v37n3.76998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: analisar a autoavaliação das equipes de saúde da família quanto à atenção integral à saúde da comunidade.Método: pesquisa transversal analítica, em cidade polo do estado de Minas Gerais, Brasil. Todas as 75 equipes existentes na cidade, no período de coleta dos dados, estavam aderidas ao programa de avaliação. As equipes com ausência de informações nos 35 padrões de qualidade analisados foram excluídas. Analisaram-se 35 itens da subdimensão atenção integral, da “Autoavaliação para Melhoria do Acesso e da Qualidade da Atenção Básica”, instrumento validado pelo Ministério da Saúde brasileiro. Foram processadas análises estatísticas descritivas e bivariadas pelos testes Likelihood ratio, Anova e correlação de Pearson, para comparar a autoavaliação segundo localização (urbana e rural) e profissionais componentes das equipes.Resultados: entre as equipes, 38 (54,28 %) ficaram no nível satisfatório e sete (10 %) no insatisfatório. Houve melhor classificação para aquelas da área urbana (p = 0,010). As categorias profissionais técnico em enfermagem (p = 0,030), médico (p = 0,018), cirurgião-dentista (p = < 0,001) e auxiliar/técnico em odontologia (p = 0,001) se correlacionaram positivamente com maior pontuação.Conclusões: evidenciou-se necessidade de aprimoramento da performance das equipes. Os achados trazem implicações para gestores e profissionais com impacto no cuidado e na atuação do enfermeiro.
Collapse
|
36
|
Kahl C, Meirelles BHS, Cunha KSD, Bernardo MDS, Erdmann AL. Contributions of the nurse's clinical practice to Primary Care. Rev Bras Enferm 2019; 72:354-359. [PMID: 31017196 DOI: 10.1590/0034-7167-2018-0348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/18/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand the repercussions of the nurse's clinical practice on Primary Health Care. METHOD Qualitative research with the theoretical and methodological contribution of Grounded Theory. Data collection took place between May and October 2016 in Florianópolis' Primary Care service. The theoretical sample was comprised of 18 nurses divided into two groups. RESULTS nurses' clinical practice has repercussions on the consolidation of the trust bond between individuals, families and communities, by amplifying the problem-solving efficacy of the Primary Health Care professional's clinical practice. This is due to the implementation of clinical nursing protocols, and also the use of the International Classification for Nursing Practice. FINAL CONSIDERATIONS Nurses' clinical practice has positive repercussions on the health of Primary Health Care users.
Collapse
Affiliation(s)
- Carolina Kahl
- Universidade Federal de Santa Catarina. Florianópolis-SC, Brasil
| | | | | | | | | |
Collapse
|
37
|
Diendéré G, Dansokho SC, Rocque R, Julien AS, Légaré F, Côté L, Mahmoudi S, Jacob P, Casais NA, Pilote L, Grad R, Giguère AMC, Witteman HO. How often do both core competencies of shared decision making occur in family medicine teaching clinics? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:e64-e75. [PMID: 30765371 PMCID: PMC6515489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess how often risk communication and values clarification occur in routine family medicine practice and to explore factors associated with their occurrence. DESIGN Qualitative and quantitative cross-sectional study. SETTING Five university-affiliated family medicine teaching clinics across Quebec. PARTICIPANTS Seventy-one health professionals (55% physicians, 35% residents, 10% nurses or dietitians) and 238 patients (76% women; age range 16 to 82 years old). MAIN OUTCOME MEASURES The presence or absence of risk communication and values clarification during visits in which decisions were made was determined. Factors associated with the primary outcome (both competencies together) were identified. The OPTION5 (observing patient involvement in decision making) instrument was used to validate the dichotomous outcome. RESULTS The presence of risk communication and values clarification during visits was associated with OPTION5 scores (area under the curve of 0.80, 95% CI 0.75 to 0.86, P < .001). Both core competencies of shared decision making occurred in 150 of 238 (63%) visits (95% CI 54% to 70%). Such an occurrence was more likely when the visit included discussion about beginning something new, treatment options, or postponing a decision, as well as when health professionals preferred a collaborative decision-making style and when the visit included more decisions or was longer. Alone, risk communication occurred in 203 of 238 (85%) visits (95% CI 82% to 96%) and values clarification in 162 of 238 (68%) visits (95% CI 61% to 75%). CONCLUSION Health professionals in family medicine are making an effort to engage patients in shared decision making in routine daily practice, especially when there is time to do so. The greatest potential for improvement might lie in values clarification; that is, discussing what matters to patients and families.
