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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.
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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
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Berret R, Senn N, Maisonneuve H, Cohidon C. Case managers within general practices in 11 Western countries: repeat cross-sectional studies. Swiss Med Wkly 2024; 154:3425. [PMID: 38885527 DOI: 10.57187/s.3425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND In the context of an ageing population and increasing health needs, primary care reform is needed and several new models have emerged, including the introduction of case managers in general practitioner practices. AIM To describe the frequency of case managers in general practices in eleven Western countries between 2012 and 2019 and to investigate the characteristics of general practitioners and their practices associated with case manager frequency. METHODS A secondary analysis of the Commonwealth Fund International Health Policy Surveys of Primary Care Physicians, which were international cross-sectional studies conducted in 2012, 2015 and 2019. Random samples of general practitioners were selected in 11 Western countries (2012: n = 9776; 2015: n = 12,049; 2019: n = 13,200). The use of case managers in general practitioner practices was determined with the question "Does your practice use personnel, such as nurses or case managers, to monitor and manage care for patients with chronic conditions that need regular follow-up care?", with possible answers "Yes, within the practice", "Yes, outside the practice", "Yes, both within and outside the practice" or "No". Other variables characterising general practitioners and their practices were considered. Mixed-effects logistic regression was performed. RESULTS The frequency of case managers within general practitioner practices varied greatly by country, with an overall trend towards an increase from 2012 to 2019. In the multivariate analysis, more case managers were found in practices located in small towns (odds ratio [OR] 1.4; 95% confidence interval [CI] 1.2-1.7) and in rural areas (OR 1.9; 95% CI 1.5-2.4) compared to cities. The frequency of case managers was higher in larger practices, as shown in comparisons of practices in the second, third and fourth quartile of full-time equivalent employee counts compared to those in the first quartile (Q2: OR 1.7, 95% CI 1.4-1.9; Q3: OR 2.1, 95% CI 1.6-2.9; Q4: OR 3.8, 95% CI 3.0-4.9). There was no significant difference in frequency with respect to the age and sex of the general practitioners. CONCLUSION The use of case managers in general practitioner practices is a promising approach, but its practice varies greatly. This practice has been developing in Western countries and is tending to increase. The implementation of case managers seems to be associated with certain characteristics linked to general practitioner practices (practice location, practice size), whereas it does not seem to depend on the personal characteristics of general practitioners, such as age or sex.
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Affiliation(s)
- Romane Berret
- Center for Primary Care and Public Health (Unisanté), Department of Family medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- Center for Primary Care and Public Health (Unisanté), Department of Family medicine, University of Lausanne, Lausanne, Switzerland
| | - Hubert Maisonneuve
- University Institute of Family and Child Medicine (IuMFE), Geneva Faculty of medicine, Geneva, Switzerland
| | - Christine Cohidon
- Center for Primary Care and Public Health (Unisanté), Department of Family medicine, University of Lausanne, Lausanne, Switzerland
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Davies G, Akbari A, Bailey R, Evans L, Smith K, Goodfellow J, Thomas M, Lutchman Singh K. Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties. PLoS One 2024; 19:e0297049. [PMID: 38335178 PMCID: PMC10857708 DOI: 10.1371/journal.pone.0297049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES The study aimed to assess if specialised healthcare service interventions in Wales benefit the population equitably in work commissioned by the Welsh Health Specialised Services Committee (WHSSC). APPROACH The study utilised anonymised individual-level, population-scale, routinely collected electronic health record (EHR) data held in the Secure Anonymised Information Linkage (SAIL) Databank to identify patients resident in Wales receiving specialist cardiac interventions. Measurement was undertaken of associated patient outcomes 2-years before and after the intervention (minus a 6-month clearance period on either side) by measuring events in primary care, hospital attendance, outpatient and emergency department. The analysis controlled for comorbidity (Charlson) and deprivation (Welsh Index of Multiple Deprivation), stratified by admission type (elective or emergency) and membership of top 5% post-intervention costs. Costs were estimated by multiplying events by mean person cost estimates. RESULTS We identified 5,999 percutaneous coronary interventions (PCI) and 1,640 coronary artery bypass graft (CABG) between 2014-06-01 to 2020-02-29. The ratio of emergency to elective interventions was 2.85 for PCI and 1.04 for CABG. In multivariate analysis significant associations were identified for comorbidity (OR = 1.52, CI = (1.01-2.27)), deprivation (OR = 1.34, CI = (1.03-1.76)) and rurality (OR = 0.81, CI = (0.70-0.95)) for PCI interventions, and comorbidity (OR = 1.47, CI = (1.10-1.98)) for CABG. Higher costs post-intervention were associated with increased comorbidity for PCI and CABG in the top 5% cost groups, but for PCI this was not seen outside the top 5%. For PCI, moderate cost increase was associated with increased deprivation, but the picture was more mixed following CABG interventions. For both interventions, lower costs post intervention were seen in rural locations. CONCLUSION We identified and compared health outcomes for selected specialist cardiac interventions amongst patients resident in Wales, with these methods and analyses, providing a template for comparing other cardiac interventions.
