Article Text
Abstract
Introduction A common reason for frequent use of healthcare services is the complex healthcare needs of individuals suffering from multiple chronic conditions, especially in combination with mental health comorbidities and/or social vulnerability. Frequent users (FUs) of healthcare services are more at risk for disability, loss of quality of life and mortality. Case management (CM) is a promising intervention to improve care integration for FU and to reduce healthcare costs. This review aims to develop a middle-range theory explaining how CM in primary care improves outcomes among FU with chronic conditions, for what types of FU and in what circumstances.
Methods and analysis A realist synthesis (RS) will be conducted between March 2017 and March 2018 to explore the causal mechanisms that underlie CM and how contextual factors influence the link between these causal mechanisms and outcomes. According to RS methodology, five steps will be followed: (1) focusing the scope of the RS; (2) searching for the evidence; (3) appraising the quality of evidence; (4) extracting the data; and (5) synthesising the evidence. Patterns in context–mechanism–outcomes (CMOs) configurations will be identified, within and across identified studies. Analysis of CMO configurations will help confirm, refute, modify or add to the components of our initial rough theory and ultimately produce a refined theory explaining how and why CM interventions in primary care works, in which contexts and for which FU with chronic conditions.
Ethics and dissemination Research ethics is not required for this review, but publication guidelines on RS will be followed. Based on the review findings, we will develop and disseminate messages tailored to various relevant stakeholder groups. These messages will allow the development of material that provides guidance on the design and the implementation of CM in health organisations.
Trial registration number Prospero CRD42017057753.
- frequent users
- chronic conditions
- interventions
- case management
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Footnotes
Contributors CH and M-CC conceived, designed and drafted the protocol manuscript. KA-B, NM, FB, PP, PB, VS, FL, LG and PM critically revised the manuscript for methodological and academic content. AG, MC, CC, MB and LE (decision makers), JG, BD and NR (clinicians), VS, CS, GG and MW (patients) revised the manuscript for content expertise. ML will implement the realist synthesis under the supervision of CH and M-CC. All authors read, provided feedback and approved the final manuscript.
Funding This work is supported by the Canadian Institutes of Health Research (CIHR) grant number 150585 and other partners such as the Clinical Stabilization Fund Management, the Département de médecine de famille de l’Université de Sherbrooke, Centre de recherche du CHUS, Décanat de la recherche de l’Université du Québec à Chicoutimi, the Saskatchewan Health Research Foundation, the Réseau-1 Québec and the Institut universitaire de première ligne de l’Estrie.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.