Collapse
Affiliation(s)
- Gisèle Diendéré
- Clinical research coordinator at the Jewish General Hospital in Montreal, Que
| | - Selma Chipenda Dansokho
- Research associate in the Research Unit of the Office of Education and Professional Development at Laval University in Quebec city, Que
| | - Rhéa Rocque
- Doctoral student in psychology at Laval University
| | - Anne-Sophie Julien
- Biostatistician in the Clinical Research Platform of the Research Centre of the CHU de Québec in Quebec city
| | - France Légaré
- Practising family physician and Full Professor in the Department of Family and Emergency Medicine at Laval University, Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Scientific Co-director of the Canadian Cochrane Network Site at Laval University, and a researcher at the Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL)
| | - Luc Côté
- Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development in the Faculty of Medicine at Laval University
| | - Sonia Mahmoudi
- Medical student in the Faculty of Medicine at Laval University
| | | | - Natalia Arias Casais
- Consultant with the Pan American Health Organization and the World Health Organization in Washington, DC
| | - Laurie Pilote
- Oncologist in the Division of Radiation Oncology in the Department of Medicine at the CHU de Québec-Laval University
| | - Roland Grad
- Family physician in the Herzl Family Practice Centre in Montreal, and Associate Professor in the Department of Family Medicine and Director of the Clinician Scholar Program in the Department of Family Medicine at McGill University in Montreal
| | - Anik M C Giguère
- Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, the Centre d'excellence sur le vieillissement de Québec at the Research Centre of the CHU de Québec, and the CERSSPL-UL
| | - Holly O Witteman
- Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, Population Health and Optimal Health Practices at the Research Centre of the CHU de Québec, the Ottawa Hospital Research Institute in Ontario, and the CERSSPL-UL.
| |
Collapse
|
38
|
Lima CDA, Moreira KS, Costa GS, Maia RS, Pinto MDQC, Vieira MA, Costa SDM. AVALIAÇÃO DO PROCESSO DE TRABALHO ENTRE EQUIPES DE SAÚDE DA FAMÍLIA DE UM MUNICÍPIO DE MINAS GERAIS, BRASIL. TRABALHO, EDUCAÇÃO E SAÚDE 2019. [DOI: 10.1590/1981-7746-sol00187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Este estudo teve como objetivo avaliar a organização do processo de trabalho entre equipes de saúde da família de um município de Minas Gerais (MG), Brasil. Pesquisa quantitativa, transversal, analítica, desenvolvida em 2014. Investigaram-se formulários da Autoavaliação para Melhoria do Acesso e da Qualidade da Atenção Básica de 73 equipes. Foram considerados 14 itens da subdimensão organização do processo de trabalho, avaliados com valores entre zero e 10 pontos, referindo-se à total inadequação ou adequação da equipe ao padrão avaliado. As equipes foram classificadas do padrão ‘muito insatisfatório’ ao ‘muito satisfatório’. Efetuaram-se análises estatísticas com nível de significância p<0,05. Classificaram-se 86,3% nos padrões muito satisfatório/satisfatório, mas 13,7% foram regular/muito insatisfatório. Três itens ‒ ‘Território definido, vínculo com a população e responsabilização pela resolução das necessidades de saúde’; ‘Coordenação do cuidado’ e ‘Monitoramento das solicitações de exames’ ‒ apresentaram desempenho inadequado. As equipes da zona urbana foram melhor avaliadas. O maior número de profissionais da odontologia foi correlacionado à maior pontuação. Atenção especial deve ser dada àquelas equipes com baixa pontuação. Melhor organização do processo de trabalho deve ser fortalecida, visando aprimorar a performance no cuidado à saúde da comunidade.