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Affiliation(s)
- Gareth Davies
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales
| | - Lloyd Evans
- NHS Wales Executive, Wales Cardiovascular Network, Cardiff, Wales
| | - Kendal Smith
- Welsh Health Specialised Services Committee, Pontypridd, Wales
| | | | - Michael Thomas
- Hywel Dda University Health Board, Hafan Derwen, Carmarthen, Wales
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Hudon C, Kessler R. Integrating case management for patients with complex needs in the ground practice: the importance of context in evaluative designs. Health Res Policy Syst 2023; 21:9. [PMID: 36694260 PMCID: PMC9873218 DOI: 10.1186/s12961-023-00960-4] [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: 08/08/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Responding to complex needs calls for integrating care across providers, settings and sectors. Among models to improve integrated care, case management demonstrates a good evidence base of facilitating the appropriate delivery of healthcare services. Since case management is a complex, multi component intervention, with its component parts interacting in a non-linear manner, effectiveness is largely influenced by the context in which the intervention is implemented. This paper discusses how to respond to implementation challenges to evaluating complex interventions for patients with complex needs. Building on the example of case management, we suggest that documenting innovation effectiveness remains important, but that evaluation needs to include theory-based and systems perspectives. We also suggest that implementation science needs to be part of intervention design while engaging stakeholders to define the most relevant research questions and implementation effectiveness, to optimize successful implementation and sustainability.
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Affiliation(s)
- Catherine Hudon
- grid.86715.3d0000 0000 9064 6198Department of Family and Emergency Medicine, Université de Sherbrooke, Pavillon Z7-local 3007, 3001, 12eAvenue Nord, Sherbrooke, QC J1H 5N4 Canada
| | - Rodger Kessler
- grid.430503.10000 0001 0703 675XDepartment of Family Medicine, University of Colorado School of Medecine, Aurora, CO United States of America
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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.
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Fleming MD, Safaeinili N, Knox M, Hernandez E, Esteban EE, Sarkar U, Brewster AL. Conceptualizing the effective mechanisms of a social needs case management program shown to reduce hospital use: a qualitative study. BMC Health Serv Res 2022; 22:1585. [PMID: 36572882 PMCID: PMC9791730 DOI: 10.1186/s12913-022-08979-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Social needs case management programs are a strategy to coordinate social and medical care for high-risk patients. Despite widespread interest in social needs case management, not all interventions have shown effectiveness. A lack of evidence about the mechanisms through which these complex interventions benefit patients inhibits effective translation to new settings. The CommunityConnect social needs case management program in Contra Costa County, California recently demonstrated an ability to reduce inpatient hospital admissions by 11% in a randomized study. We sought to characterize the mechanisms through which the Community Connect social needs case management program was effective in helping patients access needed medical and social services and avoid hospitalization. An in-depth understanding of how this intervention worked can support effective replication elsewhere. METHODS Using a case study design, we conducted semi-structured, qualitative interviews with case managers (n = 30) and patients enrolled in social needs case management (n = 31), along with field observations of patient visits (n = 31). Two researchers coded all interview transcripts and observation fieldnotes. Analysis focused on program elements identified by patients and staff as important to effectiveness. RESULTS Our analyses uncovered three primary mechanisms through which case management impacted patient access to needed medical and social services: [1] Psychosocial work, defined as interpersonal and emotional support provided through the case manager-patient relationship, [2] System mediation work to navigate systems, coordinate resources, and communicate information and [3] Addressing social needs, or working to directly mitigate the impact of social conditions on patient health. CONCLUSIONS These findings highlight that the system mediation tasks which are the focus of many social needs assistance interventions offered by health care systems may be necessary but insufficient. Psychosocial support and direct assistance with social needs, enabled by a relationship-focused program, may also be necessary for effectiveness.
