Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada
Abstract Background Case management is one of the most frequently performed interventions to mitigate the negative effects of high healthcare use on patients, primary care providers and the healthcare system. Reviews have addressed factors influencing case management interventions (CMI) implementati...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-04-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-09379-7 |
| _version_ | 1797841175177068544 |
|---|---|
| author | Catherine Hudon Mathieu Bisson Maud-Christine Chouinard Alannah Delahunty-Pike Mireille Lambert Dana Howse Charlotte Schwarz Olivier Dumont-Samson Kris Aubrey-Bassler Fred Burge Shelley Doucet Vivian R. Ramsden Alison Luke Marilyn Macdonald André Gaudreau Judy Porter Donna Rubenstein Cathy Scott Mike Warren Linda Wilhelm |
| author_facet | Catherine Hudon Mathieu Bisson Maud-Christine Chouinard Alannah Delahunty-Pike Mireille Lambert Dana Howse Charlotte Schwarz Olivier Dumont-Samson Kris Aubrey-Bassler Fred Burge Shelley Doucet Vivian R. Ramsden Alison Luke Marilyn Macdonald André Gaudreau Judy Porter Donna Rubenstein Cathy Scott Mike Warren Linda Wilhelm |
| author_sort | Catherine Hudon |
| collection | DOAJ |
| description | Abstract Background Case management is one of the most frequently performed interventions to mitigate the negative effects of high healthcare use on patients, primary care providers and the healthcare system. Reviews have addressed factors influencing case management interventions (CMI) implementation and reported common themes related to the case manager role and activities, collaboration with other primary care providers, CMI training and relationships with the patients. However, the heterogeneity of the settings in which CMI have been implemented may impair the transferability of the findings. Moreover, the underlying factors influencing the first steps of CMI implementation need to be further assessed. This study aimed to evaluate facilitators and barriers of the first implementation steps of a CMI by primary care nurses for people with complex care needs who frequently use healthcare services. Methods A qualitative multiple case study was conducted including six primary care clinics across four provinces in Canada. In-depth interviews and focus groups with nurse case managers, health services managers, and other primary care providers were conducted. Field notes also formed part of the data. A mixed thematic analysis, deductive and inductive, was carried out. Results Leadership of the primary care providers and managers facilitated the first steps of the of CMI implementation, as did the experience and skills of the nurse case managers and capacity development within the teams. The time required to establish CMI was a barrier at the beginning of the CMI implementation. Most nurse case managers expressed apprehension about developing an “individualized services plan” with multiple health professionals and the patient. Clinic team meetings and a nurse case managers community of practice created opportunities to address primary care providers’ concerns. Participants generally perceived the CMI as a comprehensive, adaptable, and organized approach to care, providing more resources and support for patients and better coordination in primary care. Conclusion Results of this study will be useful for decision makers, care providers, patients and researchers who are considering the implementation of CMI in primary care. Providing knowledge about first steps of CMI implementation will also help inform policies and best practices. |
| first_indexed | 2024-04-09T16:26:49Z |
| format | Article |
| id | doaj.art-cc89edf5951e45d88b628ccd483e7041 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-09T16:26:49Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-cc89edf5951e45d88b628ccd483e70412023-04-23T11:12:47ZengBMCBMC Health Services Research1472-69632023-04-0123111310.1186/s12913-023-09379-7Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across CanadaCatherine Hudon0Mathieu Bisson1Maud-Christine Chouinard2Alannah Delahunty-Pike3Mireille Lambert4Dana Howse5Charlotte Schwarz6Olivier Dumont-Samson7Kris Aubrey-Bassler8Fred Burge9Shelley Doucet10Vivian R. Ramsden11Alison Luke12Marilyn Macdonald13André Gaudreau14Judy Porter15Donna Rubenstein16Cathy Scott17Mike Warren18Linda Wilhelm19Department of Family Medicine and Emergency Medicine, University of SherbrookeDepartment of Family Medicine and Emergency Medicine, University of SherbrookeFaculty of Nursing, University of MontrealSchool of Nursing, Faculty of Health, Dalhousie UniversityDepartment of Family Medicine and Emergency Medicine, University of SherbrookePrimary Healthcare Research Unit, Memorial UniversityDepartment of Nursing and Health Sciences, University of New BrunswickDepartment of Family Medicine and Emergency Medicine, University of SherbrookePrimary Healthcare Research Unit, Memorial UniversitySchool of Nursing, Faculty of Health, Dalhousie UniversityDepartment of Nursing and Health Sciences, University of New BrunswickDepartment of Academic Family Medicine, University of SaskatchewanDepartment of Nursing and Health Sciences, University of New BrunswickSchool of Nursing, Faculty of Health, Dalhousie UniversityDiabetes Action CanadaNova Scotia Health AuthorityPatient Advisors NetworkCanadian Cancer