Département de Médecine de Famille et Médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada.
BMJ Open. 2018 Nov 25;8(11):e026433. doi: 10.1136/bmjopen-2018-026433.
Significant evidence in the literature supports case management (CM) as an effective intervention to improve care for patients with complex healthcare needs. However, there is still little evidence about the facilitators and barriers to CM implementation in primary care setting. The three specific objectives of this study are to: (1) identify the facilitators and barriers of CM implementation in primary care clinics across Canada; (2) explain and understand the relationships between the actors, contextual factors, mechanisms and outcomes of the CM intervention; (3) identify the next steps towards CM spread in primary care across Canada.
We will conduct a multiple-case embedded mixed methods study. CM will be implemented in 10 primary care clinics in five Canadian provinces. Three different units of analysis will be embedded to obtain an in-depth understanding of each case: the healthcare system (macro level), the CM intervention in the clinics (meso level) and the individual/patient (micro level). For each objective, the following strategy will be performed: (1) an implementation analysis, (2) a realist evaluation and (3) consensus building among stakeholders using the Technique for Research of Information by Animation of a Group of Experts method.
This study, which received ethics approval, will provide innovative knowledge about facilitators and barriers to implementation of CM in different primary care jurisdictions and will explain how and why different mechanisms operate in different contexts to generate different outcomes among frequent users. Consensual and prioritised statements about next steps for spread of CM in primary care from the perspectives of all stakeholders will be provided. Our results will offer context-sensitive explanations that can better inform local practices and policies and contribute to improve the health of patients with complex healthcare needs who frequently use healthcare services. Ultimately, this will increase the performance of healthcare systems and specifically mitigate ineffective use and costs.
文献中有大量证据表明，病例管理（CM）作为一种有效的干预措施，可以改善有复杂医疗需求的患者的护理。然而，关于在初级保健环境中实施 CM 的促进因素和障碍，仍几乎没有证据。本研究的三个具体目标是：（1）确定加拿大各地初级保健诊所实施 CM 的促进因素和障碍；（2）解释和理解 CM 干预措施中各参与者、情境因素、机制和结果之间的关系；（3）确定在加拿大各地向初级保健推广 CM 的下一步措施。
我们将进行一项多案例嵌入式混合方法研究。CM 将在加拿大五个省份的 10 个初级保健诊所实施。将嵌入三个不同的分析单位，以深入了解每个案例：医疗保健系统（宏观层面）、诊所中的 CM 干预（中观层面）和个体/患者（微观层面）。对于每个目标，将执行以下策略：（1）实施分析，（2）现实评估，（3）使用专家组动画信息研究技术在利益相关者中达成共识。
这项获得伦理批准的研究将提供有关在不同初级保健管辖区实施 CM 的促进因素和障碍的创新知识，并解释不同机制如何以及为何在不同情境中运作以在频繁使用者中产生不同的结果。将从所有利益相关者的角度提供关于在初级保健中推广 CM 的下一步措施的共识和优先事项声明。我们的研究结果将提供对情境敏感的解释，从而更好地为当地实践和政策提供信息，并有助于改善经常使用医疗保健服务的有复杂医疗需求的患者的健康。最终，这将提高医疗保健系统的绩效，并特别减轻低效使用和成本。