Collapse
|
39
|
Palumbo R, Manna R. A spotlight on chronic patients' hospitalization: Some exploratory insights. Health Serv Manage Res 2018; 32:146-157. [PMID: 30541343 DOI: 10.1177/0951484818816833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
All over the world, health care systems are experiencing the challenges raised by the epidemiological transition from the prevalence of acute diseases to the preponderance of chronic illnesses. However, the traditional design for acute conditions of most of health care systems – which triggers a hospital-centric culture – is not consistent with the special health needs of people suffering from long-term conditions. In fact, the access of chronic patients to hospital services has been variously contested to be inappropriate and ineffective to meet their demand for care. Sticking to these considerations, this study investigates the factors that influence the occurrence of hospitalization and the length of hospital stays of a representative sample of Italian chronic patients. Secondary data were collected from the European Health Interview Survey. The sample consisted of 8,127 people. A probit model and a multiple regression analysis were performed to obtain some evidence on the regressors of Italian patients’ access to hospital care. Among others, gender, work condition, health services’ use and health status were found to have a role in influencing chronic patients’ behaviors. The study findings prompted the formulation of several avenues for future developments, which provide some food for thought to policy makers and inspire an agenda for further research.
Collapse
Affiliation(s)
- Rocco Palumbo
- 1 Department of Management and Innovation System, University of Salerno, Salerno, Italy
| | - Rosalba Manna
- 2 Department of Management and Quantitative Studies, University "Parthenope" of Naples, Naples, Italy
| |
Collapse
|
40
|
Hudon C, Chouinard MC, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Brodeur M, Bush PL, Couturier Y, Dubois MF, Guénette L, Légare F, Morin P, Poder TG, Poitras MÈ, Roberge P, Valaitis R, Bighead S, Campbell C, Couture M, Davis B, Deschenes É, Edwards L, Gander S, Gauthier G, Gauthier P, Gibson RJ, Godbout J, Landry G, Longjohn C, Rabbitskin N, Roy DA, Roy J, Sabourin V, Sampalli T, Saulnier A, Spence C, Splane J, Warren M, Young J, Pluye P. Case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs: an implementation and realist evaluation protocol. BMJ Open 2018; 8:e026433. [PMID: 30478129 PMCID: PMC6254422 DOI: 10.1136/bmjopen-2018-026433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Significant evidence in the literature supports case management (CM) as an effective intervention to improve care for patients with complex healthcare needs. However, there is still little evidence about the facilitators and barriers to CM implementation in primary care setting. The three specific objectives of this study are to: (1) identify the facilitators and barriers of CM implementation in primary care clinics across Canada; (2) explain and understand the relationships between the actors, contextual factors, mechanisms and outcomes of the CM intervention; (3) identify the next steps towards CM spread in primary care across Canada. METHODS AND ANALYSIS We will conduct a multiple-case embedded mixed methods study. CM will be implemented in 10 primary care clinics in five Canadian provinces. Three different units of analysis will be embedded to obtain an in-depth understanding of each case: the healthcare system (macro level), the CM intervention in the clinics (meso level) and the individual/patient (micro level). For each objective, the following strategy will be performed: (1) an implementation analysis, (2) a realist evaluation and (3) consensus building among stakeholders using the Technique for Research of Information by Animation of a Group of Experts method. ETHICS AND DISSEMINATION This study, which received ethics approval, will provide innovative knowledge about facilitators and barriers to implementation of CM in different primary care jurisdictions and will explain how and why different mechanisms operate in different contexts to generate different outcomes among frequent users. Consensual and prioritised statements about next steps for spread of CM in primary care from the perspectives of all stakeholders will be provided. Our results will offer context-sensitive explanations that can better inform local practices and policies and contribute to improve the health of patients with complex healthcare needs who frequently use healthcare services. Ultimately, this will increase the performance of healthcare systems and specifically mitigate ineffective use and costs.
