Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception

Allmen, Michael von; Grazioli, Véronique S.; Kasztura, Miriam; Chastonay, Oriane; Moullin, Joanna C.; Daeppen, Jean‐Bernard; Bodenmann, Patrick

doi:10.1186/s12873-021-00481-9

Cited by 5 publications

(4 citation statements)

References 26 publications

(51 reference statements)

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“…The need for FUED to justify their visit to the ED was strong, and some mentioned a feeling of illegitimacy. These findings align with previous research describing the propensity of certain healthcare professionals to consider FUED’s recourse to the ED as illegitimate, 30 even influencing FUED’s access to medications. 31 In another study, most healthcare professionals at our hospital considered the motives provided for the ED visit inappropriate, whereas in most instances patients had in fact consulted for acute needs.…”

Section: Discussionsupporting

confidence: 90%

“… 31 In another study, most healthcare professionals at our hospital considered the motives provided for the ED visit inappropriate, whereas in most instances patients had in fact consulted for acute needs. 30 Furthermore, the healthcare workers’ feelings were reported to be borne out by participants' perceptions. 32 These reports are important to consider, as the perception of being discriminated against is associated with greater vulnerability and worse patient self-assessment of their health.…”

Section: Discussionmentioning

confidence: 99%

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Understanding the experience in the healthcare system of non-migrant and migrant frequent users of the emergency department in French-speaking Switzerland: a comparative qualitative study

et al. 2023

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BackgroundPrevious research revealed the vulnerability of frequent users of emergency department (FUED) because of concomitant medical, psychological and social issues. Case management (CM) provides FUED with effective medical and social support, however, the heterogeneity of this population has highlighted the need to explore the specific needs of FUED subpopulations. In response, this study aimed to explore qualitatively the lived experience of migrant and non-migrant FUED in the healthcare system to identify unmet needs.MethodsAdult migrant and non-migrant FUED (≥ 5 visits in the ED in the past 12 months) were recruited in a Swiss university hospital to collect qualitative data on their experience within the Swiss health system. Participants were selected based on predefined quotas for gender and age. Researchers conducted one-on-one semistructured interviews until reaching data saturation. Inductive conventional content analysis was used to analyse qualitative data.ResultsIn total, 23 semistructured interviews were conducted (11 migrant FUED and 12 non-migrant FUED). Four main themes emerged from the qualitative analysis: (1) self-evaluation of the Swiss healthcare system; (2) orientation within the healthcare system; (3) relationship with caregivers and (4) perception of own health. While both groups were overall satisfied with the healthcare system and care provided, migrant FUED reported language and financial barriers to access it. Both groups expressed overall satisfaction over their relationship with healthcare professionals, although migrant FUED reported a feeling of illegitimacy to consult the ED based on social status, whereas non-migrant FUED felt more often the need to justify their use of the ED. Finally, migrant FUED perceived their own health to be affected by their status.ConclusionThis study highlighted difficulties specific to subpopulations of FUED. For migrant FUED, these included access to care and impact of migrant status on own health. Adapting CM to the specific needs of migrant FUED could help reduce their vulnerability.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Understanding the experience in the healthcare system of non-migrant and migrant frequent users of the emergency department in French-speaking Switzerland: a comparative qualitative study

et al. 2023

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“…Grazioli et al proposed a protocol for implementation of case management in the Swiss health care system [ 24 ]. Such protocols will have to be adapted to the different healthcare systems, especially in the current context of overcrowded EDs that are also facing a shortage of doctors and nurses, in France as in other countries [ 25 – 27 ]. Little is known about the impact of CM on deprived frequent ED users and interventional trials in this population are crucial.…”

Section: Introductionmentioning

confidence: 99%

Health mediation: an intervention mode for improving emergency department care and support for patients living in precarious conditions

