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

IntroductionCase 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 analysisA 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 disseminationThis 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.

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Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol

BMJ Open ◽

10.1136/bmjopen-2017-016400 ◽

2017 ◽

Vol 7 (11) ◽

pp. e016400 ◽

Cited By ~ 4

Author(s):

Mathieu Bujold ◽

Pierre Pluye ◽

France Légaré ◽

Jeannie Haggerty ◽

Genevieve C Gore ◽

...

Keyword(s):

Primary Care ◽

Decision Support ◽

Mixed Methods ◽

Mental Health Problems ◽

Healthcare Services ◽

Multiple Chronic Conditions ◽

Research Approach ◽

Complex Care ◽

Care Needs ◽

Complex Care Needs

IntroductionPatients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers).Methods and analysisThis review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs’ qualitative decisional need assessment (semistructured interviews and focus group with stakeholders).Ethics and disseminationThis systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs’ decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network.PROSPERO registration numberCRD42015020558.

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Complex Care Needs in Multiple Chronic Conditions: Population Prevalence and Characterization in Primary Care. A Study Protocol

International Journal of Integrated Care ◽

10.5334/ijic.3292 ◽

2018 ◽

Vol 18 (2) ◽

Cited By ~ 3

Author(s):

Francisco Hernansanz Iglesias ◽

Clara Alavedra Celada ◽

Carmen Berbel Navarro ◽

Lidia Palau Morales ◽

Nuria Albi Visus ◽

...

Keyword(s):

Primary Care ◽

Study Protocol ◽

Chronic Conditions ◽

Multiple Chronic Conditions ◽

Complex Care ◽

Care Needs ◽

Population Prevalence ◽

Complex Care Needs

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People with an intellectual disability in the discourse of chronic and complex conditions: an invisible group?

Australian Health Review ◽

10.1071/ah080405 ◽

2008 ◽

Vol 32 (3) ◽

pp. 405 ◽

Cited By ~ 19

Author(s):

Linda Goddard ◽

Patricia M Davidson ◽

John Daly ◽

Sandra Mackey

Keyword(s):

Health Care ◽

Intellectual Disability ◽

Chronic Conditions ◽

Health Professions ◽

Disability Services ◽

Complex Care ◽

Competency Development ◽

Care Needs ◽

Complex Care Needs ◽

Respiratory Conditions

People with an intellectual disability and their families experience poorer health care compared with the general population. Living with an intellectual disability is often challenged by coexisting complex and chronic conditions, such as gastrointestinal and respiratory conditions. A literature review was undertaken to document the needs of this vulnerable population, and consultation was undertaken with mothers of children with disabilities and with professionals working within disability services for people with an intellectual disability and their families. Based on this review, there is a need to increase the profile of people with an intellectual disability in the discourse surrounding chronic and complex conditions. Strategies such as guideline and competency development may better prepare health professions to care for people with disabilities and chronic and complex care needs and their families.

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Geriatric Resource Teams: Equipping Primary Care Practices to Meet the Complex Care Needs of Older Adults

Geriatrics ◽

10.3390/geriatrics4040059 ◽

2019 ◽

Vol 4 (4) ◽

pp. 59 ◽

Cited By ~ 1

Author(s):

Gwendolen Buhr ◽

Carrissa Dixon ◽

Jan Dillard ◽

Elissa Nickolopoulos ◽

Lynn Bowlby ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Cognitive Impairment ◽

Assessment Process ◽

Complex Care ◽

Care Needs ◽

Care Practices ◽

Primary Care Practices ◽

Complex Care Needs ◽

The Impact

Primary care practices lack the time, expertise, and resources to perform traditional comprehensive geriatric assessment. In particular, they need methods to improve their capacity to identify and care for older adults with complex care needs, such as cognitive impairment. As the US population ages, discovering strategies to address these complex care needs within primary care are urgently needed. This article describes the development of an innovative, team-based model to improve the diagnosis and care of older adults with cognitive impairment in primary care practices. This model was developed through a mentoring process from a team with expertise in geriatrics and quality improvement. Refinement of the existing assessment process performed during routine care allowed patients with cognitive impairment to be identified. The practice team then used a collaborative workflow to connect patients with appropriate community resources. Utilization of these processes led to reduced referrals to the geriatrics specialty clinic, fewer patients presenting in a crisis to the social worker, and greater collaboration and self-efficacy for care of those with cognitive impairment within the practice. Although the model was initially developed to address cognitive impairment, the impact has been applied more broadly to improve the care of older adults with multimorbidity.

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Demand for community-based Case Management in Austria - a qualitative analysis

BMC Nursing ◽

10.1186/s12912-021-00775-0 ◽

2022 ◽

Vol 21 (1) ◽

Author(s):

Alessandra Schirin Gessl ◽

Angela Flörl ◽

Eva Schulc

Keyword(s):

Case Management ◽

Focus Groups ◽

Care Management ◽

Qualitative Content Analysis ◽

Community Setting ◽

Complex Care ◽

Care Providers ◽

Coordinated Care ◽

Care Needs ◽

Complex Care Needs

Abstract Background The number of people with complex nursing and care needs living in their own homes is increasing. The implementation of Case and Care Management has shown to have a positive effect on unmet care needs. Research on and implementation of Case and Care Management in the community setting in Austria is limited. This study aimed to understand the changes and challenges of changing care needs by mobile nurses and to evaluate the need for Case Management in mobile care organizations by investigating the evolution of mobile care nurses‘task profiles and the challenges in working in a dynamic field with changing target groups and complexifying care needs. Methods A qualitative study with reductive-interpretative data analysis consisting of semi-structured focus groups was conducted. Community care nurses, head nurses, and managers of community mobile care units as well as discharge managers of a community hospital (n = 24) participated in nine qualitative, semi-structured focus groups. The recorded focus groups were transcribed and analyzed using qualitative content analysis. Results The analysis revealed three main categories: the complexity of the case, innerinstitutional frameworks, and interinstitutional collaboration, which influence the perception of need for further development in the direction of Case and Care Management. Feelings of overwhelmedness among nurses were predominantly tied to cases that presented with issues beyond healthcare such as legal, financial, or social that necessitated communication and collaboration across multiple care providers. Conclusions Care institutions need to adapt to changing and increasingly complex care needs that necessitate cooperation between organizations within and across the health and social sectors. A key facilitator for care coordination and the adequate service provision for complex care needs are multidisciplinary institutional networks, which often remain informal, leaving nurses in the role of petitioner without equal footing. Embedding Case and Care Management in the community has the potential to fill this gap and facilitate flexible, timely, and coordinated care across multiple care providers.

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