Case management in primary care to improve outcomes among frequent users of health care services with chronic conditions

Case management in primary care to improve outcomes among frequent users of health care services with chronic conditions: a realist synthesis of what works, for whom and in what circumstances

Projet lauréat du concours synthèse des connaissances (été 2016) du Réseau ISSPLI (IRSC)

Responsables : Catherine Hudon, Université de Sherbrooke; Margaret Baker, Saskatchewan Ministry of Health; Cameron Campbell, Newfoundland and Labrador Ministry of Health; Lynn Edwards, Nova Scotia Capital District Health Authority; Antoine Groulx, Ministère de la santé et des services sociaux du Québec; Kris Aubrey-Brassler, Memorial University; Frederick Burge, Dalhousie University; Maud-Christine Chouinard, Université du Québec à Chicoutimi; Nazeem Muhajarine, University of Saskatchewan

A common reason for frequent use of health care services is the complex health care needs of individuals suffering from multiple chronic conditions, often together with mental health comorbidities and/or social vulnerability. Individuals with such complex health care needs require a variety of services across the health and social services system and the community networks. This often leads to difficulties in the integration of care. Frequent users of health care services (FU) are more at risk for incapacity, loss of quality of life and mortality. Currently it would appear case management (CM) is the most promising intervention to improve care integration for FU and reduce health care costs. However, important gaps in knowledge remain: we don’t know how CM works, in what populations, and in what circumstances. Our overarching goal is to ensure that patients, practitioners and policy makers better understand CM for FU with chronic conditions, the most promising effective intervention to improve outcomes for this population with complex care needs in primary care. In order to achieve this goal, we propose to explain how CM in primary care works to improve outcomes among FU with chronic conditions, for whom and in what circumstances.

Résultats :

• Hudon C et al. Case management in primary care among frequent users of health care services with chronic conditions: preliminary findings from a realist synthesis (Présentation par affiche au SPOR PIHCIN Research Day, mai 2017).
• Hudon C, et al. Case management in primary care among frequent users of healthcare services with chronic conditions: protocol of a realist synthesis (BMJ Open, septembre 2017).
• Chouinard MC et al. Case management in primary care among frequent users of healthcare services with chronic conditions: protocol of a realist synthesis (Présentation par affiche à la conférence annuelle du NAPCRG, novembre 2017).
• Research Snapshot : Exploring the role of case managers in treating patients with complex care needs (juin 2018).
• Chouinard MC et al. Case management in primary care among frequent users of health care services with chronic conditions: a realist synthesis. (Présentation par affiche à la conférence annuelle du NAPCRG, novembre 2018).
• Hudon C, et al. Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review (Annals of Family Medicine 2019; 17:5).
• Hudon, C. Case management in primary care to improve outcomes among frequent users of health care services with chronic conditions: a realist synthesis (Présentation au PIHCI Network Leadership Council, décembre 2019).
• Hudon C et al. Case management in primary care among frequent users of health care services with chronic conditions: a realist synthesis. (Annals of Family Medicine, 2020; 18 (3) 218-226).