Salem

Rotily

Apostolidis

et al. 2023

BMC Health Serv Res

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Background Severe overcrowding of emergency departments (EDs) impacts the quality of healthcare. One factor of this overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. We here present the results of an ancillary qualitative study to explore the prospects regarding a health mediation intervention implemented in EDs for deprived persons who are frequent ED users, from professionals’ and patients’ perspectives. Methods Design, data collection, and data analysis were done according to a psychosocial approach, based on thematic content analysis and semi-structured interviews of 16 frequent ED users and deprived patients exposed to HM and of 14 professionals in 4 EDs of South-eastern France. Results All patients reported multifactorial distress. Most of them expressed experiencing isolation and powerlessness, and lacking personal resources to cope with healthcare. They mentioned the use of ED as a way of quickly meeting a professional to respond to their suffering, and recognized the trustworthy alliance with health mediators (HMrs) as a means to put them back in a healthcare pathway. The presence of HMrs in EDs was appreciated by ED professionals because HMrs responded to requests they were not able to access and were perceived as an efficient support for caring for deprived persons in emergency contexts. Conclusions Our results are in favour of health mediation in EDs as a promising solution, requested by patients and ED professionals, to cope with frequent ED users and deprived patients. Our results could also be used to adapt other strategies for the most vulnerable populations to reduce the frequency of ED readmissions. At the interface of the patients’ health experience and the medico-social sector, HM could complete the immediate responses to medical needs given in EDs and contribute in alleviating the social inequalities of health.

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“…Several systematic reviews suggested that case management could reduce ED visits [ 12 , 14 , 29 , 30 ] and be cost-effective [ 31 ], but few specifically targeted vulnerable patients [ 13 , 29 , 30 ]. Case management involves multi-disciplinary teams including physicians, nurses, psychologists, social workers and/or housing and community resource liaisons, who develop tailored care strategies and protocols for patients [ 32 – 35 ]. Little is known about the impact of case management on deprived FUED, and interventional trials in this population are crucial.…”

Section: Introductionmentioning

confidence: 99%

Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?

Rotily,

Persico,

Lamouroux

et al. 2024

BMC Emerg Med

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Background Severe overcrowding of emergency departments (EDs) affects the quality of healthcare. One factor of overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. The primary aim was to determine whether HM intervention for frequent users of EDs (FUED) living in precarious conditions could reduce the readmission rate at 90 days. Methods Between February 2019 and May 2022, we enrolled and interviewed 726 FUED in four EDs of southeastern France in this randomised controlled trial. The HM intervention started in the ED and lasted 90 days. In addition to the primary endpoint (first readmission at 90 days), secondary endpoints (readmission at 30 and 180 days, number of hospitalisations at 30, 90, 180 days, admissions for the same reasons as the first admission) were also studied. The outcomes were measured in the ED information systems. Statistical methods included an intention-to-treat analysis and a per-protocol analysis. Comparisons were adjusted for gender, age, ED, and health mediator. Results 46% of patients reported attending the ED because they felt their life was in danger, and 42% had been referred to the ED by the emergency medical dispatch centre or their GP; 40% of patients were considered to be in a serious condition by ED physicians. The proportion of patients who were readmitted at 90 days was high but did not differ between the control and the HM intervention groups (31.7% vs. 36.3%, p = 0.23). There was no significant difference in any of the secondary outcome measures between the control and HM intervention groups. Per-protocol analysis also showed no significant difference for the primary and secondary endpoints. Conclusions This randomised controlled trial did not show that our health mediation intervention was effective in reducing the use of emergency services by FUED living in precarious conditions. Some limitations are discussed: the duration of the intervention (90 days), the long-term effects (> 6 months), the involvement of the ED staff. Trial registration Registered on clinicaltrials.gov as NCT03660215 on 4th September 2018.

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Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception

Cited by 5 publications

References 26 publications

Understanding the experience in the healthcare system of non-migrant and migrant frequent users of the emergency department in French-speaking Switzerland: a comparative qualitative study

Understanding the experience in the healthcare system of non-migrant and migrant frequent users of the emergency department in French-speaking Switzerland: a comparative qualitative study

Health mediation: an intervention mode for improving emergency department care and support for patients living in precarious conditions

Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?

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