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  • PublicationAccès libre
    Case management in primary care among frequent users of healthcare services with chronic conditions : protocol of a realist synthesis
    (BMJ Publishing Group Ltd, 2017-09-03) Hudon, Catherine; Godbout, Julie; Groulx, Antoine; Aubrey-Bassler, Kris; Chouinard, Maud-Christine; Muhajarine, Nazeem; Gauthier, Gilles; Burge, Fred; Guénette, Line; Pluye, Pierre; Légaré, France; Bush, Paula Louise; Ramsden, Vivian Rose; Morin, Paul; Lambert, Mireille; Couture, Martine; Campbell, Cameron; Baker, Margaret; Edwards, Lynn; Sabourin, Véronique; Spence, Claude; Warren, Mike; Davis, Breanna; Rabbitskin, Norma
    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.
  • PublicationAccès libre
    Case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs : an implementation and realist evaluation protocol
    (BMJ Publishing, 2018-11-25) Hudon, Catherine; Roy, Denis; Godbout, Julie; Aubrey-Bassler, Kris; Burge, Fred; Demers, Marie-France; Doucet, Shelley; Landry, Geneviève; Ramsden, Vivian Rose; Chouinard, Maud-Christine; Brodeur, Magaly; Guénette, Line; Bush, Paula Louise; Légaré, France; Couturier, Yves; Morin, Paul; Poder, Thomas; Poitras, Marie-Ève; Roberge, Pasquale; Valaitis, Ruta; Bighead, Shirley; Campbell, Cameron; Couture, Martine; Davis, Breanna; Edwards, Lynn; Gander, Sarah; Gautheir, Gilles; Gauthier, Patricia; Gibson, Richard J.; Longjohn, Christine; Rabbitskin, Norma; Roy, Judy; Sabourin, Véronique; Sampalli, Tara; Saulnier, Amanda; Spence, Claude; Splane, Jennifer; Warren, Mike; Young, Joanne; Pluye, Pierre; Deschênes, Élaine
    Introduction Significant evidence in the literature supports case management (CM) as an effective intervention to improve care for patients with complex healthcare needs. However, there is still little evidence about the facilitators and barriers to CM implementation in primary care setting. The three specific objectives of this study are to: (1) identify the facilitators and barriers of CM implementation in primary care clinics across Canada; (2) explain and understand the relationships between the actors, contextual factors, mechanisms and outcomes of the CM intervention; (3) identify the next steps towards CM spread in primary care across Canada. Methods and analysis We will conduct a multiple-case embedded mixed methods study. CM will be implemented in 10 primary care clinics in five Canadian provinces. Three different units of analysis will be embedded to obtain an in-depth understanding of each case: the healthcare system (macro level), the CM intervention in the clinics (meso level) and the individual/patient (micro level). For each objective, the following strategy will be performed: (1) an implementation analysis, (2) a realist evaluation and (3) consensus building among stakeholders using the Technique for Research of Information by Animation of a Group of Experts method. Ethics and dissemination This study, which received ethics approval, will provide innovative knowledge about facilitators and barriers to implementation of CM in different primary care jurisdictions and will explain how and why different mechanisms operate in different contexts to generate different outcomes among frequent users. Consensual and prioritised statements about next steps for spread of CM in primary care from the perspectives of all stakeholders will be provided. Our results will offer context-sensitive explanations that can better inform local practices and policies and contribute to improve the health of patients with complex healthcare needs who frequently use healthcare services. Ultimately, this will increase the performance of healthcare systems and specifically mitigate ineffective use and costs.
  • PublicationAccès libre
    Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study
    (Biomed Central, 2014-10-01) Giguere, Anik M. C.; Cauchon, Michel; Labrecque, Michel; Hayne, R Brian; Légaré, France; Grad, Roland; Pluye, Pierre; Greenway, Matthew; Carmichael, Pierre-Hugues
    Background: Decision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators to using the Dbox information in clinical practice. Methods: We used a mixed methods study with sequential explanatory design. We recruited family physicians, residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators to explore contextual factors influencing the use of the Dbox information. Results: One hundred clinicians completed the web surveys. In 54% of the 496 questionnaires completed, they reported that their practice would be improved after having read the Dboxes, and in 40%, they stated that they would use this information for their patients. Of those who would use the information for their patients, 89% expected it would benefit their patients, especially in that it would allow the patient to make a decision more in keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in practice (mean 5.6 ± 1.2, scale 1–7, with 7 being “high”), and their intention was significantly related to social norm, perceived behavioural control, and attitude according to the TPB (P < 0.0001). In focus groups, clinicians mentioned that co-interventions such as patient decision aids and training in shared decision-making would facilitate the use of the Dbox information. Some participants would have liked a clear “bottom line” statement for each Dbox and access to printed Dboxes in consultation rooms. Conclusions: Dboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in practice