Introduction Case management (CM) is among the most studied effective models of integrated care for people with complex needs. The goal of this study is to scale up and assess CM in primary healthcare for people with complex needs.Methods and analysis The research questions are: (1) which mechanisms contribute to the successful scale-up of CM for people with complex needs in primary healthcare?; (2) how do contextual factors within primary healthcare organisations contribute to these mechanisms? and (3) what are the relationships between the actors, contextual factors, mechanisms and outcomes when scaling-up CM for people with complex needs in primary healthcare? We will conduct a mixed methods Canadian interprovincial project in Quebec, New-Brunswick and Nova Scotia. It will include a scale-up phase and an evaluation phase. At inception, a scale-up committee will be formed in each province to oversee the scale-up phase. We will assess scale-up using a realist evaluation guided by the RAMESES checklist to develop an initial programme theory on CM scale-up. Then we will test and refine the programme theory using a mixed-methods multiple case study with 10 cases, each case being the scalable unit of the intervention in a region. Each primary care clinic within the case will recruit 30 adult patients with complex needs who frequently use healthcare services. Qualitative data will be used to identify contexts, mechanisms and certain outcomes for developing context-mechanism-outcome configurations. Quantitative data will be used to describe patient characteristics and measure scale-up outcomes.Ethics and dissemination Ethics approval was obtained. Engaging researchers, decision-makers, clinicians and patient partners on the study Steering Committee will foster knowledge mobilisation and impact. The dissemination plan will be developed with the Steering Committee with messages and dissemination methods targeted for each audience.

Patients with complex health and social care needs (hereafter "complex needs") often use services provided by different professionals, calling for integrated care to adequately meet their needs.1 In a previous publication,2 our team presented the COmplex NEeds Case-finding Tool—6 (CONECT-6), a case-finding tool including six yes or no questions, for early identification of people with complex needs who frequently use emergency department services. Even with the most robust psychometric properties, health assessment questionnaires often pose challenges for vulnerable populations, such as a lack of clarity or a lack of specificity to capture the respondents' unique and complex situations.3-6 It is good practice to provide respondents with some advice and guidelines to facilitate the questionnaires' administration and promote their understanding.6 This article aims to propose a few tips to ensure better understanding when administering CONECT-6 to people who frequently use emergency department services to identify if they have complex needs. The ongoing PriCARE Transitions project, funded by the Canadian Institutes of Health Research, aims to better understand the experience of care transitions of patients living with complex needs.7 Knowing that people with complex needs frequently use many health and social services and that emergency department visits are a good proxy of this use,8, 9 people with complex care needs were recruited in six emergency departments from three Canadian provinces (Quebec, New Brunswick, and Newfoundland and Labrador). The CONECT-6 tool was administered as a screening tool for complex needs to patients with three or more emergency visits in the previous year. Patients with two positive answers or more were then invited to complete the INTERMED Self-Assessment (IMSA)10 to confirm complex needs. A validation study of the CONECT-6 tool compared its responses against those in the IMSA,10 which is considered a gold standard for measuring complex needs. CONECT-6 validation documented a sensitivity of 90% and a specificity of 66% with a threshold of two or more positive answers, and a positive predictive value of 49% and a negative predictive value of 95%.2 Thus far, six participating emergency sites in the PriCARE Transitions study have recruited over 700 patients to complete the CONECT-6 screening tool either electronically or on paper. To overcome barriers of low literacy or reading challenges a researcher typically administered the questionnaire,11 but people who indicated that they were more comfortable self-administering the questionnaire could do so. As with many other validated questionnaires, many people raised questions regarding CONECT-6 despite its simple formula and previous validation.6 The most frequent challenges encountered across sites were: (1) for the first, third, and sixth items, people tended to elaborate on their specific situation, leaving the research team to either choose a 'yes' or 'no' option or to rephrase the question to elicit a 'yes' or 'no' response; and (2) the second and fifth items sometimes needed more explanation. The research team, including patient partners, met and shared strategies they used to facilitate respondents' understanding and proposed tips. English-speaking members of the team worked on the English version while French-speaking members worked on the French version. Teamwork and discussions ensured that the questionnaires maintained their original meaning. Here are the proposed tips to administer the CONECT-6 tool in Tables 1 and 2. In general, would you say your health is fair to poor, or would you say your health is better than that? If the patient answers better than that, the answer is no, otherwise, the answer is yes. If the patient asks for it, specify that all sources of income include employment income, benefits, annuities, investments, and scholarships. By household, we mean all the people who live under the same roof. Si le patient le demande, préciser que par toutes sources de revenus on inclut les revenus d'emploi, les prestations, les rentes et les bourses. Par ménage, on entend toutes les personnes qui habitent sous le même toit. This paper proposes tips to promote participant understanding when completing the CONECT-6 questionnaire. This 6-item questionnaire remains a useful case-finding tool to identify people with complex health and social needs in the emergency department for recruitment in research projects or in clinical programs. We thank the Canadian Institutes of Health Research for funding. The authors declare no conflict of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

