Search

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction In recent years, several projects and innovations have been carried out in primary healthcare level, in Quebec, to reduce fragmentation and improve healthcare delivery through better coordination of services for patients with complex needs. These projects were all based in family medicine clinics yet presented significant structural and content variations across clinics. Moreover, when several care coordination projects were conducted in one clinic, they included a different list of care coordination components, carried out by the same care coordinators. In this study we aim to examine similarities and divergences in terms of design, policy environment and components across care coordination projects and how these similarities or divergences are related to patients' complex needs. Methods A comparative case study was conducted using a purposive sampling of two projects, the V1SAGES project (case management targeting frequent users of healthcare services), and the Quebec Alzheimer Plan (QAP). Data collection included a documentary analysis and five semi-structured interviews with key researchers involved in the implementation of the ""cases"". The Integrated Care Case Study Descriptive Template was used as a framework. Within and cross-case analysis were performed. Results In terms of design and policy environment, both projects include a shared governance model that facilitated innovations. Patients were involved in different phases of both projects. The PAQ is a more mature project. It was lunched earlier, was intended to be scaled up at a national, had more allocated funds and a solid change management support which also impacted the staffing model and training. Common coordination activities include identifying eligible patients and assessing their needs jointly with the physician, interdisciplinary follow-up, communicating with other professionals and services and facilitating transitions. Indeed, the presence and use of referral processes varied between settings. VISAGES care coordination activities are more oriented towards linking patients and family with health and social care professionals while those of QAP focus on early diagnosis and follow up. Discussions Characteristics of patients' complex needs have a major impact on design, implementation and delivery of care coordination projects. Indeed, the homogeneity of PAQ target group population shaped the patient care trajectory as based on disease management and care while also considering social needs. In parallel, the heterogeneity of VISAGES target patient population required a case management approach where less emphasis is placed on disease and more on integrating health and social care services. A single care trajectory based on disease would not be relevant nor feasible. This main difference had an impact on the clinical tools that were developed, staff training and care coordination activities. Conclusions Care coordination projects targeting patients with complex needs may vary in terms of design and components. However, they share a commonality in that they tend to adjust to the varying homogeneity of needs. Lessons learned The scale-up of every care coordination project necessitates an effective change management support. Limitations Data collection could have included observations or interviews with healthcare professionals; however, the pandemic impeded their availability. Suggestions for future research Future research should address patient's experience of care coordination. [ABSTRACT FROM AUTHOR]

Introduction Some people frequently use healthcare services due to complex healthcare needs and are more at risk of incapacity and mortality. Literature supports case management (CM) to improve integrated care, patient experience, and patient-reported outcomes for this clientele. However, challenges remain in the interaction between hospitals and primary care clinics. The aim of the study was to implement and evaluate an intervention where case managers in hospital work closely with primary care nurses to improve integrated care of frequent users of healthcare services. Methods: Study Design Multiple embedded case study. Setting Four hospitals and four primary care clinics in the region of Saguenay-Lac-Saint-Jean, Quebec, Canada. Each clinic was considered as a case. Frequent use was defined as = 4 emergency department (ED) visits and/or = 3 hospitalizations in the previous year. Intervention: Case managers identified frequent users in each clinic within the computerized platform of the hospitals. Primary care nurses worked in close collaboration with case managers to develop an individualized service plan and ensure coordination and self-management support during 6 months. Data collection and analysis The mixed data collection included, at baseline and 6 months: 1) Semi-structured interviews with case managers (n=3), primary care nurses (n=11), programs managers (n=4), and patients (n=19), and focus groups with family physicians (n=36) and other professionals (n=26) to evaluate implementation and outcomes (care access and satisfaction, self-management, well-being and hospital services use); 2) Fieldnotes to complete and validate the qualitative data; 3) Selfadministered questionnaires for sociodemographic characteristics (age, sex, marital status, education, occupation, family income and perception of the economic situation, health literacy, and multimorbidity) and quantitative outcomes (patient experience of integrated care and selfmanagement of health) completed by frequent users who received the intervention (n=33); and 4) Services use (ED visits, hospitalizations and primary care utilization) measured in the electronic medical record. For each case, qualitative and quantitative data were first analysed separately, then combined into case stories that were compared. A patient partner was involved in data collection and analysis. Results Implementation of the intervention varied among the 4 clinics, from almost no implementation (the family physician in charge of the clinic decided to stop the implementation) to full implementation (strong leadership and collaboration among all stakeholders - case managers, primary care nurses, family physicians and managers). Qualitative and quantitative outcomes were proportional to the stage of implementation. Discussion This study adds to the literature on CM to improve integrated care by proposing the concept of integrated CM between hospitals and primary care clinics. Conclusions: Integrated CM may have positive impacts on frequent users and services use if all stakeholders engage in practice change. Lessons learned Adressing change management and mobilizing all stakeholders at the onset are mandatory when implementing such complex interventions targeting practices changes. Limitations The study lacked of power for analysis by clinic for outcomes such as self-management and services use. Results are transferable to similar contexts (to be described in the presentation). Suggestions Future research could replicate this study on a larger scale with economic analysis. [ABSTRACT FROM AUTHOR]

