Case management in primary care among frequent users of health care services with chronic conditions: protocol of a realist synthesis

Hudon, C (NPI); Chouinard, M-C; Aubrey-Bassler, K; Muhajarine, N; Burge, F; Pluye, P; Bush, PL; Ramsden, VR; Legare, F; Guenette, L; Morin, P; Lambert, M; Groulx, A; Couture, M; Campbell, C; Baker, M; Edwards, L; Sabourin, V; Spence, C; Gauthier, G; Warren, M; Godbout, J; Davis, B; Rabbitskin, N.

A common reason for frequent use of health care services is the complex health care needs of individuals suffering from multiple chronic conditions, especially with mental health comorbidities and/or social vulnerability. Frequent users of health care services (FU) 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 health care 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. A realist synthesis (RS) will be conducted to explore the causal mechanisms that underlie CM and how contextual factors influence the link between these causal mechanisms and outcomes. According to the RAMESES publication standards, 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) synthesizing the evidence. Patterns in context-mechanism-outcomes (CMO) configurations will be identified, within and across identified studies. Analysis of CMO configurations will help confirm, refute, or modify 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. Given the involvement of knowledge users in this project, such as decision-makers, practitioners, and patients, the theory will be relevant and likely to be used.