People living in precarious socio-economic conditions are at greater risk of developing mental and physical health disorders, and of having complex needs. This places them at risk of health inequity. Addressing social determinants of health (SDH) can contribute to reducing this inequity. Case management in primary care is an integrated care approach which could be an opportunity to better address SDH. The aim of this study is to better understand how case management in primary care may address the SDH of people with complex needs. A case management program (CMP) for people with complex needs was implemented in four urban primary care clinics. A qualitative study was conducted with semi-structured interviews and a focus group with key informants (n = 24). An inductive thematic analysis was carried out to identify emerging themes. Primary care case managers were well-positioned to provide a holistic evaluation of the person’s situation, to develop trust with them, and to act as their advocates. These actions helped case managers to better address individuals’ unmet social needs (e.g., poor housing, social isolation, difficulty affording transportation, food, medication, etc.). Creating partnerships with the community (e.g., streetworkers) improved the capacity in assisting people with housing relocation, access to transportation, and access to care. Assuming people provide their consent, involving a significant relative or member of their community in an individualized services plan could support people in addressing their social needs. Case management in primary care may better address SDH and improve health equity by developing a trusting relationship with people with complex needs, improving interdisciplinary and intersectoral collaboration and social support. Future research should explore ways to enhance partnerships between primary care and community organizations.

Case management (CM) is an intervention for improving integrated care for patients with complex care needs. The implementation of this complex intervention often raises opportunities for change and collective leadership has the potential to optimize the implementation. However, the application of collective leadership in real-world is not often described in the literature. This commentary highlights challenges faced during the implantation of a CM intervention in primary care for people with complex care needs, including stakeholders’ buy-in and providers’ willingness to change their practice, selection of the best person for the case manager position and staff turnover. Based on lessons learned from PriCARE research program, this paper encourages researchers to adopt collective leadership strategies for the implementation of complex interventions, including promoting a collaborative approach, fostering stakeholders’ engagement in a trusting and fair environment, providing a high level of communication, and enhancing collective leadership attitudes and skills. The learnings from the PriCARE program may help guide researchers for implementing complex healthcare interventions.

Abstract Introduction Growing evidence supports patient engagement (PE) in health implementation research to improve the quality, relevance and uptake of research. However, more guidance is needed to plan and operationalize PE before and throughout the research process. The aim of the study was to develop a logic model illustrating the causal links between context, resources, activities, outcomes and impact of PE in an implementation research programme. Methods The Patient Engagement in Health Implementation Research Logic Model (hereafter the Logic Model) was developed using a descriptive qualitative design with a participatory approach, in the context of the PriCARE programme. This programme aims to implement and evaluate case management for individuals who frequently use healthcare services in primary care clinics across five Canadian provinces. Participant observation of team meetings was performed by all team members involved in the programme and in‐depth interviews were conducted by two external research assistants with team members (n = 22). A deductive thematic analysis using components of logic models as coding categories was conducted. Data were pooled in the first version of the Logic Model, which was refined in research team meetings with patient partners. The final version was validated by all team members. Results The Logic Model highlights the importance of integrating PE into the project before its commencement, with appropriate support in terms of funding and time allocation. The governance structure and leadership of both principal investigators and patient partners have significant effects on PE activities and outcomes. As an empirical and standardized illustration that facilitates a shared understanding, the Logic Model provides guidance for maximizing the impact of patient partnership in various contexts for research, patients, providers and health care. Conclusion The Logic Model will help academic researchers, decision makers and patient partners plan, operationalize, and assess PE in implementation research for optimal outcomes. Patient or Public Contribution Patient partners from the PriCARE research programme contributed to developing the research objectives and designing, developing and validating data collection tools, producing data, developing and validating the Logic Model and reviewing the manuscript.