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Affiliation(s)
- Mark D. Fleming
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Nadia Safaeinili
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Margae Knox
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Elizabeth Hernandez
- grid.421504.60000 0004 0442 6009Contra Costa Health Services, Contra Costa County—Concord, California, USA
| | - Emily E. Esteban
- grid.421504.60000 0004 0442 6009Contra Costa Health Services, Contra Costa County—Concord, California, USA
| | - Urmimala Sarkar
- grid.267103.10000 0004 0461 8879Department of Medicine—San Francisco, University of California, San Francisco, California, USA
| | - Amanda L. Brewster
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
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Hudon C, Chouinard MC, Bisson M, Danish A, Karam M, Girard A, Bossé PL, Lambert M. Case Study With a Participatory Approach: Rethinking Pragmatics of Stakeholder Engagement for Implementation Research. Ann Fam Med 2021; 19:540-546. [PMID: 34750129 PMCID: PMC8575520 DOI: 10.1370/afm.2717] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 02/11/2021] [Accepted: 03/15/2021] [Indexed: 11/09/2022] Open
Abstract
The case study design is particularly useful for implementation analysis of complex health care innovations in primary care that can be influenced by the context of dynamic environments. Case studies may be combined with participatory approaches where academics conduct joint research with nonacademic stakeholders, to foster translation of findings results into practice. The aim of this article is to clarify epistemological and methodological considerations of case studies with a participatory approach. It also aims to propose best practice recommendations when using this case study approach. We distinguish between the participatory case study with full co-construction and co-governance, and the case study with a participatory approach whereby stakeholders are consulted in certain phases of the research. We then compare the epistemological posture of 3 prominent case study methodologists, Yin, Stake, and Merriam, to present the epistemological posture of case studies with a participatory approach. The relevance, applications, and procedures of a case study with a participatory approach methodology are illustrated through a concrete example of a primary care research program (PriCARE). We propose 12 steps for designing and conducting a case study with a participatory approach that may help guide researchers in the implementation analysis of complex health care innovations in primary care.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alya Danish
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marlène Karam
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada
| | - Ariane Girard
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Pierre-Luc Bossé
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mireille Lambert
- Integrated University Health and Social Services Centre, Chicoutimi, Quebec, Canada
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Stockdale SE, Katz ML, Bergman AA, Zulman DM, Denietolis A, Chang ET. What Do Patient-Centered Medical Home (PCMH) Teams Need to Improve Care for Primary Care Patients with Complex Needs? J Gen Intern Med 2021; 36:2717-2723. [PMID: 33511564 PMCID: PMC8390729 DOI: 10.1007/s11606-020-06563-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intensive primary care (IPC) programs for patients with complex needs do not generate cost savings in most settings. Strengthening existing patient-centered medical homes (PCMH) to address the needs of these patients in primary care is a potential high-value alternative. OBJECTIVES Explore PCMH team functioning and characteristics that may impact their ability to perform IPC tasks; identify the IPC components that could be incorporated into PCMH teams' workflow; and identify additional resources, trainings, and staff needed to better manage patients with complex needs in primary care. METHODS We interviewed 44 primary care leaders, PCMH team members (providers, nurses, social workers), and IPC program leaders at 5 VA IPC sites and analyzed a priori themes using a matrix analysis approach. RESULTS Higher-functioning PCMH teams were described as already performing most IPC tasks, including panel management and care coordination. All sites reported that PCMH teams had the knowledge and skills to perform IPC tasks, but not with the same intensity as specialized IPC teams. Home visits/assessments and co-attending appointments were perceived as not feasible to perform. Key stakeholders identified 6 categories of supports and capabilities that PCMH teams would need to better manage complex patients, with care coordination/management and fully staffed teams as the most frequently mentioned. Many thought that PCMH teams could make better use of existing VA and non-VA resources, but might need training in identifying and using those resources. CONCLUSIONS PCMH teams can potentially offer certain clinic-based services associated with IPC programs, but tasks that are time intensive or require physical absence from clinic might require collaboration with community service providers and better use of internal and external healthcare system resources. Future studies should explore the feasibility of PCMH adoption of IPC tasks and the impact on patient outcomes.
