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BMJ Open. 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.

Author information

1
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
2
Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada.
3
Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada.
4
Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
5
Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
6
Department of Family Medicine, Université McGill, Montréal, Quebec, Canada.
7
Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
8
Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada.
9
Faculty of Pharmacy and CHU de Québec Research Center, Université Laval, Quebec, Canada.
10
School of Social Work, University de Sherbrooke, Sherbrooke, Quebec, Canada.
11
Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada.
12
Ministère de la Santé et des Services Sociaux, Quebec, Canada.
13
Department of Health and Community Services, St. John's, Newfoundland, Canada.
14
Saskatchewan Government - Ministry of Health, Regina, Saskatchewan, Canada.
15
Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
16
Université du Québec à Chicoutimi, Quebec, Canada.
17
St. John's, Newfoundland and Labrador, Canada.
18
University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
19
Sturgeon Lake Health Centre, Prince Albert, Saskatchewan, Canada.

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

PMID:
28871027
PMCID:
PMC5589014
DOI:
10.1136/bmjopen-2017-017701
[Indexed for MEDLINE]
Free PMC Article

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