Context: Abundant literature supports case management (CM) as an intervention to improve care for people with complex care needs, but little explains how and why CM is effective, or not, in particular contexts. Objective: To understand and explain how CM in primary care for people with complex care needs works, under what conditions and for whom. Study design: Realist evaluation. Setting: Seven primary care clinics across 4 provinces in Canada. Population studied: People with chronic conditions and complex care needs. Intervention: CM led by case managers in partnership with patients and other healthcare professionals according to four core components: 1) Patient needs assessment; 2) Care planning, including individualized services plan; 3) Care coordination; 4) Self-management support. Methods. Data collection: realist interviews with patients (n=13), case managers (n=6), clinic managers (n=3) and other healthcare professionals (n=8). Analysis: Context (i.e. background of the intervention), mechanism (i.e. reasoning, attitudes and behaviors of stakeholders) and outcome (i.e. intervention impact) (CMO) were identified in a comprehensive table for each interview. CMO were then aggregated, organized and interpreted by the team. Regular discussions with the team helped to refine and validate the CMOs. Results: Fourteen CMOs that demonstrate the mechanisms triggered to drive outcomes in particular contexts were identified. CM was most likely to be successful if all stakeholders were engaged in the intervention and felt supported by managers and colleagues. Moreover, positive patient effects were likely to be reported if trusting relationships were developed between patients and case managers. Differences in CM effectiveness across clinics were related to patient characteristics (motivation and complexity of healthcare needs), case manager characteristics (experience, background, skills and attitude) as well as organizational factors (access to care and external support, time and providers workload, team culture, and work location). Positive impacts on family members were also observed when they felt supported, respected, and accepted. Conclusions: The realist evaluation offer context-sensitive explanations to better inform local practices and policies and to contribute to improved health of patients with complex care needs.

BACKGROUND:Case management is one of the most frequently performed interventions to mitigate the negative effects of high healthcare use on patients, primary care providers and the healthcare system. Reviews have addressed factors influencing case management interventions (CMI) implementation and reported common themes related to the case manager role and activities, collaboration with other primary care providers, CMI training and relationships with the patients. However, the heterogeneity of the settings in which CMI have been implemented may impair the transferability of the findings. Moreover, the underlying factors influencing the first steps of CMI implementation need to be further assessed. This study aimed to evaluate facilitators and barriers of the first implementation steps of a CMI by primary care nurses for people with complex care needs who frequently use healthcare services.METHODS:A qualitative multiple case study was conducted including six primary care clinics across four provinces in Canada. In-depth interviews and focus groups with nurse case managers, health services managers, and other primary care providers were conducted. Field notes also formed part of the data. A mixed thematic analysis, deductive and inductive, was carried out.RESULTS:Leadership of the primary care providers and managers facilitated the first steps of the of CMI implementation, as did the experience and skills of the nurse case managers and capacity development within the teams. The time required to establish CMI was a barrier at the beginning of the CMI implementation. Most nurse case managers expressed apprehension about developing an "individualized services plan" with multiple health professionals and the patient. Clinic team meetings and a nurse case managers community of practice created opportunities to address primary care providers' concerns. Participants generally perceived the CMI as a comprehensive, adaptable, and organized approach to care, providing more resources and support for patients and better coordination in primary care.CONCLUSION:Results of this study will be useful for decision makers, care providers, patients and researchers who are considering the implementation of CMI in primary care. Providing knowledge about first steps of CMI implementation will also help inform policies and best practices.

Objective With the onset of the COVID-19 pandemic, telehealth case management (TCM) was introduced in primary care for patients requiring care by distance. While not all healthcare needs can be addressed via telehealth, the use of information and communication technology to support healthcare delivery has the potential to contribute to the management of patients with chronic conditions and associated complex care needs. However, few qualitative studies have documented stakeholders’ perceptions of TCM. This study aimed to describe patients’, primary care providers’ and clinic managers’ perceptions of the use of a nurse-led TCM intervention for primary care patients with complex care needs.Design Qualitative descriptive study.Setting Three primary care clinics in three Canadian provinces.Participants Patients with complex care needs (n=30), primary care providers (n=11) and clinic managers (n=2) participated in qualitative individual interviews and focus groups.Intervention TCM intervention was delivered by nurse case managers over a 6-month period.Results Participants’ perceptions of the TCM intervention were summarised in three themes: (1) improved patient access, comfort and sense of reassurance; (2) trusting relationships and skilled nurse case managers; (3) activities more suitable for TCM. TCM was a generally accepted mode of primary care delivery, had many benefits for patients and providers and worked well for most activities that do not require physical assessment or treatment. Participants found TCM to be useful and a viable alternative to in-person care.Conclusions TCM improves access to care and is successful when a relationship of trust between the nurse case manager and patient can develop over time. Healthcare policymakers and primary care providers should consider the benefits of TCM and promote this mode of delivery as a complement to in-person care for patients with complex care needs.