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Affiliation(s)
- Susan E Stockdale
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
| | - Marian L Katz
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Alicia A Bergman
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Evelyn T Chang
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
- VA Greater Los Angeles Healthcare System, Division of General Internal Medicine, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Gabrielian S, Jones AL, Hoge AE, deRussy AJ, Kim YI, Montgomery AE, Blosnich JR, Gordon AJ, Gelberg L, Austin EL, Pollio D, Holmes SK, Varley AL, Kertesz SG. Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey. J Prim Care Community Health 2021; 12:2150132721993654. [PMID: 33543675 PMCID: PMC7871055 DOI: 10.1177/2150132721993654] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives: Patients experiencing homelessness (PEH) with serious mental illness (SMI) have poor satisfaction with primary care. We assessed if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs)) provide this population with superior experiences than mainstream primary care and explored whether integrated behavioral health and social services were associated with favorable experiences. Methods: We surveyed VA PEH with SMI (n = 1095) to capture the valence of their primary care experiences in 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs). We surveyed clinicians (n = 52) from 29 H-PACTs to elucidate if their clinics had embedded mental health, addiction, social work, and/or housing services. We counted these services in each H-PACT (0-4) and classified H-PACTs as having high (3-4) versus low (0-2) service integration. We controlled for demographics, housing history, and needs in comparing H-PACT versus mainstream experiences; and experiences in high versus low integration H-PACTs. Results: Among respondents, 969 (91%) had complete data and 626 (62%) were in H-PACTs. After covariate adjustment, compared to mainstream respondents, H-PACT respondents were more likely (P < .01) to report favorable experiences (AORs = 1.7-2.1) and less likely to report unfavorable experiences (AORs = 0.5-0.6) in all 4 domains. Of 29 H-PACTs, 27.6% had high integration. High integration H-PACT respondents were twice as likely as low integration H-PACT respondents to report favorable access/coordination experiences (AOR = 1.7). Conclusions: Homeless-tailored clinics with highly-integrated services were associated with better care experiences among PEH with SMI. These observational data suggest that tailored primary care with integrated services may improve care perceptions among complex patients.
