Hudon Catherine, Chouinard Maud-Christine, Lambert Mireille, Dufour Isabelle, Krieg Cynthia
Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada.
BMJ Open. 2016 Sep 29;6(9):e012353. doi: 10.1136/bmjopen-2016-012353.
Frequent users of healthcare services are a vulnerable population, often socioeconomically disadvantaged, who can present multiple chronic conditions as well as mental health problems. Case management (CM) is the most frequently performed intervention to reduce healthcare use and cost. This study aimed to examine the evidence of the effectiveness of CM interventions for frequent users of healthcare services.
Scoping review.
An electronic literature search was conducted using the MEDLINE, Scopus and CINAHL databases covering January 2004 to December 2015. A specific search strategy was developed for each database using keywords 'case management' and 'frequent use'.
To be included in the review, studies had to report effects of a CM intervention on healthcare use and cost or patient outcomes. Eligible designs included randomised and non-randomised controlled trials and controlled and non-controlled before-after studies. Studies limited to specific groups of patients or targeting a single disease were excluded. Three reviewers screened abstracts, screened each full-text article and extracted data, and discrepancies were resolved by consensus.
The final review included 11 articles evaluating the effectiveness of CM interventions among frequent users of healthcare services. Two non-randomised controlled studies and 4 before-after studies reported positives outcomes on healthcare use or cost. Two randomised controlled trials, 2 before-after studies and 1 non-randomised controlled study presented mitigated results. Patient outcomes such as drug and alcohol use, health locus of control, patient satisfaction and psychological functioning were evaluated in 3 studies, but no change was reported.
Many studies suggest that CM could reduce emergency department visits and hospitalisations as well as cost. However, pragmatic randomised controlled trials of adequate power that recruit the most frequent users of healthcare services are still needed to clearly confirm its effectiveness.
医疗服务的频繁使用者是弱势群体，往往在社会经济方面处于不利地位，可能患有多种慢性病以及心理健康问题。病例管理（CM）是为减少医疗服务使用和成本而最常实施的干预措施。本研究旨在考察病例管理干预措施对医疗服务频繁使用者有效性的证据。
范围综述。
使用MEDLINE、Scopus和CINAHL数据库进行电子文献检索，涵盖2004年1月至2015年12月。针对每个数据库制定了特定的检索策略，使用关键词“病例管理”和“频繁使用”。
要纳入综述，研究必须报告病例管理干预措施对医疗服务使用、成本或患者结局的影响。符合条件的设计包括随机和非随机对照试验以及对照和非对照前后研究。仅限于特定患者群体或针对单一疾病的研究被排除。三位评审员筛选摘要、审阅每篇全文并提取数据，分歧通过协商解决。
最终综述纳入了11篇评估病例管理干预措施对医疗服务频繁使用者有效性的文章。两项非随机对照研究和四项前后研究报告了在医疗服务使用或成本方面的积极结果。两项随机对照试验、两项前后研究和一项非随机对照研究呈现了减轻的结果。三项研究评估了患者结局，如药物和酒精使用、健康控制点、患者满意度和心理功能，但未报告有变化。
许多研究表明病例管理可减少急诊科就诊和住院次数以及成本。然而，仍需要进行足够样本量的实用随机对照试验，招募医疗服务最频繁使用者，以明确证实其有效性。
