Key factors of case management interventions for frequent users of healthcare services : a thematic analysis review

Objective : The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Design : Thematic analysis review of CM studies. Methods : We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004–December 2015 period, then updated to July 2017, with the keywords ‘CM’ and ‘frequent use’. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir’s implementation of health innovations framework was used to organise results into four broad levels of factors: (1) ,environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Results : Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. Conclusions : CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts

The Chronic Disease Self-Management Program: the experience of frequent users of health care services and peer leaders

BACKGROUND: Large amount of evidence supports the contribution of the Stanford Chronic Disease Self-Management Program (CDSMP) to a global chronic disease management strategy. However, many studies have suggested further exploring of the factors influencing acceptance and completion of participants in this program. OBJECTIVE: This study aimed to describe and examine factors associated with acceptance and completion rates of the CDSMP among frequent users of health care services, and to highlight the experience of patients and peer leaders who facilitated the program. METHODS: A descriptive design with mixed sequential data was used. Acceptance and completion rates were calculated and their relationship with patient characteristics was examined in regression analysis (n = 167). Interviews were conducted among patients who accepted (n = 11) and refused (n = 13) to participate and with the program coordinator. Focus groups were held with the seven peer leaders who facilitated the program. Data were analysed using thematic analysis. RESULTS: Of the 167 patients invited, 60 (36%) accepted to participate in the program. Group format was the most frequent reason to decline the invitation to participate. Twenty-eight participants (47%) completed the program. Participants who dropped out during the program raised different reasons such as poor health and too much heterogeneity among participants. Factors such as location, schedule, content, group composition and facilitation were considered as important elements contributing to the success of the program. CONCLUSION: The CDSMP could therefore be considered as a self-management support option for this vulnerable clientele, while taking measures to avoid too much heterogeneity among participants to improve completion rates

Les stratégies d'adaptation utilisées par les femmes atteintes de la dystrophie myotonique de type 1

Les femmes atteintes d’une maladie chronique telle que la dystrophie myotonique de type 1 (DM1) doivent composer avec des difficultés inhérentes aux conséquences de la maladie sur leur vie au quotidien et sur leur capacité à assumer leurs rôles sociaux. La présente étude avait pour objectif général de documenter les stratégies d’adaptation qu’utilisent les femmes atteintes de DM1 pour faire face aux difficultés rencontrées dans leurs rôles sociaux. Pour ce faire, 17 entrevues semi-dirigées réalisées auprès de femmes atteintes de la DM1 dans la région du Saguenay-Lac-Saint-Jean ont été analysées sous l’angle spécifique des stratégies d’adaptation. Les deux objectifs spécifiques visés par cette étude étaient : 1) Identifier les stratégies d’adaptation utilisées par les femmes atteintes de DM1 pour faire face aux différentes difficultés de la vie qu’elles rencontrent au point de vue personnel et social et ce, en fonction de leur statut matrimonial; 2) Explorer la manière dont les stratégies d’adaptation utilisées leur permettent de composer avec les difficultés inhérentes à cette maladie et comment les stratégies d’adaptation qu’elles utilisent influencent leur bien-être et la perception de leur moral. Les résultats reposant sur trois modèles théoriques ayant trait aux stratégies d’adaptation formant le cadre de référence, démontrent que les stratégies d’adaptation utilisées ont une influence sur la perception du moral et le bien-être des participantes. Ils ont de plus, mis en lumière, l’influence de certains déterminants, tant situationnels que personnels, sur l’utilisation des stratégies ainsi que sur le moral des participantes. Par ailleurs, l’étude a permis de constater que le soutien social est un élément clé pour les femmes atteintes de DM1 et que c’est la qualité et la disponibilité de celui-ci qui importent plutôt que sa source. À ce sujet, chez les femmes vivant avec un conjoint ou un proche, ce sont ces derniers qui apportent leur soutien. Dans les cas où les participantes vivent seules, le réseau social élargi semble offrir un soutien satisfaisant. Les participantes utilisent des stratégies variées mais certaines d’entre elles favorisent un meilleur moral. En effet, les participantes ayant la perception d’un très bon moral ont tendance à minimiser les conséquences négatives de la maladie sur leur vie et à réévaluer positivement leur situation. Les participantes mentionnant avoir un bon moral ont les mêmes prédispositions que les précédentes mais il leur arrive de montrer de la résignation et elles font davantage appel au soutien émotionnel. Les personnes ayant un moral variable présentent davantage de résignation, du fatalisme, du déni mais chez ce dernier groupe, les participantes se préoccupent davantage de fournir de l’information aux différents membres de leur entourage sur leur maladie et ses impacts, ce qui leur permet d’obtenir un soutien plus adéquat de la part de leurs proches. Cette étude présente certaines limites, soit de ne pas prendre en considération le stade d’évolution de la maladie chez les participantes. De plus, la présente étude a été réalisée à partir d’une analyse secondaire de données recueillies qui ne visaient pas à identifier les stratégies d’adaptation utilisées par les répondantes. Cette situation fait en sorte que certaines questions et instruments de mesure spécifiques permettant d’identifier rigoureusement les stratégies d’adaptation utilisées par les répondantes n’ont pas été utilisés. Toutefois, la présente recherche, malgré ces deux limites, permet d’éclairer sous un angle nouveau les stratégies d’adaptation spécifiquement utilisées par les femmes atteintes de DM1. Elle ouvre des possibilités d’intervention auprès de ces femmes afin de les aider à atteindre et à maintenir un meilleur bien-être en dépit des difficultés liées à la DM1