1. Context: Eighteen percent of people in primary healthcare face interacting challenges among the physical, mental, and social dimensions of health, experiencing the most complex needs and resulting in decreased quality of life as well as increased disability and mortality risk. The organization of services for this population calls for integrated care. 2. Objective: This presentation aims to report on the development and evaluation of the V1SAGES Approach over the last decade, to improve integrated care for adults with complex needs, and to present the V1SAGES Approach toolkit supporting its implementation. 3. Study Designs: The approach was developed through many study designs within a participatory culture involving stakeholders across Canada: literature reviews (scoping, systematic, and realist); qualitative studies; case studies; a randomized controlled trial; logic model and analysis; and validation of measurement tools, including a case-finding tool. 4. Setting: Case managers in hospitals and care navigators in primary care clinics. 5. Population Studied: People with complex needs who frequently use health services. 6. Program: Case managers and navigators evaluate, plan, and coordinate services around the patient's and their family's needs in close collaboration with providers at all levels of healthcare and community organizations. The standard of care proposes to: identify adults with complex needs; assess their needs, life project, and preferences; develop an individualized services plan (ISP) with relevant partners during an in-person or virtual meeting; coordinate care among all providers according to the ISP; offer self-management support and education to the person and their family. The toolkit includes five web-based modules, the CONECT-6 case-finding tool, the standard of care, and all clinical tools. 7. Results: Our studies reported that the V1SAGES Approach was effective, reducing psychological distress and improving the patient's sense of security. Facilitators and barriers to the implementation will be presented. 8. Conclusions: The evidencebased V1SAGES Approach and toolkit could be useful to researchers, clinicians, and decision-makers engaged in improving the health of people with complex needs, their experiences of integrated care, and their satisfaction with care services. This approach could also improve the healthcare system's efficiency and reduce its economic burden.

Context: Growing evidence suggests that case management (CM) is an effective intervention to improve the care of patients with chronic conditions and complex care needs who are at risk for poorer health outcomes. While positive outcomes have been associated with CM in a range of settings and for a variety of patient populations, less is known about CMs potential when implemented in Canadian primary care settings for patients with complex care needs. Objective: To identify positive outcomes and limitations of a CM program in primary care for patients with complex care needs. Study design: Secondary data analysis of realist evaluation data. Setting: Seven primary care clinics across four provinces in Canada. Population studied: People with complex care needs. Intervention: Twelve-month CM intervention led by nurse case managers (NCMs) in partnership with patients and other healthcare professionals consisting of four core components: 1) Patient needs assessment; 2) Care planning, including individualized services plan; 3) Care coordination; 4) Self-management support. Outcome measures: Program experiences and outcomes reported via realist interviews with patients (15), relatives (1), NCMs (6), providers (4), clinic managers (3) and other healthcare professionals (4) and analyzed thematically. Results: Five themes represent the positive outcomes associated with the CM program: more appropriate and efficient use of health services (e.g., fewer emergency department visits), improved patient health and well-being (e.g., improved physical and mental health and health management), enhanced professional collaboration (e.g., communication between NCMs and providers), expanded professional practice (e.g., increased NCM knowledge and networks), and greater satisfaction for all stakeholders. CM limitations include limited availability of appropriate services and patient circumstances that impede their readiness to participate. Conclusions: CM can positively affect patient satisfaction, health, and collaborative care in primary care settings by focusing on patient needs and goals and dedicating time and resources to coordinate care for patients with complex care needs. Patient circumstances and wider health system challenges may limit the effectiveness of CM for some.

