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Research ArticleSystematic Review

Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review

Catherine Hudon, Maud-Christine Chouinard, Pierre Pluye, Reem El Sherif, Paula Louise Bush, Benoît Rihoux, Marie-Eve Poitras, Mireille Lambert, Hervé Tchala Vignon Zomahoun and France Légaré
The Annals of Family Medicine September 2019, 17 (5) 448-458; DOI: https://doi.org/10.1370/afm.2419
Catherine Hudon
1Département de Médecine de Famille et de Médecine d’Urgence, Université de Sherbrooke, Québec, Canada
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  • For correspondence: Catherine.Hudon@usherbrooke.ca
Maud-Christine Chouinard
2Département des Sciences de la Santé, Université du Québec à Chicoutimi, Québec, Canada
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Pierre Pluye
3Département de Médecine de Famille, Université McGill, Québec, Canada
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Reem El Sherif
3Département de Médecine de Famille, Université McGill, Québec, Canada
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Paula Louise Bush
3Département de Médecine de Famille, Université McGill, Québec, Canada
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Benoît Rihoux
4Institut de Sciences Politiques Louvain-Europe (ISPOLE), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
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Marie-Eve Poitras
2Département des Sciences de la Santé, Université du Québec à Chicoutimi, Québec, Canada
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Mireille Lambert
5Centre Intégré Universitaire de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
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Hervé Tchala Vignon Zomahoun
6Centre de Recherche du CHU de Québec–Université Laval, Québec, Canada
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France Légaré
7Département de Médecine Familiale et de Médecine d’Urgence, Université Laval, Québec, Canada
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Abstract

PURPOSE Case management (CM) interventions are effective for frequent users of health care services, but little is known about which intervention characteristics lead to positive outcomes. We sought to identify characteristics of CM that yield positive outcomes among frequent users with chronic disease in primary care.

METHODS For this systematic review of both quantitative and qualitative studies, we searched MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) and included articles meeting the following criteria: (1)population: adult frequent users with chronic disease, (2)intervention: CM in a primary care setting with a postintervention evaluation, and (3)primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Independent reviewers screened abstracts, read full texts, appraised methodologic quality (Mixed Methods Appraisal Tool), and extracted data from the included studies. Sufficient and necessary CM intervention characteristics were identified using configurational comparative methods.

RESULTS Of the 10,687 records retrieved, 20 studies were included; 17 quantitative, 2 qualitative, and 1 mixed methods study. Analyses revealed that it is necessary to identify patients most likely to benefit from a CM intervention for CM to produce positive outcomes. High-intensity intervention or the presence of a multidisciplinary/interorganizational care plan was also associated with positive outcomes.

CONCLUSIONS Policy makers and clinicians should focus on their case-finding processes because this is the essential characteristic of CM effectiveness. In addition, value should be placed on high-intensity CM interventions and developing care plans with multiple types of care providers to help improve patient outcomes.

Key words
  • case management
  • frequent users
  • primary health care
  • systematic review
  • Received for publication October 12, 2018.
  • Revision received February 28, 2019.
  • Accepted for publication March 29, 2019.
  • © 2019 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 17 (5)
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Vol. 17, Issue 5
September/October 2019
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Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review
Catherine Hudon, Maud-Christine Chouinard, Pierre Pluye, Reem El Sherif, Paula Louise Bush, Benoît Rihoux, Marie-Eve Poitras, Mireille Lambert, Hervé Tchala Vignon Zomahoun, France Légaré
The Annals of Family Medicine Sep 2019, 17 (5) 448-458; DOI: 10.1370/afm.2419

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Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review
Catherine Hudon, Maud-Christine Chouinard, Pierre Pluye, Reem El Sherif, Paula Louise Bush, Benoît Rihoux, Marie-Eve Poitras, Mireille Lambert, Hervé Tchala Vignon Zomahoun, France Légaré
The Annals of Family Medicine Sep 2019, 17 (5) 448-458; DOI: 10.1370/afm.2419
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Subjects

  • Domains of illness & health:
    • Chronic illness
  • Person groups:
    • Older adults
    • Vulnerable populations
  • Methods:
    • Qualitative methods
    • Quantitative methods
    • Mixed methods
  • Core values of primary care:
    • Coordination / integration of care
  • Other topics:
    • Multimorbidity

Keywords

  • case management
  • frequent users
  • primary health care
  • systematic review

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