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Affiliation(s)
- Sonya Gabrielian
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
| | - Audrey L Jones
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - April E Hoge
- Birmingham VA Medical Center, Birmingham, AL, USA
| | | | - Young-Il Kim
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - John R Blosnich
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,University of Southern California, Los Angeles, CA, USA
| | - Adam J Gordon
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lillian Gelberg
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
| | - Erika L Austin
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - David Pollio
- University of Alabama at Birmingham College of Letters and Sciences, Birmingham, AL, USA
| | | | | | - Stefan G Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Béland S, Dumont-Samson O, Hudon C. Case Management and Telehealth: A Scoping Review. Telemed J E Health 2021; 28:11-23. [PMID: 33847524 DOI: 10.1089/tmj.2021.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Case management (CM) is an intervention adapted to the needs of patients with chronic conditions or complex needs. Factors associated with effectiveness of CM, such as high intervention intensity, can represent challenges to its implementation. Telehealth has the potential to help overcome these challenges, but little work has been done to synthesize available evidence on telehealth CM. The purpose of this scoping review was thus to fill this gap and document which telehealth modalities have been used, summarize perspectives of key users, and discuss evidence on effectiveness of telehealth-delivered CM. Methods: A search in MEDLINE, Scopus, and CINAHL for articles published between January 2005 and January 2021 was done. Studies in which telehealth was used for patient-case manager interaction and conducted in a population with complex health needs and/or chronic conditions were included. Articles selected for full-text review were independently screened by two reviewers. Data extraction was conducted once and validated by a second reviewer. Results: Of 3,108 articles, 22 were retained for data extraction. A narrative synthesis was conducted. Most studies evaluated CM interventions delivered over telephone, yet, literature suggests that face-to-face contact is essential to CM success. Results also indicate that telehealth CM is acceptable and effective, associated with better utilization of health services and favorable clinical outcomes. Conclusions: Lack of research evaluating telehealth CM delivered using modalities other than telephone. Further research should evaluate CM interventions that integrate platforms enabling visual information exchange.
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Affiliation(s)
- Sophie Béland
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Olivier Dumont-Samson
- Centre Intégré Universitaire de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Catherine Hudon
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Canada
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Towards Better Health, Social, and Community-Based Services Integration for Patients with Chronic Conditions and Complex Care Needs: Stakeholders' Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228437. [PMID: 33202631 PMCID: PMC7696991 DOI: 10.3390/ijerph17228437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/30/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
The objective was to report on issues related to patients with complex care needs and recommendations identified by 160 key participants at a summit in Quebec City about better integration of primary health care services for patients with chronic diseases and complex care needs. A descriptive qualitative approach was used. While focus groups were led by a facilitator, a rapporteur noted highlights and a research team member took independent notes. All notes were analyzed by using a thematic analysis according to an inductive method. Seven issues were identified, leading to the formulation of recommendations: (1) valuing the experience of the patient; (2) early detecting of a non-homogeneous patient population; (3) defining interprofessional collaboration based on patient needs; (4) conciliating services provided by clinical settings according to a registered clientele-based logic with the population-based logic; (5) working with the community sector; (6) aligning patient-oriented research values with existing challenges to primary care integration; and (7) promoting resource allocation consistent with targeted recommendations. The summit highlighted the importance of engaging all stakeholders in improvement of integrated care for patients with complex care needs. The resulting recommendations target shared priorities towards better health, social, and community-based services integration for these patients.
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Huhtakangas M, Tuomikoski AM, Kyngäs H, Kanste O. Frequent attenders' experiences of encounters with healthcare personnel: A systematic review of qualitative studies. Nurs Health Sci 2020; 23:53-68. [PMID: 33034401 DOI: 10.1111/nhs.12784] [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: 07/10/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Abstract
Rather than measure demographic factors such as socioeconomics, the aim of this study was to examine the lived experience of frequent attenders by synthesizing findings on their encounters with healthcare personnel. The Scopus, CINAHL, PsycARTICLES, and PubMed (Medline) databases were searched in May 2020 in order to screen studies by title and abstract (n = 1794) and full-text (n = 20). Findings from the included studies (n = 6) were then pooled using meta-aggregation, yielding the following results: difficulties in resolving frequent attenders' situations may create "service circles," frustrating patients with their situation; frequent attenders' own expertise regarding their condition should be recognized and valued alongside that of healthcare professionals when performing collaborative care; a lack of empathy and disparagement may make frequent attenders feel misunderstood and unappreciated; frequent attenders should be recognized as individuals by taking their circumstances into account and providing support accordingly. Frequent attenders' experiences demonstrate the importance of shared decision-making, continuity of care, and acknowledging these patients' individual circumstances. Identifying the variety of frequent attenders' service needs by synthesizing their experiences is a practical way of organizing patient-centered healthcare services.
