PONE-D-21-11296

Case management programs for people with complex needs: towards better engagement of community pharmacies and community-based organisations.

PLOS ONE

Dear Dr. Chouinard,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Chaisiri Angkurawaranon

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: No

Reviewer #3: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for the opportunity to review this paper that reports on interviews and focus groups to explore the roles of community pharmacies and community-based organisations in the case management of patients with complex needs. This topic is relevant to an international audience considering the growing numbers of people with multiple co-morbidities and complex needs. The actual systems that are in place in various countries will differ, especially in terms of funding models, however the overall involvement of pharmacies and community support organisations would be relevant internationally.

General feedback

The manuscript is well written and flows well. My main comments relate to the need to incorporate more details in the methods section and the reason for the chosen methodology used for the analysis.

Introduction

The paragraph starting line 99 mentions the lack of knowledge about CBOs. There is literature showing lack of understanding of the role and scope of community pharmacies from consumers as well as health professionals that could be included here.

Minor:

Line 52: delete comma after episodic.

Line 91: this sentence does not read well. Should this be: … complex care needs such as those needing CMPs.?

Material and methods

The authors used descriptive qualitative design and include two references although both > 10 yrs (2000 and 2009). Why was this methodology followed? Reading the manuscript the process followed seemed to be similar to framework analysis. Could the authors add a statement on the chosen methodology?

Why do both focus groups and interviews? An explanation as to the reasoning behind using both would be useful.

Table 1 provides demographic details of patients however there is no details of the health professionals and managers in terms of years of practice experience and working in their various roles.

Minor: write out numbers <10

Results

More details are needed:

• When were the focus groups and interviews conducted?

• Who conducted the interviews and who facilitated the focus groups? Did the researcher have the appropriate skills?

• How long were interviews and focus groups (mean/median, min max)

• Were all interviews face-to-face?

• How was the interview tool developed and validated (face and content validation)?

Considering the number of interviews and focus groups conducted, I wanted to see more quotes to support the interpretation. I assume the interviews would have provided a wealth of data however only a few quotes are included to support the interpretation.

Discussion

The last sentence of the first paragraph: is there a gap between CBOs and community pharmacies or rather between these stakeholders and CMPs?

Reviewer #2: The aims of this studied were 1) to describe how case management programs engaged community pharmacies and community-based organisations in a perspective of integrated care for people with complex needs, and 2) to identify enablers, barriers and potential strategies for this engagement. However, there are no evidences derived from the scientific and statistical analyze in this study. The information of participants’ characteristics is lacking (e.g. comorbidity, reason for visiting to the emergency department or hospitalizations, drug history). What types of disease improved by using this program?

In addition, the authors should show the evidence of improving patients’ outcome. Did the number of hospitalization reduce by this program? How about the number of visiting to the emergency department? The study design is not sufficient to sustain the claims of the authors.

Reviewer #3: Summary of the research: This manuscript was a qualitative study examining how case management programs can better bridge/engage CBOs and community pharmacies to the health care system. The Taxonomy of Integrated Care was used to analyze the results. The results illustrate how different stakeholders view CMPs, CBOs, community pharmacies, etc., as well as the various components and stakeholders involved. Upon first read, I had a very difficult time following this paper and how the objective, conceptual model, methods, and results all tied together. Therefore, I would recommend substantial revisions to help enhance the clarity of this work.

Major issues:

1. In the introduction, with so many different players (CBOs, CMPs, community pharmacies, hospitals, clinics) that is was difficult to keep track of how they all tied together. It may help clarify this if there could be a figure of some sort. For example, CBOs and community pharmacies on one side, other stakeholder on the other, and CMPs forming a bridge between the two. Or CMPs serving as some type of umbrella. As it is now, it was not immediately apparent how all these pieces function in an ideal setting.

2. I was unfamiliar with the conceptual model. I think it could benefit from a sentence or two describing why that model was selected and how the model was developed. I think most readers will also be unfamiliar with the Rainbow Model of Integrated Care, so that requires a brief explanation. I also wonder if it would be more clearly described in a table where one column has the care processes and the second column has a description. This would make it easier to read and follow.

3. Why were both interview and focus groups carried out? This should be justified for the reader. Also, focus group size varied widely, what was the rationale for determining focus group size? Were focus group best practices followed? I think far more description of the methods is needed such as how participants were identified, how they were solicited to participate, their previous experience with CMPs, etc.

4. Analysis: I thought this work was guided by the Taxonomy for Integrated Care? Please clarify. I also think that more detail of the data analysis is needed. For example, can you describe in more detail what happened in each of the three stages? In addition, what is meant by cross-validation? Was there interrater reliability? Peer review? Member checking? I think more description is needed of how validity was maximized.

5. I found the results quite hard to follow. It may be better here to describe what each integration component means and how it appeared in the results of this study. Currently, the reader has to scroll between the conceptual model section and the results section to understand what each heading means. I also think it would benefit from more description (in other words, if all the quotes were removed, I think there should be adequate descriptions of each theme so that the reader understands how they presented in the results)

6. In the limitations, if participants had varying exposure to CMPs, it may have been helpful to organize the focus groups according to their exposure. For example, put all of those with high exposure in to the same groups and all of those with low exposure into the same groups. Since the authors state in the limitations that the Rainbow Model is difficult to use, there needs to be more justification for why it was selected.

7. It is difficult to understand how the results link to the objectives. It may be better to frame the results in terms of engagement strategies, engagement barriers, and engagement enablers to better answer the objective than group the results using the Rainbow Model. Alternatively, these engagement pieces can more clearly be described within each Rainbow Model component.

8. The objectives seem somewhat distinct. For example, at first why patients and physicians were being interviewed as they don't seem to be needed to address the first objective. Therefore, if the intent is to answer objective one, then it may be necessary to exclude data from patients, nurses, physicians.

Minor issues:

1. In the introduction, I would define CMPs similar to how you define integrated care

2. I would suggest consulting with a pharmacist on how to describe community pharmacy services as I am not sure what is meant by "file analysis"

3. There were a lot of acronyms making it hard to keep track of what they stood for. I would suggest writing more of them out.

4. What is a "descriptive qualitative design"? I would suggest describing this to the reader

5. p. 9 line 168 – what stakeholders were typically involved in the meeting?

6. I think including an interview guide would be helpful as the broad interview topics that are provided in the appendix to not give much insight on what was discussed.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Case management programs for people with complex needs: towards better engagement of community pharmacies and community-based organisations.

PONE-D-21-11296R1

Dear Dr. Chouinard,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Chaisiri Angkurawaranon

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: Thank you for your careful review of feedback and addressing all of the provided comments. No further edits are needed in my opinion

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No