Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland.
Curtin University, Perth, Western Australia, Australia.
Inquiry. 2023 Jan-Dec;60:469580231159745. doi: 10.1177/00469580231159745.
Effective management of frequent users of emergency departments (FUED) remains challenging. Case management (CM) has shown to improve patient quality of life while reducing ED visits and associated costs. However, little data is available on FUED's perception of CM outside of North America to further improve CM implementation.
Explore the FUED's perspectives about CM in Switzerland.
DESIGN, SETTING & PARTICIPANTS: Semi-structured qualitative interviews eliciting FUED's experiences of CM were conducted among 20 participants (75% female; mean age = 40.6, SD = 12.8) across 6 hospital ED.
OUTCOMES MEASURES & ANALYSIS: Inductive content analysis.
Most participants were satisfied with the CM program. In particular, FUEDs identified the working relationship with the case manager (cm) as key for positive outcomes, and also valued the holistic evaluation of their needs and resources. Overall, patients reported increased motivation and health literacy, as well as facilitated interactions within the healthcare system. Conversely, a small number of participants reported negative views on CM (, stigmatization, lack of concrete outcomes). Barriers identified were cm's lack of time, COVID-19's negative impact on CM organization, as well as lack of clarity on the objectives of CM. FUED perceived CM as useful, in particular establishing a working relationship with the cm. Our results suggest that CM can be further improved by (1) professionals remaining non-judgmental toward FUED, (2) making sure the aims and objectives of the CM are understood by the participants, and (3) allowing more time for the cm to carry out their work.
有效管理急诊科（ED）频繁就诊者（FUED）仍然具有挑战性。病例管理（CM）已被证明可以提高患者的生活质量，同时减少 ED 就诊次数和相关费用。然而，除了北美之外，关于 FUED 对 CM 的看法的数据很少，这不利于进一步改进 CM 的实施。
探索瑞士 FUED 对 CM 的看法。
设计、地点和参与者：采用半结构式定性访谈，在 6 家医院 ED 共招募了 20 名参与者（75%为女性；平均年龄 40.6 岁，标准差 12.8 岁），了解其 CM 经历。
采用归纳内容分析法。
大多数参与者对 CM 项目感到满意。特别是，FUED 确定了与病例经理（cm）的工作关系是取得积极成果的关键，并且还重视对其需求和资源的全面评估。总体而言，患者报告说增加了动力和健康素养，并且促进了医疗系统内的互动。相反，少数参与者对 CM 有负面看法（例如，污名化、缺乏具体成果）。确定的障碍包括 cm 缺乏时间、COVID-19 对 CM 组织的负面影响，以及对 CM 目标的不明确。FUED 认为 CM 很有用，特别是与 cm 建立了工作关系。我们的研究结果表明，通过以下方式可以进一步改进 CM：（1）专业人员对 FUED 保持非评判态度；（2）确保参与者理解 CM 的目标和目的；（3）为 cm 开展工作提供更多时间。