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Affiliation(s)
- Moona Huhtakangas
- Department of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Anna-Maria Tuomikoski
- Oulu University of Applied Sciences (Principal Lecturer), The Finnish Centre for Evidence-Based Health care: A JBI Centre of Excellence, Oulu, Finland
| | - Helvi Kyngäs
- Department of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Department of Nursing Science and Health Management, University of Oulu, Medical Research Centre, University Hospital of Oulu, Oulu, Finland
| | - Outi Kanste
- Department of Nursing Science and Health Management, University of Oulu, Oulu, Finland
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Poitras ME, Légaré F, Tremblay Vaillancourt V, Godbout I, Poirier A, Prévost K, Spence C, Chouinard MC, Zomahoun HTV, Khadhraoui L, Massougbodji J, Bujold M, Pluye P, Hudon C. High Users of Healthcare Services: Development and Alpha Testing of a Patient Decision Aid for Case Management. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 13:757-766. [PMID: 33083997 DOI: 10.1007/s40271-020-00465-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Some patients with complex healthcare needs become high users of healthcare services. Case management allows these patients and their interprofessional team to work together to evaluate their needs, priorities and available resources. High-user patients must make an informed decision when choosing whether to engage in case management and currently there is no tool to support them. OBJECTIVE The objective of this study was to develop and conduct a pilot alpha testing of a patient decision aid that supports high-user patients with complex needs and the teams who guide those patients in shared decision making when engaging in case management. METHODS We chose a user-centered design to co-develop a patient decision aid with stakeholders informed by the Ottawa Research Institute and International Patient Decision Aid Standards frameworks. Perceptions and preferences for the patient decision aid's content and format were assessed with patients and clinicians and were iteratively collected through interviews and focus groups. We developed a prototype and assessed its acceptability by using a think-aloud method and a questionnaire with three patient-partners, six clinicians and seven high-user patients with complex needs. RESULTS The three rounds of evaluation to assess the decision aid's acceptability highlighted comments related to simplicity, readability and visual aspect. A section presenting clinical vignettes including story telling was identified as the most helpful. CONCLUSIONS We created and evaluated a patient decision aid. Considering the positive comments, we believe that this aid has the potential to help high-user patients with complex care needs make better choices concerning case management.
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Affiliation(s)
- Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine/Nursing School, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Saguenay, Saguenay, QC, Canada. .,Département de la recherche, Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, QC, Canada. .,Centre de Recherche Charles-LeMoyne-Saguenay-Lac-Saint-Jean Sur Les Innovations en Santé, Saguenay, QC, Canada.
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada.,Population Health and Practice-Changing Research, CHU de Québec, Université Laval, Québec, QC, Canada
| | - Vanessa Tremblay Vaillancourt
- Department of Family Medicine and Emergency Medicine/Nursing School, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Saguenay, Saguenay, QC, Canada.,Département de la recherche, Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, QC, Canada.,Centre de Recherche Charles-LeMoyne-Saguenay-Lac-Saint-Jean Sur Les Innovations en Santé, Saguenay, QC, Canada
| | - Isabelle Godbout
- Québec SPOR Support Unit, Université du Québec à Montréal, Montréal, QC, Canada
| | | | - Karina Prévost
- Département de la recherche, Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, QC, Canada
| | - Claude Spence
- Department of Family Medicine and Emergency Medicine/Nursing School, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Saguenay, Saguenay, QC, Canada
| | | | - Hervé Tchala Vignon Zomahoun
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada.,Centre de Recherche sur ses Soins et les Services de Première Ligne, Université Laval, Québec, QC, Canada
| | | | | | - Mathieu Bujold
- Family Medicine Department, McGill University, Montréal, QC, Canada
| | - Pierre Pluye
- Family Medicine Department, McGill University, Montréal, QC, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine/Nursing School, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Saguenay, Saguenay, QC, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
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