Catherine Hudon1,2, Maud-Christine Chouinard3,4,5, Marie-France Dubois6, Pasquale Roberge7,2, Christine Loignon7, Éric Tchouaket8, Mireille Lambert3, Émilie Hudon3,4, Fatoumata Diadiou3, Danielle Bouliane3. 1. Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada Catherine.Hudon@usherbrooke.ca. 2. Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Québec, Canada. 3. Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada. 4. Département des sciences de la santé, Université du Québec à Chicoutimi, Québec, Canada. 5. Centre de recherche de l'Hôpital Charles-LeMoyne, Québec, Canada. 6. Département des sciences de la santé communautaire, Université de Sherbrooke, Québec, Canada. 7. Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada. 8. Département des sciences infirmières, Université du Québec en Outaouais, Québec, Canada.
Abstract
PURPOSE: This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation. METHODS: We used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. The second phase had a qualitative descriptive design and entailed thematic analysis of in-depth interviews (25 patients, 6 case management nurses, 9 health managers) and focus groups (8 patients' spouses, 21 family physicians) to understand stakeholders' perceived effects of the intervention on patients. RESULTS: A total of 247 patients were randomized into the intervention group (n = 126) or the control group (n = 121). Compared with usual care, the intervention reduced psychological distress (odds ratio = 0.43; 95% CI, 0.19-0.95, P = .04), but did not have any significant effect on patient activation (P = .43). Qualitative results suggested that patients and their spouses benefitted from the case management intervention, gaining a sense of security, and stakeholders noted better patient self-management of health. CONCLUSIONS: Together, our study's quantitative and qualitative results suggest that case management reduces psychological distress, making patients and caregivers feel more secure, whereas impact on self-management is unclear. Case management is a promising avenue to improve outcomes among frequent users of health care with complex needs.
RCT Entities:
PURPOSE: This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation. METHODS: We used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. The second phase had a qualitative descriptive design and entailed thematic analysis of in-depth interviews (25 patients, 6 case management nurses, 9 health managers) and focus groups (8 patients' spouses, 21 family physicians) to understand stakeholders' perceived effects of the intervention on patients. RESULTS: A total of 247 patients were randomized into the intervention group (n = 126) or the control group (n = 121). Compared with usual care, the intervention reduced psychological distress (odds ratio = 0.43; 95% CI, 0.19-0.95, P = .04), but did not have any significant effect on patient activation (P = .43). Qualitative results suggested that patients and their spouses benefitted from the case management intervention, gaining a sense of security, and stakeholders noted better patient self-management of health. CONCLUSIONS: Together, our study's quantitative and qualitative results suggest that case management reduces psychological distress, making patients and caregivers feel more secure, whereas impact on self-management is unclear. Case management is a promising avenue to improve outcomes among frequent users of health care with complex needs.
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