Department of Social Work, Stockholm University, Stockholm, Sweden.
Health Soc Care Community. 2022 May;30(3):1077-1085. doi: 10.1111/hsc.13311. Epub 2021 Mar 24.
Fragmentation of social service and healthcare services has been given attention in many countries and a variety of strategies and models are used in attempts to remedy the problem. In a parallel development, demands have been made that users/patients should have more influence over their own care, and research has shown that user involvement can support the recovery process. This article focuses on how professionals view user involvement in collaborative efforts in care planning, using the Coordinated Individual Plan (CIP) in Sweden as an example. Since 2009, social service and healthcare agencies are required to draw up CIPs when they are judged to be needed, with the purpose of improving the care process. An additional purpose is to increase users' involvement in their own care. Semi-structured interviews were conducted in 2019 with 20 professionals working within social service and healthcare agencies for people with mental health and/or substance abuse problems in the Stockholm region. Analysis was by qualitative content analysis. Findings show that professionals study experience ambivalence concerning user involvement in care planning. On the one hand, they support the user´s own demands of services and, on the other hand, they correct the user´s demands to fit the range of services and organisation of care. The user/patient's position is expressed as vulnerable, caught between caregivers who often safeguard their organisational duties and economical restrictions. These findings reflect the conflict predicted by Lipsky's theory of street-level bureaucracy. Professionals are expected to act as advocates for the user/patient, while at the same time exercising a controlling and gatekeeping function. The question is raised whether a model such as CIP provides sufficiently for factors which can counterbalance the power of the professionals relative to the user/patient in care planning.
社会服务和医疗保健服务的碎片化问题已经引起了许多国家的关注，并且已经尝试使用各种策略和模式来解决这个问题。与此同时，人们也要求患者/用户对自己的护理有更多的影响力，并且研究表明患者参与可以支持康复过程。本文以瑞典协调个人计划（CIP）为例，重点关注专业人员如何看待患者在护理计划中的协作努力中的参与。自 2009 年以来，当社会服务和医疗保健机构被认为需要时，就必须制定 CIP，目的是改善护理过程。另一个目的是增加用户对自己护理的参与度。2019 年，对斯德哥尔摩地区从事心理健康和/或药物滥用问题的社会服务和医疗保健机构的 20 名专业人员进行了半结构化访谈。分析采用定性内容分析。研究结果表明，专业人员对患者参与护理计划的经验表现出矛盾心理。一方面，他们支持用户对服务的自身需求，另一方面，他们纠正用户的需求，以适应服务范围和护理组织。用户/患者的立场被表达为脆弱的，夹在经常维护其组织职责和经济限制的护理人员之间。这些发现反映了 Lipsky 的街头官僚理论所预测的冲突。专业人员应该充当患者的倡导者，同时行使控制和把关职能。问题是，CIP 等模式是否为平衡护理计划中专业人员相对于患者的权力的因素提供了足够的支持。
