Vass Mikkel, Holmberg Rasmus, Fiil-Nielsen Henrik, Lauridsen Jørgen, Avlund Kirsten, Hendriksen Carsten
Department of General Practice and Central Research Unit for General Practice, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark.
Department of Political Science, University of Copenhagen, Copenhagen, Denmark.
Eur J Ageing. 2007 Aug 22;4(3):133-140. doi: 10.1007/s10433-007-0056-2. eCollection 2007 Sep.
The organisational influence on benefits of preventive home visitation programmes for older people has escaped scientific evaluation. This study aims to investigate organisational structures and processes in relation to preventive home visits. As part of a randomised controlled trial investigating whether educational intervention towards municipality health care professionals could enhance active life expectancy, information of municipality leadership, home visit approach, strengths and limitations of communication within the organisation were obtained using individual and focus group interviews. Thirty-four municipalities in four counties participated. Data was systematically condensed using a phenomenological approach upon which general patterns were categorised into a theory-based formal typology of the preventive home visitation management in the municipalities. Three distinct strategies for preventive home visitation programmes were identified. Eighteen municipalities were categorised as "Framework Management", 15 as "Management by Rules" and one as "Project Management". Small municipality size was associated with the "Framework Management" type. "Management by Rules" municipalities had higher population densities and their overall expenses for older people were higher. "Framework Management" municipalities used more resources on preventive home visits, communicated better, experienced less staff changing and had higher social capital than "Management by Rules" municipalities. Municipality structures and management processes of preventive home visitation programmes varied considerably in 34 Danish municipalities, but the majority could be categorised as using either a "Framework Management" or a "Management by Rules" strategy. Each strategy is associated with particular advantages and disadvantages, which may explain differences in the overall benefit of the programme between municipalities.
组织对老年人预防性家访计划效益的影响尚未得到科学评估。本研究旨在调查与预防性家访相关的组织结构和流程。作为一项随机对照试验的一部分，该试验旨在研究对市政医疗保健专业人员的教育干预是否能提高积极预期寿命，通过个人访谈和焦点小组访谈获取了有关市政领导信息、家访方式、组织内部沟通的优势和局限性等内容。四个县的34个市政当局参与了研究。采用现象学方法对数据进行系统归纳，在此基础上，将一般模式归类为基于理论的市政预防性家访管理正式类型学。确定了三种不同的预防性家访计划策略。18个市政当局被归类为“框架管理”，15个为“规则管理”，1个为“项目管理”。市政规模较小与“框架管理”类型相关。“规则管理”的市政当局人口密度较高，其老年人总体支出也较高。与“规则管理”的市政当局相比，“框架管理”的市政当局在预防性家访上使用的资源更多、沟通更好、员工变动更少且社会资本更高。丹麦34个市政当局的预防性家访计划的市政结构和管理流程差异很大，但大多数可归类为采用“框架管理”或“规则管理”策略。每种策略都有其特定的优缺点，这可能解释了各市政当局之间该计划总体效益的差异。
