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Randomized Controlled Trial
. 2018 May;16(3):232-239.
doi: 10.1370/afm.2233.

Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study

Catherine Hudon  1   2 , Maud-Christine Chouinard  3   4   5 , Marie-France Dubois  6 , Pasquale Roberge  7   2 , Christine Loignon  7 , Éric Tchouaket  8 , Mireille Lambert  3 , Émilie Hudon  3   4 , Fatoumata Diadiou  3 , Danielle Bouliane  3
Affiliations
Randomized Controlled Trial

Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study

Catherine Hudon et al. Ann Fam Med. 2018 May.

Abstract

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.

Trial registration: ClinicalTrials.gov NCT01719991.

Keywords: case management; comorbidity; frequent users; mixed methods; outcomes; practice-based research; primary care; utilization.

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Conflict of interest statement

Conflicts of interest: authors report none.

Figures

Figure 1
Figure 1
Flow of patients through the randomized trial. ED = emergency department.
See this image and copyright information in PMC

References

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