Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre

Deborah Kahan, Daniel Poremski, Deborah Wise-Harris, Daniel Pauly, Molyn Leszcz, Donald Wasylenki, Vicky Stergiopoulos, Deborah Kahan, Daniel Poremski, Deborah Wise-Harris, Daniel Pauly, Molyn Leszcz, Donald Wasylenki, Vicky Stergiopoulos

Abstract

Objectives: This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention.

Methods: We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care.

Results: Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers.

Conclusion: Interventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Di Somma S, Paladino L, Vaughan L, Lalle I, Magrini L, Magnanti M. Overcrowding in emergency department: an international issue. Intern Emerg Med. 2015. March; 10 (2): 171–5. 10.1007/s11739-014-1154-8
    1. LaCalle E, Rabin E. Frequent Users of Emergency Departments: The Myths, the Data, and the Policy Implications. Ann Emerg Med. 2010. July; 56(1): 42–48. 10.1016/j.annemergmed.2010.01.032
    1. Althaus F, Paroz S, Hugli O, Ghali WA, Daeppen JB, Peytremann-Bridevaux I, et al. Effectiveness of interventions targeting frequent users of emergency departments: a systematic review. Ann Emerg Med. 2011. July; 58 (1): 41–52. 10.1016/j.annemergmed.2011.03.007
    1. Byrne M, Murphy AW, Plunkett PK, McGee HM, Murray A, Bury G. Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics. Ann Emerg Med. 2003. March; 41(3): 309–18. 10.1067/mem.2003.68
    1. Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML. Characteristics of frequent users of emergency departments. Ann Emerg Med. 2006. July; 48(1): 1–8. 10.1016/j.annemergmed.2005.12.030
    1. Soril LJJ, Leggett LE, Lorenzetti DL, Noseworthy TW, Clement FM. Reducing frequent visits to the emergency department: a systematic review of interventions. PLoS One. 2015. April 1; 10 (4): e0123660 10.1371/journal.pone.0123660
    1. Bodenmann P, Velonaki VS, Ruggeri O, Hugli O, Burnand B, Wasserfallen JB. Case management for frequent users of the emergency department: study protocol of a randomised controlled trial. BMC Health Serv Res. 2014. June; 14: 264 Identifier: NCT01934322 10.1186/1472-6963-14-264
    1. Shumway M, Boccellari A, O'Brien K, Okin RL. Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial. Am J Emerg Med. 2008. February; 26(2): 155–64. 10.1016/j.ajem.2007.04.021
    1. Kumar GS, Klein R. Effectiveness of Case Management Strategies in Reducing Emergency Department Visits in Frequent User Patient Populations: A Systematic Review. J Emerg Med. 2013; 44(3): 717–729. 10.1016/j.jemermed.2012.08.035
    1. Spillane LL, Lumb EW, Cobaugh DJ, Wilcox SR, Clark JS, Schneider SM. Frequent users of the emergency department: can we intervene? Acad Emerg Med. 1997; 4: 574–580.
    1. Reinius P, Johansson M, Fiellner A, Werr J, Ohlen G, Edgren G. A telephone-based case-management intervention reduces healthcare utilization for frequent emergency department visitors. Eur J Emerg Med. 2013; 20 (5): 327–34. 10.1097/MEJ.0b013e328358bf5a
    1. Mautner DB, Pang H, Brenner JC, Shea JA, Gross KS, Frasso R, et al. Generating hypotheses about care needs of high utilizers: lessons from patient interviews. Popul Health Manag. 2013; 16 Suppl 1: S26–33.
    1. Wise Harris D, Pauly D, Kahan D, Tan de Bibiana J, Hwang SW, Stergiopoulos V. "Hospital was the only option": Experiences of Frequent Emergency Department Users in Mental Health. Adm Policy Ment Health. 2016. March 9; [Epub ahead of print].
    1. Choo EK, Garro AC, Ranney ML, Meisel ZF, Morrow Guthrie K. Qualitative research in emergency care part I: Research principles and common applications. Acad Emerg Med. 2015. September; (9):1096–102 Epub 2015 Aug 18. 10.1111/acem.12736
