Ekenes Maren, Wehling Eike, Oldeide Olin
Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.
Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
Health Serv Insights. 2024 Oct 20;17:11786329241293347. doi: 10.1177/11786329241293347. eCollection 2024.
The transition of patients with complex needs from hospital to municipal rehabilitation following moderate and severe brain injury is challenging. This qualitative study explored the municipal service allocation processes within such transitions. The caseworkers' comprehensive task of combining patients' preferences and needs, healthcare providers' recommendations and municipal guidelines and service allocation were analysed. Data comprised of patients' health records, meeting observations and semi-structured interviews with municipal staff, patients and next of kin. Results demonstrated that the issue of most concern was the location of where the patient was to continue municipal rehabilitation. Municipal caseworkers gathered extensive information, including recommendations from healthcare providers and preferences of patients and next of kin. These were frequently in contrast to the municipal guidelines' requirements and the services' organisational structure. The discrepancies led to tension, which was difficult to manoeuvre. This study indicates that incorporating individually tailored services into the daily service allocation practice can be demanding and even dilemmatic. The designated focus on the transition of patients with complex rehabilitation needs gives insights into how service allocation, user involvement and coordination policies are acted out in practice and may directly influence rehabilitation trajectories.
中度和重度脑损伤后，有复杂需求的患者从医院向市政康复机构过渡具有挑战性。这项定性研究探讨了此类过渡过程中的市政服务分配流程。分析了个案工作者在结合患者偏好与需求、医疗服务提供者建议以及市政指南和服务分配方面的综合任务。数据包括患者的健康记录、会议观察以及对市政工作人员、患者及其近亲的半结构化访谈。结果表明，最受关注的问题是患者继续接受市政康复的地点。市政个案工作者收集了广泛的信息，包括医疗服务提供者的建议以及患者及其近亲 的偏好。这些信息常常与市政指南的要求和服务的组织结构相悖。这些差异导致了紧张局面，难以应对。本研究表明，将个性化定制服务纳入日常服务分配实践可能具有挑战性，甚至会造成两难局面。对有复杂康复需求患者过渡的指定关注，揭示了服务分配以及用户参与和协调政策在实践中的实施方式，并可能直接影响康复轨迹。
