PT - JOURNAL ARTICLE AU - Hudon, Catherine AU - Chouinard, Maud-Christine AU - Dubois, Marie-France AU - Roberge, Pasquale AU - Loignon, Christine AU - Tchouaket, Éric AU - Lambert, Mireille AU - Hudon, Émilie AU - Diadiou, Fatoumata AU - Bouliane, Danielle TI - Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study AID - 10.1370/afm.2233 DP - 2018 May 01 TA - The Annals of Family Medicine PG - 232--239 VI - 16 IP - 3 4099 - http://www.annfammed.org/content/16/3/232.short 4100 - http://www.annfammed.org/content/16/3/232.full SO - Ann Fam Med2018 May 01; 16 AB - 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.