SocietyPatient Advisory Council, Newfoundland and Labrador SPOR SUPPORT UnitCanadian Arthritis Patient AllianceAbstract Background Case management is one of the most frequently performed interventions to mitigate the negative effects of high healthcare use on patients, primary care providers and the healthcare system. Reviews have addressed factors influencing case management interventions (CMI) implementation and reported common themes related to the case manager role and activities, collaboration with other primary care providers, CMI training and relationships with the patients. However, the heterogeneity of the settings in which CMI have been implemented may impair the transferability of the findings. Moreover, the underlying factors influencing the first steps of CMI implementation need to be further assessed. This study aimed to evaluate facilitators and barriers of the first implementation steps of a CMI by primary care nurses for people with complex care needs who frequently use healthcare services. Methods A qualitative multiple case study was conducted including six primary care clinics across four provinces in Canada. In-depth interviews and focus groups with nurse case managers, health services managers, and other primary care providers were conducted. Field notes also formed part of the data. A mixed thematic analysis, deductive and inductive, was carried out. Results Leadership of the primary care providers and managers facilitated the first steps of the of CMI implementation, as did the experience and skills of the nurse case managers and capacity development within the teams. The time required to establish CMI was a barrier at the beginning of the CMI implementation. Most nurse case managers expressed apprehension about developing an “individualized services plan” with multiple health professionals and the patient. Clinic team meetings and a nurse case managers community of practice created opportunities to address primary care providers’ concerns. Participants generally perceived the CMI as a comprehensive, adaptable, and organized approach to care, providing more resources and support for patients and better coordination in primary care. Conclusion Results of this study will be useful for decision makers, care providers, patients and researchers who are considering the implementation of CMI in primary care. Providing knowledge about first steps of CMI implementation will also help inform policies and best practices.https://doi.org/10.1186/s12913-023-09379-7Case managementFrequent usersImplementationMultiple case studyPrimary careChronic conditions |
| spellingShingle | Catherine Hudon Mathieu Bisson Maud-Christine Chouinard Alannah Delahunty-Pike Mireille Lambert Dana Howse Charlotte Schwarz Olivier Dumont-Samson Kris Aubrey-Bassler Fred Burge Shelley Doucet Vivian R. Ramsden Alison Luke Marilyn Macdonald André Gaudreau Judy Porter Donna Rubenstein Cathy Scott Mike Warren Linda Wilhelm Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada BMC Health Services Research Case management Frequent users Implementation Multiple case study Primary care Chronic conditions |
| title | Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada |
| title_full | Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada |
| title_fullStr | Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada |
| title_full_unstemmed | Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada |
| title_short | Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada |
| title_sort | implementation analysis of a case management intervention for people with complex care needs in primary care a multiple case study across canada |
| topic | Case management Frequent users Implementation Multiple case study Primary care Chronic conditions |
| url | https://doi.org/10.1186/s12913-023-09379-7 |
| work_keys_str_mv | AT catherinehudon implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT mathieubisson implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT maudchristinechouinard implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT alannahdelahuntypike implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT mireillelambert implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT danahowse implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT charlotteschwarz implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT olivierdumontsamson implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT krisaubreybassler implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT fredburge implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT shelleydoucet implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT vivianrramsden implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT alisonluke implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT marilynmacdonald implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT andregaudreau implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT judyporter implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT donnarubenstein implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT cathyscott implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT mikewarren implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada AT lindawilhelm implementationanalysisofacasemanagementinterventionforpeoplewithcomplexcareneedsinprimarycareamultiplecasestudyacrosscanada |