Qualitative realist evaluation identifies 12 case-management configurations in Canadian primary care

A qualitative realist evaluation of an integrated primary care case-management program identified 12 context-mechanism-outcome configurations associated with how the program worked for individuals with complex needs. The study examined mechanisms including trust between case managers and patients, accountability, integration with interdisciplinary teams, interprofessional collaboration, patient empowerment and family inclusion. Its abstract also reports two demi-regularities: engagement and greater control over health through trusting case-manager relationships, and stronger teamwork and care delivery through providers’ commitment to the program.

Researchers developed an initial program theory to guide data collection and analysis. They conducted 24 individual interviews and three focus groups between February 2022 and May 2023 with case managers, patients, clinic managers and providers from seven participating primary care clinics in New Brunswick, Nova Scotia, Newfoundland and Labrador, and Quebec, Canada. The analysis focused on identifying context-mechanism-outcome configurations and recurring patterns known as demi-regularities.

The reported mechanisms included case managers building mutual trust with individuals, feeling accountable and integrating into interdisciplinary teams. Clinic teams collaborated and valued interprofessional work, while participating individuals reported feeling supported, informed about their health status and empowered. Families also reported feeling supported, respected and included. The demi-regularities linked individuals’ engagement in care and increased control over their health with trusting relationships with case managers, while providers’ commitment to and engagement with the program were associated with enhanced teamwork and care delivery.

The findings are based on qualitative evidence from participants at seven clinics in four Canadian provinces and describe the mechanisms and implementation patterns identified in the analysis; they do not quantify changes in health outcomes, healthcare use, costs or workload. The supplied abstract does not report controlled comparisons or other results that would establish causal effects. The authors’ conclusions emphasize trust-building, empowerment, interprofessional collaboration and supportive organizational and policy environments for implementing case management. This report is based on the published abstract and associated metadata, rather than an independent assessment of the complete article.

Subject of Research: Realist evaluation of integrated primary care case management for individuals with complex needs

Article Title: A realist evaluation of an integrated care program in primary care for individuals with complex needs

Article References: Lambert, M., Chouinard, M.-C., Lemay-Compagnat, A., Howse, D., Schwarz, C., Bisson, M., Aubrey-Bassler, K., Doucet, S., Ramsden, V. R., Zed, J., Luke, A., Rubenstein, D., Taylor, J., Wilhelm, L., & Hudon, C. (2026). A realist evaluation of an integrated care program in primary care for individuals with complex needs. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15700-x

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15700-x

Keywords: case management, integrated care, primary care, complex needs, realist evaluation, qualitative research, patient empowerment, interprofessional collaboration, trust building, Canada, realist, evaluation