Case management in primary care for frequent users of health care services with chronic diseases: A qualitative study of patient and family experience

PURPOSE: Although case management (CM) is increasingly being implemented to address the complex needs of vulnerable clienteles, few studies have examined the patient experience of CM. This study aimed to examine the experience of patients and their family members with care integration as part of a primary care CM intervention. Patients in the study were frequent users of health care services who had chronic diseases. METHODS: A descriptive, qualitative approach was conducted involving 25 patients and 8 of their family members. Data were collected through in-depth interviews of the patients and 2 focus groups of family members and were analyzed thematically. RESULTS: While some participants did not fully understand the CM intervention and a few believed that it involved too many appointments, the CM nurses were patients' preferred contact with primary care. The nurses actively involved the patients in developing and carrying out their individualized services plans (ISPs) with other health care partners. Patients felt that their needs were taken into consideration, especially regarding access to the health care system. The case manager facilitated access to information as well as communication and coordination among health care and community partners. This improved communication comforted the patients and nurtured a relationship of trust. Participants were actively involved in decision-making. Their ISPs helped them know where they were going and improved transitions between services. CONCLUSIONS: The experience of patients and family members was overall very positive regarding care integration. They reported improved access, communication, coordination, and involvement in decision-making as well as better health care transitions

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

PURPOSE This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation. METHODS We used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. The second phase had a qualitative descriptive design and entailed thematic analysis of in-depth interviews (25 patients, 6 case management nurses, 9 health managers) and focus groups (8 patients’ spouses, 21 family physicians) to understand stakeholders’ perceived effects of the intervention on patients. RESULTS A total of 247 patients were randomized into the intervention group (n = 126) or the control group (n = 121). Compared with usual care, the intervention reduced psychological distress (odds ratio = 0.43; 95% CI, 0.19–0.95, P = .04), but did not have any significant effect on patient activation (P = .43). Qualitative results suggested that patients and their spouses benefitted from the case management intervention, gaining a sense of security, and stakeholders noted better patient self-management of health. CONCLUSIONS Together, our study’s quantitative and qualitative results suggest that case management reduces psychological distress, making patients and caregivers feel more secure, whereas impact on self-management is unclear. Case management is a promising avenue to improve outcomes among frequent users of health care with complex needs