Collapse
Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et Médecine d’urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maud-Christine Chouinard
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John’s, Newfoundland and Labrador, Canada
| | - Frederick Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Magaly Brodeur
- Département de Médecine de Famille et Médecine d’urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Paula L Bush
- Department of Family Medicine, Université McGill, Montréal, Quebec, Canada
| | - Yves Couturier
- School of Social Work, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - France Légare
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Paul Morin
- School of Social Work, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Thomas G Poder
- Département de Médecine de Famille et Médecine d’urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- UETMIS and CRCHUS, CIUSSS de l’Estrie - CHUS, Sherbrooke, Quebec, Canada
| | - Marie-Ève Poitras
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Pasquale Roberge
- Département de Médecine de Famille et Médecine d’urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ruta Valaitis
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Shirley Bighead
- Sturgeon Lake First Nation, Sturgeon Lake, Saskatchewan, Canada
| | - Cameron Campbell
- Department of Health and Community Services, St-John’s, Newfoundland and Labrador, Canada
| | - Martine Couture
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada
| | - Breanna Davis
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Élaine Deschenes
- Centre de pédiatrie sociale Sud-Est (CPSSE), Memramcook, New Brunswick, Canada
| | - Lynn Edwards
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Sarah Gander
- Horizon Health Network, Miramichi, New Brunswick, Canada
| | | | - Patricia Gauthier
- Centre intégré universitaire de santé et services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Julie Godbout
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada
| | - Geneviève Landry
- Ministere de la Sante et des Services sociaux Quebec, Quebec, Quebec, Canada
| | | | | | - Denis A Roy
- Institut national d’excellence en santé et en services sociaux, Québec, Quebec, Canada
| | - Judy Roy
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | | | - Tara Sampalli
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | | | | | - Mike Warren
- NL SPOR SUPPORT Unit, St. John’s, Newfoundland and Labrador, Canada
| | - Joanne Young
- Chronic Disease Prevention and Management Health, Government of New Brunswick, Fredericton, New Brunswick, Canada
| | - Pierre Pluye
- Department of Family Medicine, Université McGill, Montréal, Quebec, Canada
| |
Collapse
|
41
|
Braillard O, Slama-Chaudhry A, Joly C, Perone N, Beran D. The impact of chronic disease management on primary care doctors in Switzerland: a qualitative study. BMC FAMILY PRACTICE 2018; 19:159. [PMID: 30205832 PMCID: PMC6134721 DOI: 10.1186/s12875-018-0833-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/14/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patient-centeredness and therapeutic relationship are widely explored as a means to address the challenge of chronic disease and multi-morbidity management, however research focusing on the perspective of doctors is still rare. In this study, we aimed to explore the impact of the patient's chronic disease(s) on their healthcare provider. METHODS A qualitative approach was taken using semi-structured interviews with general practitioners working in outpatient clinics either in individual practices or in a hospital setting in Geneva, Switzerland. Codes were developed through an iterative process and using grounded theory an inductive coding scheme was performed to identify the key themes. Throughout the analysis process the research team reviewed the analysis and refined the coding scheme. RESULTS Twenty interviews, 10 in each practice type, allowed for saturation to be reached. The following themes relevant to the impact of managing chronic diseases emerge around the issue of feeling powerless as a doctor; facing the patient's socio-economic context; guidelines versus the reality of the patient; time; and taking on the patient's burden. Primary care practitioners face an emotional burden linked with their powerlessness and work conditions, but also with the empathetic bond with their patients and their circumstances. Doctors seem poorly prepared for this emotional strain. The health system is also not facilitating this with time constraints and guidelines unsuitable for the patient's reality. CONCLUSIONS Chronic disease and multi-morbidity management is a challenge for healthcare providers. This has its roots in patient characteristics, the overall health system and healthcare providers themselves. Structural changes need to be implemented at different levels: medical education; health systems; adapted guidelines; leading to an overall environment that favors the development of the therapeutic relationship.
