title: Improving continuity of care for frequent users of emergency departments: service user and provider perspectives.
abstract: This study explored service user and provider perspectives on barriers and facilitators of continuity of care for frequent users of emergency departments (ED) participating in a brief intensive case management intervention.
  
  
  
  We conducted semistructured interviews with 20 frequent ED users with mental health and addiction challenges participating in a brief intensive case management intervention, eliciting experiences of care and care continuity. We interviewed 13 service providers working with this population. We used thematic analysis to determine shared and unique barriers and facilitators to continuity of care, and we gave priority to themes reported by both service users and providers.
  
  
  
  Within fragmented systems of care, strong working relationships between service users and providers, timely access to coordinated services and seamless transitions to needed supports increased perceived care continuity. Barriers to continuity of care included difficulties engaging this population, short intervention duration and the lack of a single accountable service provider to address health and social needs.
  
  
  
  Although brief intensive case management interventions have the potential to improve continuity of care for frequent ED users, continuity of care, especially for people with complex health and social needs, may be compromised by program and personal characteristics as well as lack of broader system integration.
authors.affiliation: Institute of Mental Health, Singapore; St. Michael's Hospital Centre for Research on Inner City Health, Canada. Electronic address: Daniel.poremski@mail.mcgill.ca.
authors.forename: Daniel
authors.initials: D
authors.lastname: Poremski
authors.affiliation: St. Michael's Hospital Centre for Research on Inner City Health, Canada.
authors.forename: Deborah Wise
authors.initials: DW
authors.lastname: Harris
authors.affiliation: University of Toronto Department of Psychiatry, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kahan
authors.affiliation: University of Toronto, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pauly
authors.affiliation: University of Toronto Department of Psychiatry, Canada; Mount Sinai Hospital, USA.
authors.forename: Molyn
authors.initials: M
authors.lastname: Leszcz
authors.affiliation: St. Michael's Hospital Centre for Research on Inner City Health, Canada; University of Toronto Dalla Lana School of Public Health, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
authors.affiliation: St. Michael's Hospital Centre for Research on Inner City Health, Canada; University of Toronto Department of Psychiatry, Canada.
authors.forename: Donald
authors.initials: D
authors.lastname: Wasylenki
authors.affiliation: St. Michael's Hospital Centre for Research on Inner City Health, Canada; University of Toronto Department of Psychiatry, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Stergiopoulos
mesh_terms: D000328:Adult; D019090:Case Management / Q000592:standards*; D003266:Continuity of Patient Care / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D036301:Qualitative Research; D058996:Quality Improvement / Q000592:standards*
keywords: Brief intensive case management; Continuity of care; Frequent emergency service users; Mental illness