Steihaug Sissel, Lippestad Jan-W, Werner Anne
a SINTEF Technology and Society , Department of Health Research , Blindern , Oslo , Norway ;
b Health Services Research Unit , Akershus University Hospital , Lørenskog , Norway.
Scand J Prim Health Care. 2016;34(1):46-54. doi: 10.3109/02813432.2015.1132888. Epub 2016 Feb 1.
The growing elderly population and the rising number of people with chronic diseases indicate an increasing need for rehabilitation. Norwegian municipalities are required by law to offer rehabilitation. The aim of this study was to investigate how rehabilitation work is perceived and carried out by first-line service providers compared with the guidelines issued by Norway's health authorities.
In this action research project, qualitative data were collected through 24 individual interviews and seven group interviews with employees--service providers and managers--in the home-based service of two boroughs in Oslo, Norway. The data were analysed using a systematic text-condensation method.
The results show that rehabilitation receives little attention in the boroughs and that patients are seldom rehabilitated at home. There is disagreement among professional staff as to what rehabilitation is and should be. The purchaser-provider organization, high speed of service delivery, and scarcity of resources are reported to hamper rehabilitation work.
A discrepancy exists between the high level of ambitious goals of Norwegian health authorities and the possibilities that practitioners have to achieve them. This situation results in healthcare staff being squeezed by the increasing expectations and demands of the population and the promises and statutory rights coming from politicians and administrators. For the employees in the municipalities to place rehabilitation on the agenda, it is a requirement that authorities understand the clinical aspect of rehabilitation and provide the municipalities with adequate framework conditions for successful rehabilitation work.
Home-based rehabilitation is documented to be effective, and access to rehabilitation has been established in Norwegian law. The purchaser-provider organization, high rate of speed, and a scarcity of resources in home-based services hamper rehabilitation work. Healthcare providers find themselves squeezed between the health authorities' overarching guidelines and requirements and the possibilities of achieving them. Rehabilitation must be placed on the agenda on the condition that authorities understand the clinical aspect of rehabilitation.
老年人口不断增长以及慢性病患者数量不断上升，这表明对康复服务的需求日益增加。挪威法律要求市政当局提供康复服务。本研究的目的是调查一线服务提供者对康复工作的看法以及与挪威卫生当局发布的指南相比康复工作的开展情况。
在这个行动研究项目中，通过对挪威奥斯陆两个行政区居家服务的员工（服务提供者和管理人员）进行24次个人访谈和7次小组访谈收集了定性数据。使用系统的文本浓缩方法对数据进行了分析。
结果表明，康复在行政区内很少受到关注，患者很少在家中接受康复治疗。专业人员对于康复是什么以及应该是什么存在分歧。据报告，购买方 - 提供方组织、服务提供的高速度以及资源稀缺阻碍了康复工作。
挪威卫生当局的宏伟目标水平与从业者实现这些目标的可能性之间存在差异。这种情况导致医护人员受到民众日益增长的期望和需求以及政治家和管理人员的承诺和法定权利的挤压。为了让市政当局的员工将康复提上议程，当局需要了解康复的临床方面，并为市政当局提供成功开展康复工作的适当框架条件。
居家康复已被证明是有效的，并且挪威法律已规定可获得康复服务。购买方 - 提供方组织、高速度以及居家服务资源稀缺阻碍了康复工作。医疗服务提供者发现自己处于卫生当局的总体指导方针和要求与实现这些要求的可能性之间的夹缝中。只有当局了解康复的临床方面，康复才必须被提上议程。
