RT Journal Article SR Electronic T1 Case Management in Primary Care for Frequent Users of Health Care Services: A Realist Synthesis JF The Annals of Family Medicine JO Ann Fam Med FD American Academy of Family Physicians SP 218 OP 226 DO 10.1370/afm.2499 VO 18 IS 3 A1 Hudon, Catherine A1 Chouinard, Maud-Christine A1 Aubrey-Bassler, Kris A1 Muhajarine, Nazeem A1 Burge, Fred A1 Bush, Paula Louise A1 Danish, Alya A1 Ramsden, Vivian R. A1 Légaré, France A1 Guénette, Line A1 Morin, Paul A1 Lambert, Mireille A1 Fick, Fiona A1 Cleary, Olivia A1 Sabourin, Véronique A1 Warren, Mike A1 Pluye, Pierre YR 2020 UL http://www.annfammed.org/content/18/3/218.abstract AB PURPOSE Case management (CM) is a promising intervention for frequent users of health care services. Our research question was how and under what circumstances does CM in primary care work to improve outcomes among frequent users with chronic conditions?METHODS We conducted a realist synthesis, searching MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) for 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. Academic and gray literature were evaluated for relevance and robustness. Independent reviewers extracted data to identify context, mechanism, and outcome (CMO) configurations. Analysis of CMO configurations allowed for the modification of an initial program theory toward a refined program theory.RESULTS Of the 9,295 records retrieved, 21 peer-reviewed articles and an additional 89 documents were retained. We evaluated 19 CM interventions and identified 11 CMO configurations. The development of a trusting relationship fostering patient and clinician engagement in the CM intervention was recurrent in many CMO configurations.CONCLUSION Our refined program theory proposes that in the context of easy access to an experienced and trusted case manager who provides comprehensive care while maintaining positive interactions with patients, the development of this relationship fosters the engagement of both individuals and yields positive outcomes when the following mechanisms are triggered: patients and clinicians feel supported, respected, accepted, engaged, and committed; and patients feel less anxious, more secure, and empowered to self-manage.