Collapse
Affiliation(s)
- Olivia Braillard
- Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals, 1205, Geneva, Switzerland.
| | - Anbreen Slama-Chaudhry
- Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - Catherine Joly
- Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - Nicolas Perone
- Department of Community Health and Care, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, 1205, Geneva, Switzerland
| |
Collapse
|
42
|
Poitras ME, Chouinard MC, Fortin M, Girard A, Crossman S, Gallagher F. Nursing activities for patients with chronic disease in family medicine groups: A multiple-case study. Nurs Inq 2018; 25:e12250. [DOI: 10.1111/nin.12250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 04/27/2018] [Accepted: 05/13/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Marie-Eve Poitras
- Département des Sciences de la Santé; Université du Québec à Chicoutimi; Chicoutimi Québec Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean; Saguenay Québec Canada
| | - Maud-Christine Chouinard
- Département des Sciences de la Santé; Université du Québec à Chicoutimi; Chicoutimi Québec Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean; Saguenay Québec Canada
| | - Martin Fortin
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean; Saguenay Québec Canada
- Faculté de Médecine et des Sciences de la Santé; Université de Sherbrooke; Sherbrooke Québec Canada
| | - Ariane Girard
- Faculté de Médecine et des Sciences de la Santé; Université de Sherbrooke; Sherbrooke Québec Canada
| | | | - Frances Gallagher
- Faculté de Médecine et des Sciences de la Santé; Université de Sherbrooke; Sherbrooke Québec Canada
| |
Collapse
|
43
|
Viana ALD, Bousquat A, Melo GA, Negri Filho AD, Medina MG. Regionalização e Redes de Saúde. CIENCIA & SAUDE COLETIVA 2018; 23:1791-1798. [DOI: 10.1590/1413-81232018236.05502018] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/01/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo O artigo teve como objetivo refletir sobre os desafios da construção das Regiões e Redes de Saúde no Brasil. São elencados como desafios centrais para a constituição das Regiões e Redes de Saúde: o Modelo de Atenção, a Atenção Primária à Saúde, o Cuidado aos Usuários com Doenças Crônicas e a Assistência Hospitalar. Para a consolidação das Regiões e Redes é necessária a incorporação de um sentido ético da organização: a centralidade nas necessidades sociais, populacionais e individuais, derivadas da integralidade, dos direitos humanos e sociais, em amplas interações multiescalares e intersetoriais; com a constituição de uma inovação sistêmica regionalizada. É central a capacidade de divisar quais são os princípios gerais responsáveis por manter a unidade (o modo de atenção), buscando balizar a coerência dos diferentes modelos de provisão que o sistema pode desenvolver segundo as necessidades sociais em contextos regionais. Sem isso, os usuários continuarão a buscar e a criar maneiras de acessar os serviços de saúde que desafiam a racionalidade dos próprios serviços. É também necessária uma reforma hospitalar que integre e reoriente as redes. Essas ponderações são importantes para que o SUS mantenha seu projeto de solidariedade, expresso na tríade da universalidade-integralidade-equidade.
Collapse
|
44
|
Jobe I, Lindberg B, Nordmark S, Engström Å. The care-planning conference: Exploring aspects of person-centred interactions. Nurs Open 2018; 5:120-130. [PMID: 29599987 PMCID: PMC5867285 DOI: 10.1002/nop2.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/27/2017] [Indexed: 12/03/2022] Open
Abstract
Aim The aim of this study was to describe the care‐planning conference from the participants' and researchers' perspectives, focusing on exploring aspects of person‐centred interactions. Design A single‐instrumental, qualitative case study design was used describing a care‐planning conference taking place in the home of an older woman and her daughter. Methods Data collection consisted of observation and digital recording of the care‐planning conference and individual interviews with all the participants before and after the conference. Data were analysed in several phases: first, a narrative description followed by a general description and, thereafter, qualitative content analysis. Results The findings revealed that the care‐planning conference conducted had no clear purpose and did not fulfil all parts of the planning process. Three themes emerged related to aspects of person‐centred interactions. The theme “expectations meet reality” showed different expectations, and participants could not really connect during the conference. The theme “navigate without a map” revealed health professionals' lack of knowledge about the care‐planning process. The theme “lose the forest for the trees” described that the conference was conducted only as part of the health professionals' duties. Management and healthcare professionals cannot automatically assume that they are delivering person‐centred care. Healthcare professionals need to be sensitive to the context, use the knowledge and tools available and continuously evaluate and reassess the work carried out.