Context: Patients with complex health and social care needs face significant service coordination and integration issues. They often require a variety of services from different programs and the community network. A case management program (CMP) for patients with complex care needs was implemented in primary care clinics to improve services coordination with community resources and integrated health and social services centers. Objective: Identify factors facilitating or hindering: 1) the implementation of the CMP in primary care clinics; and 2) interactions with community resources. Study Design and Analysis: A qualitative descriptive multiple case study using an inductive thematic analysis approach. Setting or Dataset: Four clinics in an urban area of the province of Quebec (Canada), where the CMP was implemented. Population Studied: Key informants (n=36) involved in the implementation of the CMP: 2 implementation project managers, 4 clinic managers, 1 case manager from an integrated health and social services center, 8 case managers in primary care clinics, 4 physician leads, and 5 other healthcare professionals. Method: Semi-structured interviews and focus groups with key informants, and participant observation (n=12 hours) during executive meetings. Outcome Measures: Themes that emerged from the inductive thematic analysis. Results: The active support of an experienced case manager from the integrated health and social center, the participation in a community of practice, and the collaboration between social workers and nurses, helped case managers to engage, gain confidence in performing new tasks and be aware of community resources. The density of services in the urban area presented advantages in terms of various services adapted to the patient's needs but also raised care coordination challenges for patients who use multiple services over a wide area. More interaction between internal and external partners would have been useful in monitoring the implementation process, particularly with family physicians. Limited access to mental care services may hinder the engagement of case managers, especially with patients with important mental health challenges. Conclusions: This study informs policy makers, clinicians, and researchers on levers and pitfalls to avoid in the implementation of complex interventions such as CMP for patients with complex care needs in primary care settings.

Context: PriCARE is a patient-oriented research program to implement and assess case management (CM) for patients with complex care needs that traditional primary care services cannot address. This initiative spans five jurisdictions including anglophone and francophone representation, as well as a First Nation community, with PriCARE engaged public patient partners. Objective: To highlight how patient partners participated in each step of the work on this research team, and specifically with recruitment. Study Design: Participatory approach involving patient partners and academic researchers. Setting: Research program implemented in primary care clinics in Quebec, New Brunswick, Newfoundland-and-Labrador, Nova Scotia and Saskatchewan. Population Studied: Patients with complex care needs. Program: In each of five Canadian jurisdictions, one to two patient partners, that is, patients or family caregivers of patients that experienced complex care needs and the health care system, were engaged to work closely with the academic researchers. The patient partners participated in a community of practice meeting on a regular basis. The patient partners were involved in each step of the initiative and participated in the decision-making process. Results: Patient partners reviewed and contributed to the initial grant application, and subsequently to the development of tools for recruitment and data collection, testing of tools, sharing insights on data analysis and interpretation, developing simple, understandable infographics videos, abstracts, presentations and contributing to published manuscripts to communicate the value of CM to potential patient participants. Specifically patient partners played a central role in recruitment of patient participants to PriCARE. Conclusions: Patient partners keep the research team focused on the study participants, their needs and how the health care system must function to meet the needs of the patient and their families.

Context: Case management (CM) is an effective intervention for patients with chronic conditions and complex care needs. While CM often leads to positive outcomes, it has rarely been implemented in primary care in Canada, and little is known of the factors which promote or hinder implementation. Objective: To identify the factors which facilitated or hindered the implementation of CM in primary care from the perspective of nurse case managers, clinic managers and providers. Study Design and Analysis: A secondary analysis of qualitative data from interviews and focus groups conducted throughout the PriCARE program (implementation analysis, telehealth sub-study and realist evaluation). Setting: Primary care clinics in 4 jurisdictions in Canada (New Brunswick, Newfoundland and Labrador, Quebec, and Nova Scotia). Population Studied: Key informants involved in the implementation of CM in primary care clinics: nurse case managers (NCMs); clinic managers and providers. Intervention: A 12-month CM intervention including 4 components: patient needs assessment, care planning, coordination of services, and self-management support. This intervention was completed without additional clinic funding. Outcome Measures: Key informant experiences of and reflections on CM implementation and researcher observations. Instrument: Semi-structured interviews and focus groups with participants, as well as the reflections of the research team during the implementation process. Results: Clinic factors which encouraged the implementation included a holistic collaborative team-based culture, an engaged and supportive clinic manager, the active involvement of care providers, and dedicated and protected time for NCMs to complete CM tasks. Lack of engagement from managers and physicians often led to low recruitment numbers and difficulty completing the intervention. NCMs who did not have set time in their schedules or who did not integrate the CM duties into their regular role struggled to carry out the program. Difficulty coordinating with specialists and external services also acted as a barrier. It was difficult for NCM's to address individuals' complex mental health needs due to lack of access to care. Conclusions: The findings from this study provide insight into what worked well in implementing a 12-month CM intervention in a multi case study, as well as areas for improvement from the perspective of nurse case managers, clinic managers and providers.

