Background. Management of frequent users of the emergency department (= FUED) defined as coming ≥5 times/year to the emergency department, is a known challenge. Studies show that case management (CM) improves FUEDs’ quality of life while reducing their number of ED visits and associated costs. However, little is known about FUEDs’ own perspectives on CM: its usefulness, its perceived impact on their lives and on their healthcare management, the perceived disadvantages, the modifications, and improvement to make.
Method. This qualitative study was part of a larger study aiming to implement CM for FUED in French-speaking Switzerland. Participants were FUEDs included in the parent study, who had either completed the CM or were still enrolled. Semi-structured qualitative interviews were conducted with 20 participants (75% female; mean age=40.55, SD=12.84), randomly drawn from the parent study sample. Content analysis was performed by two researchers to assess participants’ opinion and experiences.
Results. Most participants endorsed a positive opinion about CM. Two main differences with usual care were reported by the participants: CM’s holistic approach and the quality of the relationship with the case manager (cm). The participants perceived the relationship with the cm as a mechanism enabling the CM’s outcomes. They identified three outcomes: increase in motivation (e.g., in day-to-day life or health-related motivation), improvement of the relationship with the healthcare system, and improvement of their health literacy (e.g., symptoms understanding, orientation in the healthcare system). A few participants identified some negative consequences (e.g., fear of coming back to the ED) and lack of concrete outcome as the main negative aspects. Finally, participants identified some barriers to CM: cm’s lack of time, the COVID-19 negative influence on CM’s organization and the uncertainty around CM.
Conclusions. FUED perceived the program as useful and considered the relationship with the cm as key for positive outcomes. Our findings also identified barriers to CM and ways to reduce them. As for clinical implications, our results highlight way to reduce barriers to CM by (1) adopting a non-judgmental attitude towards FUED, (2) providing clear information about CM, (3) allowing more time to cm to take care of FUED.