Collapse
Affiliation(s)
- Ingela Jobe
- Division of Nursing Department of Health Science Luleå University of Technology Luleå Sweden
| | - Birgitta Lindberg
- Division of Nursing Department of Health Science Luleå University of Technology Luleå Sweden
| | - Sofi Nordmark
- Division of Nursing Department of Health Science Luleå University of Technology Luleå Sweden.,Health Department Norrbotten Region Luleå Sweden
| | - Åsa Engström
- Division of Nursing Department of Health Science Luleå University of Technology Luleå Sweden
| |
Collapse
|
45
|
Primary Care Outcomes Questionnaire: psychometric testing of a new instrument. Br J Gen Pract 2018; 68:e433-e440. [PMID: 29581130 PMCID: PMC6001981 DOI: 10.3399/bjgp18x695765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/08/2017] [Indexed: 11/15/2022] Open
Abstract
Background Patients attend primary care for many reasons and to achieve a range of possible outcomes. There is currently no Patient Reported Outcome Measure (PROM) designed to capture these diverse outcomes, and trials of interventions in primary care may thus fail to detect beneficial effects. Aim This study describes the psychometric testing of the Primary Care Outcomes Questionnaire (PCOQ), which was designed to capture a broad range of outcomes relevant to primary care. Design and setting Questionnaires were administered in primary care in South West England. Method Patients completed the PCOQ in GP waiting rooms before a consultation, and a second questionnaire, including the PCOQ and seven comparator PROMs, after 1 week. Psychometric testing included exploratory factor analysis on the PCOQ, internal consistency, correlation coefficients between domain scores and comparator measures, and repeated measures effect sizes indicating change across 1 week. Results In total, 602 patients completed the PCOQ at baseline, and 264 (44%) returned the follow-up questionnaire. Exploratory factor analysis suggested four dimensions underlying the PCOQ items: health and wellbeing, health knowledge and self-care, confidence in health provision, and confidence in health plan. Each dimension was internally consistent and correlated as expected with comparator PROMs, providing evidence of construct validity. Patients reporting an improvement in their main problem exhibited small to moderate improvements in relevant domain scores on the PCOQ. Conclusion The PCOQ was acceptable, feasible, showed strong psychometric properties, and was responsive to change. It is a promising new tool for assessment of outcomes of primary care interventions from a patient perspective.
Collapse
|
46
|
Murphy M, Hollinghurst S, Salisbury C. Identification, description and appraisal of generic PROMs for primary care: a systematic review. BMC FAMILY PRACTICE 2018; 19:41. [PMID: 29544455 PMCID: PMC5856382 DOI: 10.1186/s12875-018-0722-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/23/2018] [Indexed: 11/11/2022]
Abstract
Background Patients attend primary care with many types of problems and to achieve a range of possible outcomes. There is currently a lack of patient-reported outcome measures (PROMs) designed to capture these diverse outcomes. The objective of this systematic review was to identify, describe and appraise generic PROMs suitable for measuring outcomes from primary care. Methods We carried out a systematic Medline search, supplemented by other online and hand-searches. All potentially relevant PROMs were itemised in a long-list. Each PROM in the long-list which met inclusion criteria was included in a short-list. Short-listed PROMs were then described in terms of their measurement properties and construct, based on a previously published description of primary care outcome as three constructs: health status, health empowerment and health perceptions. PROMs were appraised in terms of extent of psychometric testing (extensive, moderate, low) and level of responsiveness (high, medium, low, unknown). Results More than 5000 abstracts were identified and screened to identify PROMs potentially suitable for measuring outcomes from primary care. 321 PROMs were long-listed, and twenty PROMs were catalogued in detail. There were five PROMs which measured change directly, without need for a baseline. Although these had less strong psychometric properties, they may be more responsive to change than PROMs which capture status at a point in time. No instruments provided coverage of all three constructs. Of the health status questionnaires, the most extensively tested was the SF-36. Of the health empowerment instruments, the PEI, PAM and heiQ provided the best combination of responsiveness and psychometric testing. The health perceptions instruments were all less responsive to change, and may measure a form of health perception which is difficult to shift in primary care. Conclusions This systematic review is the first of its kind to identify papers describing the development and validation of generic PROMs suitable for measuring outcomes from primary care. It identified that: 1) to date, there is no instrument which comprehensively covers the outcomes commonly sought in primary care, and 2) there are different benefits both to PROMs which measure status at a point in time, and PROMs which measure change directly. Electronic supplementary material The online version of this article (10.1186/s12875-018-0722-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mairead Murphy