    1. Raven MC, Billings JC, Goldfrank LR, Manheimer ED, Gourevitch MN. Medicaid patients at high risk for frequent hospital admission: real-time identification and remediable risks. J Urban Health. 2009. March; 86(2): 230–41. 10.1007/s11524-008-9336-1
    1. Pines JM, Asplin BR, Kaji AH, Lowe RA, Magid DJ, Raven M, et al. Frequent Users of Emergency Department Services: Gaps in Knowledge and a Proposed Research Agenda. Acad Emerg Med. 2011. June; 18(6): e64–9. 10.1111/j.1553-2712.2011.01086.x
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2):77–101. Available from: Referenced in 10.1191/1478088706qp063oa
    1. Poremski P, Wise-Harris D, Kahan D, Pauly D, Leszcz M, O’Campo P, et al. Improving continuity of care for frequent users of emergency departments: service user and provider perspectives. Gen Hosp Psychiatry. 2016. May-Jun; 40: 55–9. 10.1016/j.genhosppsych.2016.01.004
    1. Kartha A, Brower V, Saitz R, Samet JH, Keane TM, Liebschutz J. The Impact of Trauma Exposure and Post-Traumatic Stress Disorder on Healthcare Utilization Among Primary Care Patients. Med Care. 2008. April; 46 (4): 388–93. 10.1097/MLR.0b013e31815dc5d2
    1. Solomon SD, Davidson JR. Trauma: prevalence, impairment, service use, and cost [review]. J Clin Psychiatry. 1997; 58 Suppl 9: S5–11.
    1. Elhai JD, North TC, Frueh BC. Health service use predictors among trauma survivors: a critical review. Psychol Serv. 2005; 2: 3–19.
    1. Hastings SN, George LK, Fillenbaum GG, Park RS, Burchett BM, Schmader KE. Does lack of social support lead to more ED visits for older adults? Am J Emerg Med. 2008. May; 26(4): 454–61. 10.1016/j.ajem.2007.07.005
    1. Althaus F, Stucki S, Guyot S, Trueb L, Moschetti K, Daeppen JB, et al. Characteristics of highly frequent users of a Swiss academic emergency department: a retrospective consecutive case series. Eur J Emerg Med. 2013. December; 20(6):413–9. 10.1097/MEJ.0b013e32835e078e
    1. Olsson M, Hansagi H. Repeated use of the emergency department: qualitative study of the patient’s perspective. Emerg Med J. 2001. November; 18(6): 430–4. 10.1136/emj.18.6.430
    1. Kopera M, Suszek H, Bonar E, Myszka M, Gmai B, Ilgen M, et al. Evaluating Explicit and Implicit Stigma of Mental Illness in Mental Health Professionals and Medical Students. Community Ment Health J. 2015. July; 51 (5): 628–34. Epub 2014 Dec 23. 10.1007/s10597-014-9796-6
    1. Dabby L, Tranulis C, Krimayer LJ. Explicit and implicit attitudes of Canadian psychiatrists toward people with mental illness. Can J Psychiatry. 2015. October; 60(10):451–9.
    1. Clarke DE, Dusome D, Hughes L. Emergency department from the mental health client’s perspective. Int J Ment Health Nurs. 2007. April; 16(2):126–31. 10.1111/j.1447-0349.2007.00455.x
    1. Skosireva A, O’Campo P, Zerger S, Chambers C, Gapka S, Stergiopoulos V. Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings. BMC Health Serv Res. 2014. September 7; 14:376 International Standard Randomized Control Trial Registration Number: ISRCTN42520374 10.1186/1472-6963-14-376
    1. Zerger S, Bacon S, Corneau S, Skosireva A, McKenzie K, Gapka S. Differential experiences of discrimination among ethnoracially diverse persons experiencing mental illness and homelessness. BMC Psychiatry. 2014. December; 14: 353 10.1186/s12888-014-0353-1
    1. Stuart H, Shu-Ping C, Romie C, Dobson K, Kirsh B, Knaak S. Opening Minds in Canada: Targeting Change. Can J Psychiatry. 2014. October; 5910 Suppl 1): S13–8.
    1. Charatan F. US mental health service is “highly fragmented”. BMJ. 2000. January 1; 320 (7226): 7.
    1. Open minds, healthy minds: Ontario’s comprehensive mental health and addictions strategy. Government of Ontario. 2011. .
