Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Pavillon Z10, 3001, 12e Avenue Nord, Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada.
Faculty of Nursing, Université de Montréal, Pavillon Marguerite-d'Youville, 2375 chemin de la Côte Ste-Catherine, Montreal, QC, H3T 1A8, Canada.
BMC Prim Care. 2024 Nov 6;25(1):391. doi: 10.1186/s12875-024-02643-7.
People living in precarious socio-economic conditions are at greater risk of developing mental and physical health disorders, and of having complex needs. This places them at risk of health inequity. Addressing social determinants of health (SDH) can contribute to reducing this inequity. Case management in primary care is an integrated care approach which could be an opportunity to better address SDH. The aim of this study is to better understand how case management in primary care may address the SDH of people with complex needs.
A case management program (CMP) for people with complex needs was implemented in four urban primary care clinics. A qualitative study was conducted with semi-structured interviews and a focus group with key informants (n = 24). An inductive thematic analysis was carried out to identify emerging themes.
Primary care case managers were well-positioned to provide a holistic evaluation of the person's situation, to develop trust with them, and to act as their advocates. These actions helped case managers to better address individuals' unmet social needs (e.g., poor housing, social isolation, difficulty affording transportation, food, medication, etc.). Creating partnerships with the community (e.g., streetworkers) improved the capacity in assisting people with housing relocation, access to transportation, and access to care. Assuming people provide their consent, involving a significant relative or member of their community in an individualized services plan could support people in addressing their social needs.
Case management in primary care may better address SDH and improve health equity by developing a trusting relationship with people with complex needs, improving interdisciplinary and intersectoral collaboration and social support. Future research should explore ways to enhance partnerships between primary care and community organizations.
生活在不稳定社会经济条件下的人面临更大的风险，可能会出现精神和身体健康障碍，以及存在复杂需求。这使他们面临健康不平等的风险。解决社会决定因素（SDH）可以有助于减少这种不平等。初级保健中的病例管理是一种综合护理方法，可能是更好地解决 SDH 的机会。本研究旨在更好地了解初级保健中的病例管理如何解决有复杂需求的人的 SDH。
在四个城市初级保健诊所实施了一项针对复杂需求人群的病例管理计划（CMP）。对关键信息员（n=24）进行了半结构化访谈和焦点小组的定性研究。采用归纳主题分析方法确定出现的主题。
初级保健病例经理能够很好地评估个人的情况，与他们建立信任，并为他们辩护。这些行动有助于病例经理更好地解决个人的未满足的社会需求（例如，住房条件差、社会孤立、难以负担交通、食品、药物等）。与社区（例如，街头工作者）建立伙伴关系，提高了帮助人们搬迁住房、获得交通和获得护理的能力。如果人们同意，让他们的重要亲属或社区成员参与个性化服务计划，可能会支持他们解决社会需求。
初级保健中的病例管理可以通过与有复杂需求的人建立信任关系，改善跨学科和跨部门的合作和社会支持，更好地解决 SDH，并改善健康公平。未来的研究应该探索如何加强初级保健和社区组织之间的伙伴关系。
