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Review
. 2017 Sep 3;7(9):e017701.
doi: 10.1136/bmjopen-2017-017701.

Case management in primary care among frequent users of healthcare services with chronic conditions: protocol of a realist synthesis

Catherine Hudon  1 , Maud-Christine Chouinard  2 , Kris Aubrey-Bassler  3 , Nazeem Muhajarine  4 , Fred Burge  5 , Pierre Pluye  6 , Paula L Bush  6 , Vivian R Ramsden  7 , France Legare  8 , Line Guenette  9 , Paul Morin  10 , Mireille Lambert  11 , Antoine Groulx  12 , Martine Couture  11 , Cameron Campbell  13 , Margaret Baker  14 , Lynn Edwards  15 , Véronique Sabourin  16 , Claude Spence  16 , Gilles Gauthier  16 , Mike Warren  17 , Julie Godbout  16 , Breanna Davis  18 , Norma Rabbitskin  19
Affiliations
Review

Case management in primary care among frequent users of healthcare services with chronic conditions: protocol of a realist synthesis

Catherine Hudon et al. BMJ Open. .

Abstract

Introduction: A common reason for frequent use of healthcare services is the complex healthcare needs of individuals suffering from multiple chronic conditions, especially in combination with mental health comorbidities and/or social vulnerability. Frequent users (FUs) of healthcare services are more at risk for disability, loss of quality of life and mortality. Case management (CM) is a promising intervention to improve care integration for FU and to reduce healthcare costs. This review aims to develop a middle-range theory explaining how CM in primary care improves outcomes among FU with chronic conditions, for what types of FU and in what circumstances.

Methods and analysis: A realist synthesis (RS) will be conducted between March 2017 and March 2018 to explore the causal mechanisms that underlie CM and how contextual factors influence the link between these causal mechanisms and outcomes. According to RS methodology, five steps will be followed: (1) focusing the scope of the RS; (2) searching for the evidence; (3) appraising the quality of evidence; (4) extracting the data; and (5) synthesising the evidence. Patterns in context-mechanism-outcomes (CMOs) configurations will be identified, within and across identified studies. Analysis of CMO configurations will help confirm, refute, modify or add to the components of our initial rough theory and ultimately produce a refined theory explaining how and why CM interventions in primary care works, in which contexts and for which FU with chronic conditions.

Ethics and dissemination: Research ethics is not required for this review, but publication guidelines on RS will be followed. Based on the review findings, we will develop and disseminate messages tailored to various relevant stakeholder groups. These messages will allow the development of material that provides guidance on the design and the implementation of CM in health organisations.

Trial registration number: Prospero CRD42017057753.

Keywords: case management; chronic conditions; frequent users; interventions.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
RS design. CM, case management; CMO, context, mechanism and outcomes; RS, realist synthesis.
Figure 2
Figure 2
Template for the development of the middle-range theory about CM in primary care for FU in primary care. CM, case management; FU, frequent users of healthcare services.
See this image and copyright information in PMC

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