    1. Anderson JE, Larke SC. Navigating the mental health and addictions maze: a community- based pilot project of a new role in primary mental health care. Ment Health Fam Med. 2009. March; 6 (1): 15–9.
    1. The Standing Senate Committee on Social Affairs, Science and Technology. Mental health, mental illness and addiction: Overview of policies and programs in Canada. 2004; 25–8.
    1. Tai-Seale M, McGuire TG, Zhang W. Time allocation in primary care office visits. Health Serv Res. 2007. October; 42 (5): 1871–94. 10.1111/j.1475-6773.2006.00689.x
    1. Rapp CA, Goscha RJ. The principles of effective case management of mental health services. Psychiatr Rehabil J. 2004; 27 (4): 319–33.
    1. Heinonen E, Lindfors O, Härkänen T, Virtala E, Jääskeläinen T, Knekt P. Therapists’ professional and personal characteristics as predictors of working alliance in short-term and long-term psychotherapies. Clin Psychol Psychother. 2014. Nov-Dec; 21(6): 475–94. Epub 2013 Jun 28. 10.1002/cpp.1852
    1. Thompson SJ, Bender K, Lantry J, Flynn PM. Treatment engagement: building therapeutic alliance in home-based treatment with adolescents and their families. Contemp Fam Ther. 2007. June; 29 (1–2): 39–55. 10.1007/s10591-007-9030-6
    1. Rocque R, Leanza Y. A systematic review of patients’ experiences in communicating with primary care physicians: intercultural encounters and a balance between vulnerability and integrity. PLoS ONE. 2015. October; 10(10): e0139577 10.1371/journal.pone.0139577
    1. Chen FP, Ogden L. A working relationship model that reduces homelessness among people with mental illness. Qual Health Res. 2012. March; 22 (3): 373–83. Epub 2011 Sep 2. 10.1177/1049732311421180
    1. Buck PW, Alexander LB. Neglected voices: consumers with serious mental illness speech about intensive case management. Adm Policy Mental Health. 2006. July; 33 (4): 470–81. Epub 2005 Nov 15.
    1. Goldman HH. Making progress in mental health policy in conservative times: one step at a time. Schizophr Bull. 2006. July; 32 (3): 424–7. Epub 2006 Jan 25. 10.1093/schbul/sbj042
    1. Slade M. Everyday solutions for everyday problems: how mental health systems can support recovery. Psychiatr Serv. 2012. July; 63(7): 702–704. 10.1176/appi.ps.201100521
    1. Rabenschlag F, Konrad A, Rueegg S, Jaeger M. A recovery-oriented approach for an acute psychiatric ward: is it feasible and how does it affect staff satisfaction? Psychiatr Q. 2014. June; 85(2): 225–39. 10.1007/s11126-013-9285-z
    1. Young AT, Green CA, Estroff SE. New Endeavors, Risk-taking and Personal Growth in the Recovery Process: STARS Study Findings. Psychiatr Serv. 2008. December; 59 (12): 1430–6. 10.1176/appi.ps.59.12.1430
    1. Jacob KS. Recovery model of mental illness: a complementary approach to psychiatric care. Indian J. Psychol Med. 2015. Apr-Jun; 37 (2): 117–9. 10.4103/0253-7176.155605
    1. Repper J, Carter T. A review of the literature on peer support in mental health services. J Ment Health. 2011. August; 20(4): 392–411. 10.3109/09638237.2011.583947
    1. Ochocka J, Nelson G, Janzen R, Trainor J. A longitudinal study of mental health consumer/survivor initiatives: Part 3– A qualitative study of impacts of participation on new members. J Community Psychol. 2006. May; 34(3): 273–83. Epub 2006 Mar 30.
    1. Miyamoto Y, Sono T. Lessons from peer support among individuals with mental health difficulties: a review of the literature. Clin Pract Epidemiol Ment Health. 2012; 8: 22–9. Epub 2012 Apr 16. 10.2174/1745017901208010022
    1. Davidson L, Ridgeway P, Schmutte T, O’Connell M. Purposes and goals: Handbook of service user involvement in mental health research. West Sussex: Wiley-Blackwell; 2009.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner