Case management for adults with complex care needs in primary care: A qualitative study of factors impacting early implementation

Abstract

Background: Case management (CM) is a multi-faceted integrated care intervention designed to improve care coordination and health outcomes for individuals with complex care needs. Over the past decade, the V1sage approach to CM has been co-developed by researchers, people with lived experience, care providers and decision makers, and is now being scaled up in New Brunswick (NB) and Quebec (QC), Canada.   Approach:This study explores the early implementation of the CM scale-up to identify factors influencing adoption and sustainability across diverse primary care settings. Semi-structured interviews have been conducted with case managers, primary care providers, and allied health professionals from 10 primary care clinics in NB. Data were analyzed using thematic analysis in collaboration with patient partners to identify factors influencing adoption, sustainability, and scalability of the CM approach.   Results: Three overarching themes emerged: (1) team dynamics and clinic culture; (2) professional preparedness and support, and (3) local adaptations to the approach. Team-based collaboration, leadership engagement, and protected time for implementation were key facilitators of early adoption.   Professional preparedness, particularly prior experience with similar roles and familiarity with the clientele supported implementation, while lack of team buy-in hindered it. Local adaptations were necessary to tailor the intervention to the specific context of each clinic. While most clinic teams perceived the approach as sustainable, especially when it aligned with clinic goals, they emphasized the need for dedicated time and resources to maintain the CM role.   Implications: By examining the early implementation across various clinics, this study provides insights into factors facilitating and hindering integrated care interventions in primary care. These findings can inform the spread and scale of similar integrated care interventions across other settings seeking to enhance coordinated, patient-centred care for adults with complex needs.