Introduction: Growing evidence supports patient engagement (PE) in health implementation research to improve the quality, relevance and uptake of research. However, more guidance is needed to plan and operationalize PE before and throughout the research process. The aim of the study was to develop a logic model illustrating the causal links between context, resources, activities, outcomes and impact of PE in an implementation research programme. Methods: The Patient Engagement in Health Implementation Research Logic Model (hereafter the Logic Model) was developed using a descriptive qualitative design with a participatory approach, in the context of the PriCARE programme. This programme aims to implement and evaluate case management for individuals who frequently use healthcare services in primary care clinics across five Canadian provinces. Participant observation of team meetings was performed by all team members involved in the programme and in‐depth interviews were conducted by two external research assistants with team members (n = 22). A deductive thematic analysis using components of logic models as coding categories was conducted. Data were pooled in the first version of the Logic Model, which was refined in research team meetings with patient partners. The final version was validated by all team members. Results: The Logic Model highlights the importance of integrating PE into the project before its commencement, with appropriate support in terms of funding and time allocation. The governance structure and leadership of both principal investigators and patient partners have significant effects on PE activities and outcomes. As an empirical and standardized illustration that facilitates a shared understanding, the Logic Model provides guidance for maximizing the impact of patient partnership in various contexts for research, patients, providers and health care. Conclusion: The Logic Model will help academic researchers, decision makers and patient partners plan, operationalize, and assess PE in implementation research for optimal outcomes. Patient or Public Contribution: Patient partners from the PriCARE research programme contributed to developing the research objectives and designing, developing and validating data collection tools, producing data, developing and validating the Logic Model and reviewing the manuscript. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via the original article. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Cardiovascular Nursing is the property of Canadian Council of Cardiovascular Nurses (CCCN) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Adults with chronic conditions who also suffer from mental health comorbidities and/or social vulnerability require services from many providers across different sectors. They may have complex health and social care needs and experience poorer health indicators and high mortality rates while generating considerable costs to the health and social services system. In response, the literature has stressed the need for a collaborative approach amongst providers to facilitate the care transition process. A better understanding of care transitions is the next step towards the improvement of integrated care models. The aim of the study is to better understand care transitions of adults with complex health and social care needs across community, primary care, and hospital settings, combining the experiences of patients and their families, providers, and health managers.Methods/design: We will conduct a two-phase mixed methods multiple case study (quantitative and qualitative). We will work with six cases in three Canadian provinces, each case being the actual care transitions across community, primary care, and hospital settings. Adult patients with complex needs will be identified by having visited the emergency department at least three times over the previous 12 months. To ensure they have complex needs, they will be invited to complete INTERMED Self-Assessment and invited to enroll if positive. For the quantitative phase, data will be obtained through questionnaires and multi-level regression analyses will be conducted. For the qualitative phase, semi-structured interviews and focus groups will be conducted with patients, family members, care providers, and managers, and thematic analysis will be performed. Quantitative and qualitative results will be compared and then merged.Discussion: This study is one of the first to examine care transitions of adults with complex needs by adopting a comprehensive vision of care transitions and bringing together the experiences of patients and family members, providers, and health managers. By using an integrated knowledge translation approach with key knowledge users, the study's findings have the potential to inform the optimization of integrated care, to positively impact the health of adults with complex needs, and reduce the economic burden to the health and social care systems. [ABSTRACT FROM AUTHOR]

