Norwegian Centre of Electronic Health Records (NSEP), Faculty of Medicine, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter [Research Centre of Medical Technology], NO-7489 Trondheim, Norway.
Int J Integr Care. 2011 Jan;11:e001. doi: 10.5334/ijic.530. Epub 2011 Jan 26.
A mandatory multidisciplinary plan for individual care, the 'Individual care Plan', was introduced by law in Norway in 2001. The regulation was established to meet the need for improved efficiency and quality of health and social services, and to increase patient involvement. The plan was intended for patients with long-term and complex needs for coordinated care. The aim of this study was to elaborate on knowledge of such planning processes in Norwegian municipalities.
A piloted questionnaire was sent to 92 randomly selected municipalities in 2005-2006, addressing local organization and participation in the work with individual care plans. Local political governance, size of the population, funds available for health care, and problems related to living conditions were indicators for analysing the extent to which the individual care plan was used five years after the regulation was introduced.
Our results showed that 0.5% as opposed to an expected 3% of the population had an individual care plan. This was independent of the political, social and financial situation in the municipalities or the way the planning process had been carried out. The planning process was mostly taken care of by local health and social care professionals, rather than by hospital staff and general practitioners.
The low number of care plans and the oblique responsibility among professionals for planning showed that the objectives of the national initiative had not been achieved. More research is needed to determine the reasons for this lack of success and to contribute to solutions for improved multidisciplinary cooperation.
2001 年，挪威通过法律规定了强制性的多学科个体化护理计划，即“个体化护理计划”。该法规的制定是为了满足提高卫生和社会服务效率和质量以及增加患者参与度的需求。该计划旨在为那些需要协调护理的长期、复杂的患者提供服务。本研究旨在详细阐述挪威市在个体化护理计划方面的知识。
2005-2006 年，我们向 92 个随机选定的市发送了一份试点问卷，内容涉及地方组织和参与个体化护理计划的工作。地方政治治理、人口规模、医疗保健资金以及与生活条件相关的问题，是分析该计划在引入法规五年后使用程度的指标。
我们的结果表明，0.5%的人口拥有个体化护理计划，而预期的比例为 3%。这与市的政治、社会和财务状况或规划过程的进行方式无关。规划过程主要由当地的卫生和社会保健专业人员负责，而不是由医院工作人员和全科医生负责。
护理计划的数量较少，专业人员对规划的责任不明确，表明国家倡议的目标没有实现。需要进一步研究以确定这种缺乏成功的原因，并为改进多学科合作提供解决方案。