INTRODUCTION:Case management programs (CMP) for frequent users of healthcare services presenting complex healthcare needs constitute an effective strategy to improve patient experience of integrated care and to decrease healthcare overuse and cost. This study sought to identify characteristics of these programs, and their implementation contexts, that help to improve patient self-management, experience of integrated care, and healthcare services use. METHODS:A mixed methods multiple embedded case study design was conducted, with six CMP implemented in six hospitals of a region of Quebec (Canada). RESULTS:Within-case analysis describes the structural, environmental, organizational, practitioner, patient, and innovation level characteristics of each CMP and their services integration outcomes based on patient experience, self-management and healthcare services use. Cross-case analysis suggests that the skills, leadership and experience of the case manager, providers' access to the individualized services plan, consideration of the needs of the patient and family members, their participation in decision-making, and the self-management approach, impact integrated care and healthcare services use. CONCLUSION AND DISCUSSION:This study underscores the necessity of an experienced, knowledgeable and well-trained case manager with interpersonal skills to optimize CMP implementation such that patients are more proactive in their care and their outcomes improve.

AbstractBackgroundStudies have highlighted common challenges and barriers to patient engagement in research, but most were based on patient partners' or academic researchers' experiences. A better understanding of how both groups differentially experience their partnership could help identify strategies to improve collaboration in patient engagement research.AimThis study aimed to describe and compare patient partners' and academic researchers' experiences in patient engagement research.MethodsBased on a participatory approach, a descriptive qualitative study was conducted with patient partners and academic researchers who are involved in the PriCARE research programme in primary health care to examine their experience of patient engagement. Individual semi‐structured interviews with patient partners (n = 7) and academic researchers (n = 15) were conducted. Academic researchers' interview verbatims, deidentified patient partners' summaries of their interviews and summaries of meetings with patient partners were analysed using inductive thematic analysis in collaboration with patient partners.ResultsPatient partners and academic researchers' experiences with patient engagement are captured within four themes: (1) evolving relationships; (2) creating an environment that fosters patient engagement; (3) striking a balance; and (4) impact and value of patient engagement. Evolving relationships refers to how partnerships grew and improved over time with an acceptance of tensions and willingness to move beyond them, two‐way communication and leadership of key team members. Creating an environment that fosters patient engagement requires appropriate structural support, such as clear descriptions of patient partner roles; adequate training for all team members; institutional guidance on patient engagement; regular and appropriate translation services; and financial assistance. For patient partners and academic researchers, striking a balance referred to the challenge of reconciling patient partners' interests and established research practices. Finally, both groups recognized the value and positive impact of patient engagement in the programme in terms of improving the relevance of research and the applicability of results. While patient partners and academic researchers identified similar challenges and strategies, their experiences of patient engagement differed according to their own backgrounds, motives and expectations.ConclusionBoth patient partners and academic researchers highlighted the importance of finding a balance between providing structure or guidelines for patient engagement, while allowing for flexibility along the way.Patient or Public ContributionPatient partners from the PriCARE research programme were involved in the following aspects of the current study: (1) development of the research objectives; (2) planning of the research design; (3) development and validation of data collection tools (i.e., interview guides); (4) production of data (i.e., acted as interviewees); (5) validation of data analysis tools (code book); (6) analysis of qualitative data; and (7) drafting of the manuscript and contributing to other knowledge translation activities, such as conference presentations and the creation of a short animated video.

Context. Case management interventions (CMIs) are recognized to improve patients’ experience of integrated care, to promote better utilization of healthcare resources, and to reduce emergency department visits, hospitalizations and health care costs. However, contextual factors influencing implementation of CMIs in primary care settings in Canada still need to be studied. Objective. To examine facilitators and barriers influencing implementation planning, engagement of key actors and the start-up phases of a CMI led by nurse case managers for frequent users of healthcare services with chronic diseases and complex care needs. Study design. Qualitative multiple case study design. Setting. Six primary care clinics across four provinces in Canada. Population studied. Frequent users of healthcare services with chronic diseases and complex care needs. Intervention. A CMI led by nurse case managers that included four main components: 1) patient needs assessment; 2) care planning, including an individual services plan (ISP); 3) coordination of services among health and social services partners; 4) self-management support for patients and families. Methods. Data collection: in-depth interviews with nurse case managers (n=10), clinic managers (n=5), and other healthcare professionals (n=5); six focus groups with family physicians (n=20), and other healthcare professionals (n=8); and field notes by research coordinators. Analysis: Mixed descriptive thematic analysis; intra-case histories; systematic comparison among cases by means of a descriptive and interpretative matrix; investigator and patient partners triangulation. Outcome Measures. Factors influencing the implementation of the CMI in primary care settings. Results. Difficulty of access to patient hospital information is a common barrier to all cases, as well as identification and recruitment of patients with the greatest needs of a CMI. Nurse case managers need extra time in the short term, especially when preparing and conducting the ISP. On the other hand, a culture of patient-centredness and collaboration; managerial and clinical leadership and support; and a positive perception of the CMI alongside provider engagement helps to overcome these barriers. Conclusions. This study may help researchers, decision-makers and clinicians plan the implementation of CMIs in primary care settings for frequent users of healthcare services with chronic diseases and complex care needs.