Background : Frequent geriatric users of emergency departments (EDs) constitute a small group of individuals accounting for a disproportionately high number of ED visits. In addition to overcrowding, this situation might result in a less appropriate response to health needs and negative health impacts. Geriatric patients turn to EDs for a variety of reasons. A better understanding of the variables associated with frequent ED use will help implement interventions best suited for their needs. Objective : This review aimed at identifying variables associated with frequent ED use by older adults. Methods : For this systematic review, we searched Medline, CINAHL, Healthstar, and PsyINFO (before June 2018). Articles written in English or French meeting these criteria were included: targeting a population aged 65 years or older, reporting on frequent ED use, using an observational study design and multivariate regression analysis. The search was supplemented by manually examining the reference lists of relevant studies. Independent reviewers identified articles for inclusion, extracted data, and assessed quality with the JBI Critical Appraisal Checklist for Studies Reporting Prevalence. A narrative synthesis was done to combine the study results. A sensitivity analysis was performed to evaluate the effect of removing the studies not meeting the quality criteria. Results : Out of 5096 references, 8 met our inclusion criteria. A high number of past hospital and ED admissions, living in a rural area adjacent to an urban center, low income, a high number of prescribed drugs, and a history of heart disease were associated with frequent ED use among older adults. In addition, having a principal-care physician and living in a remote rural area were associated with fewer ED visits. Some variables recognized in the literature as influencing ED use among older adults received scant consideration, such as comorbidity, dementia, and considerations related to primary-care and community settings. Conclusion: Further studies should bridge the gap in understanding and give a more global portrait by adding important personal variables e.g dementia, organizational variables such as use of community and primary care, and contextual variables such as social and economic frailty. [ABSTRACT FROM AUTHOR]

Background: Frequent users of healthcare services are a vulnerable population that deserves attention due to high costs and negative outcomes such as lower quality of life and higher mortality. Healthcare systems should offer interventions tailored to their needs and to their level of health literacy, including strategies to promote activation. The relationship between health literacy and patient activation remains to be explored. The aim of this study was to examine the association between health literacy and patient activation in a population of frequent users of healthcare services with chronic diseases. Methods: Cross-sectional data were collected (before randomization) through a clinical trial evaluating a case management intervention in primary care. Participants (n = 247) were recruited from the list of frequent users of 4 Family Medicine Groups (FMG) in the Saguenay-Lac-St-Jean region of Québec (Canada). They completed questionnaires by self-report during an encounter with a research assistant: (1) the Newest Vital Sign (NVS) to evaluate health literacy (independent variable); and (2) the Patient Activation Measure-13 (PAM-13) to evaluate patient activation (dependent variable). The relationship between health literacy and activation was examined using biserial correlations. Results: No association was found between health literacy (independent variable) and patient activation (rb = 0.075, ρ = 0.07) for this population of frequent users of healthcare services. Conclusions: This study suggests that there is no relationship between health literacy and patient activation among frequent users of healthcare services. Trial registration: NCT01719991. Registered October 25, 2012. [ABSTRACT FROM AUTHOR]

Aim: To identify indicators sensitive to the practice of primary healthcare nurse practitioners (PHCNPs). Materials and methods: A review of systematic reviews was undertaken to identify indicators sensitive to PHCNP practice. Published and grey literature was searched from January 1, 2010 to December 2, 2022. Titles/abstracts (n = 4251) and full texts (n = 365) were screened independently by two reviewers, with a third acting as a tie-breaker. Reference lists of relevant publications were reviewed. Risk of bias was examined independently by two reviewers using AMSTAR-2. Data were extracted by one reviewer and verified by a second reviewer to describe study characteristics, indicators, and results. Indicators were recoded into categories. Findings were summarized using narrative synthesis. Results: Forty-four systematic reviews were retained including 271 indicators that were recoded into 26 indicator categories at the patient, provider and health system levels. Nineteen reviews were assessed to be at low risk of bias. Patient indicator categories included activities of daily living, adaptation to health conditions, clinical conditions, diagnosis, education-patient, mortality, patient adherence, quality of life, satisfaction, and signs and symptoms. Provider indicator categories included adherence to best practice-providers, education-providers, illness prevention, interprofessional team functioning, and prescribing. Health system indicator categories included access to care, consultations, costs, emergency room visits, healthcare service delivery, hospitalizations, length of stay, patient safety, quality of care, scope of practice, and wait times. Discussion: Equal to improved care for almost all indicators was found consistently for the PHCNP group. Very few indicators favoured the control group. No indicator was identified for high/low fidelity simulation, cultural safety and cultural sensitivity with people in vulnerable situations or Indigenous Peoples. Conclusion: This review of systematic reviews identified patient, provider and health system indicators sensitive to PHCNP practice. The findings help clarify how PHCNPs contribute to care outcomes. PROSPERO registration number: CRD42020198182. [ABSTRACT FROM AUTHOR]