title: Case Management in Primary Care for Frequent Users of Health Care Services With Chronic Diseases: A Qualitative Study of Patient and Family Experience.
abstract: OBJECTIVE
  Although case management (CM) is increasingly being implemented to address the complex needs of vulnerable clienteles, few studies have examined the patient experience of CM. This study aimed to examine the experience of patients and their family members with care integration as part of a primary care CM intervention. Patients in the study were frequent users of health care services who had chronic diseases.
  
  
  METHODS
  A descriptive, qualitative approach was conducted involving 25 patients and 8 of their family members. Data were collected through in-depth interviews of the patients and 2 focus groups of family members and were analyzed thematically.
  
  
  RESULTS
  While some participants did not fully understand the CM intervention and a few believed that it involved too many appointments, the CM nurses were patients' preferred contact with primary care. The nurses actively involved the patients in developing and carrying out their individualized services plans (ISPs) with other health care partners. Patients felt that their needs were taken into consideration, especially regarding access to the health care system. The case manager facilitated access to information as well as communication and coordination among health care and community partners. This improved communication comforted the patients and nurtured a relationship of trust. Participants were actively involved in decision-making. Their ISPs helped them know where they were going and improved transitions between services.
  
  
  CONCLUSIONS
  The experience of patients and family members was overall very positive regarding care integration. They reported improved access, communication, coordination, and involvement in decision-making as well as better health care transitions.
authors.affiliation: Département de médecine de famille et médecine d'urgence, Université de Sherbrooke, Québec, Canada Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Québec, Canada catherine.hudon@usherbrooke.ca.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hudon
authors.affiliation: Centre de santé et de services sociaux de Chicoutimi, Québec, Canada Département des sciences de la santé, Université du Québec à Chicoutimi, Québec, Canada.
authors.forename: Maud-Christine
authors.initials: MC
authors.lastname: Chouinard
authors.affiliation: Centre de santé et de services sociaux de Chicoutimi, Québec, Canada.
authors.forename: Fatoumata
authors.initials: F
authors.lastname: Diadiou
authors.affiliation: Centre de santé et de services sociaux de Chicoutimi, Québec, Canada.
authors.forename: Mireille
authors.initials: M
authors.lastname: Lambert
authors.affiliation: Centre de santé et de services sociaux de Chicoutimi, Québec, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Bouliane
mesh_terms: D000368:Aged; D019090:Case Management; D003142:Communication; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D011792:Quebec; D035502:Trust
keywords: chronic disease; frequent users of health care; nursing; patient care management; patient experience; primary care