Context. There is growing evidence supporting patients’ engagement (PE) in primary care research to improve the quality, relevance, and uptake of research. However, guidance is still needed to plan and operationalize this engagement during the research process. Objective. To develop a logic model illustrating empirically the causal links between context, resources, activities, and expected outcomes of PE in an implementation research program in primary care. Study design. Instrumental case study. Setting. A research program (PriCARE) aiming to implement and evaluate a case management intervention (CMI) in primary care clinics across five provinces in Canada. Population studied. Research team members. Methods. Data collection. Participant observation and in-depth interviews (n=22) conducted by two independent research assistants with research team members: principal investigators (n=5); co-investigators (n=2); research coordinators and assistants (n=8); and patient partners (n=7). Analysis. Deductive thematic analysis using components of the logic model as coding categories. All data were coded using NVivo 12 software. Data were reduced and organized in a first logic model version. Team meetings helped to refine the logic model. The final version was validated by all research team members. Results. The logic model provides an empirical illustration of the relationship between context, resources, activities, and expected outcomes for PE. Mobilized resources (human, financial, organizational, and communicational) allow research team members to be involved in many activities related to PE: recruitment, training, and support of patient partners; development of a governance structure; participation in research activities; agreement on decision-making processes; training and support of clinicians; development of tools for patients’ involvement in the CMI. These activities lead to the following benefits for health research: improved communication amongst all team members, results and knowledge translation; development of a PE culture; capacity building; democratization of health research; and for healthcare: improved implementation of the intervention; improved patient engagement in their care; better health outcomes and resource utilization; support of decision-makers and clinicians; and better practices. Conclusions. The logic model may be useful for the planning, operationalization and evaluation of PPE in primary care research programs.

Context: Health researchers are increasingly engaging patients and their families as partners in the research process, from inception to knowledge translation. The trend toward ‘patient-oriented’ research is encouraged by a growing view that studies which integrate the patient perspective will make better use of resources to produce more relevant evidence that can be more easily translated to clinical settings. While there is an emerging literature on best practices, challenges, and learnings related to patient engagement (PE), few studies consider the experiences of patient partners (PP) and researchers in the same project. This presentation will present PP and researcher experiences of PE, highlighting important similarities and differences and proposing recommendations. Objectives: To characterize PE experience from the perspective of researchers and PP working together on the same research program, PriCARE; to identify successes and challenges; to ascertain contributions of PE in health research. Study Design: Qualitative. Setting or Dataset: This study was conducted within the larger 5-province PriCARE study examining a nurse-led case management intervention for primary care patients with complex needs. Population studied: 22 members of the study team (7 PP, 8 coordinators, 2 co-investigators, 5 principal investigators). Methods: Data collection: In-depth interviews using guides co-created by researchers and PP covering topics such as PE-related training and knowledge, and reflections on PE processes and impact. Research assistants external to the PriCARE study conducted interviews, transcribed researcher interviews, and generated a summary of PP interviews. Analysis: Data were analyzed thematically using a coding framework that was co-developed with PP. Outcome Measures: Researcher and patient experiences of PE, PP contributions to health research. Results: All team members need PE training at the beginning of and throughout the research process. Evolving trust and flexibility helped team members to navigate different experiences and priorities. PP make integral contributions to study and instrument design, data analysis, and knowledge translation. Clear expectations about the degree and nature of PE and team members’ roles are critical. Conclusions: Meaningful PE requires patient-researcher partnership and clear expectation setting at the outset and throughout the research process, and ongoing flexibility to adapt.