School of Health Sciences (HEdS-FR), University of Applied Sciences Western Switzerland (HES-SO), Route des Cliniques 15, 1700, Fribourg, Switzerland.
Center for the Understanding of Social Processes, University of Neuchâtel, Neuchâtel, Switzerland.
Qual Life Res. 2018 Feb;27(2):503-513. doi: 10.1007/s11136-017-1739-6. Epub 2017 Nov 29.
Frequent Emergency Department users are likely to experience poor quality of life (QOL). Case management interventions are efficient in responding to the complex needs of this population, but their effects on QOL have not been tested yet. Therefore, the aim of our study was to examine to what extent a case management intervention improved frequent Emergency Department users' QOL in a universal health coverage system.
Data were part of a randomized controlled trial designed to improve frequent Emergency Department users' QOL at the Lausanne University Hospital, Switzerland. A total of 250 frequent Emergency Department users (≥ 5 attendances during the previous 12 months) were randomly assigned to the control (n = 125) or the intervention group (n = 125). The latter benefited from case management intervention. QOL was evaluated using the WHOQOL-BREF at baseline, two, five and a half, nine, and twelve months later. It included four dimensions: physical health, psychological health, social relationship, and environment. Linear mixed-effects models were used to analyze the change in the patients' QOL over time.
Patients' QOL improved significantly (p < 0.001) in both groups for all dimensions after two months. However, environment QOL dimension improved significantly more in the intervention group after 12 months.
Environment QOL dimension was the most responsive dimension for short-term interventions. This may have been due to case management's assistance in obtaining income entitlements, health insurance coverage, stable housing, or finding general health care practitioners. Case management in general should be developed to enhance frequent users' QOL.
http://www.clinicaltrials.gov , Unique identifier: NCT01934322.
频繁使用急诊部的患者可能生活质量较差。病例管理干预措施在应对此类人群的复杂需求方面非常有效，但尚未对其对生活质量的影响进行测试。因此，我们的研究旨在检验在全民健康覆盖系统中，病例管理干预在多大程度上改善了频繁使用急诊部的患者的生活质量。
数据来自一项旨在改善瑞士洛桑大学医院频繁使用急诊部的患者生活质量的随机对照试验。共有 250 名频繁使用急诊部的患者（过去 12 个月内就诊次数≥5 次）被随机分配到对照组（n=125）或干预组（n=125）。后者受益于病例管理干预。使用 WHOQOL-BREF 在基线、两个月、五个半月、九个月和十二个月后评估生活质量。它包括四个维度：身体健康、心理健康、社会关系和环境。使用线性混合效应模型分析患者生活质量随时间的变化。
两组患者在两个月后所有维度的生活质量均显著改善（p<0.001）。然而，干预组在 12 个月后环境维度的生活质量显著改善。
环境维度的生活质量是短期干预最敏感的维度。这可能是由于病例管理协助获得收入权益、医疗保险覆盖、稳定住房或寻找一般医疗保健从业者。应进一步开展病例管理工作，以提高频繁使用者的生活质量。