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Sandra Hollinghurst
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Chris Salisbury
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| |
Collapse
|
47
|
Bousquat A, Giovanella L, Campos EMS, Almeida PFD, Martins CL, Mota PHDS, Mendonça MHMD, Medina MG, Viana ALD, Fausto MCR, Paula DBD. Primary health care and the coordination of care in health regions: managers' and users' perspective. CIENCIA & SAUDE COLETIVA 2018; 22:1141-1154. [PMID: 28444041 DOI: 10.1590/1413-81232017224.28632016] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/18/2016] [Indexed: 11/22/2022] Open
Abstract
This paper aims to analyze the healthcare coordination by Primary Health Care (PHC), with the backdrop of building a Health Care Network (RAS) in a region in the state of São Paulo, Brazil. We conducted a case study with qualitative and quantitative approaches, proceeding to the triangulation of data between the perception of managers and experience of users. We drew analysis realms and variables from the three pillars of healthcare coordination - informational, clinical and administrative/organizational. Stroke was the tracer event chosen and therapeutic itineraries were conducted with users and questionnaires applied to the managers. The central feature of the construction of the Health Care Network in the studied area is the prominence of a philanthropic organization. The results suggest fragility of PHC in healthcare coordination in all analyzed realms. Furthermore, we identified a public-private mix, in addition to services contracted from the Unified Health System (SUS), with out-of-pocket payments for specialist consultation, tests and rehabilitation. Much in the same way that there is no RAS without a robust PHC capable of coordinating care, PHC is unable to play its role without a solid regional arrangement and a virtuous articulation between the three federative levels.
Collapse
Affiliation(s)
- Aylene Bousquat
- Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| | - Ligia Giovanella
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | | | | | - Cleide Lavieri Martins
- Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| | - Paulo Henrique Dos Santos Mota
- Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| | | | | | | | | | - Daniel Baffini de Paula
- Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| |
Collapse
|
48
|
Davis MM, Gunn R, Gowen LK, Miller BF, Green LA, Cohen DJ. A qualitative study of patient experiences of care in integrated behavioral health and primary care settings: more similar than different. Transl Behav Med 2018; 8:649-659. [DOI: 10.1093/tbm/ibx001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Melinda M Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Rural Practice-based Research Network, Portland, OR, USA
| | - Rose Gunn
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - L Kris Gowen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Benjamin F Miller
- Eugene S. Farley, Jr. Health Policy Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Larry A Green
- Eugene S. Farley, Jr. Health Policy Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
49
|
Joo J, Liu M. Experiences of case management with chronic illnesses: a qualitative systematic review. Int Nurs Rev 2018; 65:102-113. [DOI: 10.1111/inr.12429] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J.Y. Joo
- College of Nursing Gachon University Incheon Korea
| | - M.F. Liu
- College of Nursing School of Gerontology Health Management Taipei Medical University Taipei Taiwan
| |
Collapse
|
50
|
Vaz EMC, Collet N, Cursino EG, Forte FDS, Magalhães RKBP, Reichert APDS. Care coordination in Health Care for the child/adolescent in chronic condition. Rev Bras Enferm 2018; 71:2612-2619. [DOI: 10.1590/0034-7167-2017-0787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/06/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To analyze the care coordination for the child and adolescent in chronic condition and users planning in the Health Care Network. Method: Qualitative study, conducted with 26 health professionals and managers through Focus Groups. Thematic content analysis was used. Results: Care coordination is fragile, with lack of support from the management, and presence of high turnover of managers and professionals. The limits in the network planning are due to frequent changes in the careflow. Communication between levels of care and lack of counter-referral makes network care unfeasible. Final considerations: There is a need for planning in the Health Care Network and establishment of careflow, as well as the construction of communication channels and tools of referral and counter-referral between professionals and services, for the constitution and integration of the network from the perspective of user-centered care.
Collapse
|