Harris Ulrika, Andersson Anna, Plessen Veronica, Hjelm Markus
Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden.
Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.
BMC Health Serv Res. 2025 Apr 23;25(1):583. doi: 10.1186/s12913-025-12770-1.
Multimorbidity is increasing globally, affecting over one-third of the population. Adults with complex needs often experience physical, mental, and cognitive disorders, leading to increased healthcare utilization, reduced quality of life, and social challenges. The frequent co-occurrence of psychiatric conditions, substance abuse, addiction, and homelessness highlights the complexity of these needs. Collaboration between healthcare and social services is essential for delivering integrated care but is often hindered by legislative constraints and difficulties in coordinating care. Although integrated care has been shown to improve outcomes, persistent challenges affect staff in their daily work with adults with complex needs. Therefore, the aim was to describe health and social care staff's experiences working with adults with complex needs, with a focus on what promotes or hinders collaboration and the individual's participation.
This study employed a descriptive qualitative design. Data were collected through four focus group interviews with 17 health and social care staff members and analyzed using qualitative content analysis.
Data analysis resulted in three generic categories: (i) collaboration between authorities is complex, (ii) challenges working according to the person's needs, and (iii) participation under difficult conditions.
This study highlights both challenges and facilitators in working with adults with complex needs. Collaboration was hindered by legislative, financial, and organizational disparities but facilitated by interprofessional forums and collaborative meetings. Establishing trusting relationships free from bureaucratic constraints was important for providing person-centered care. However, fostering meaningful participation remains challenging because of the individual's limited capacity to engage and the complexities that staff face in balancing respect for autonomy with acting in the person's best interest. Further research incorporating perspectives from adults with complex needs, their relatives, and management could enhance the understanding of how collaboration, participation, and organizational barriers impact the provision of integrated healthcare and social services.
全球范围内多重疾病的发生率正在上升，影响着超过三分之一的人口。有复杂需求的成年人经常经历身体、心理和认知障碍，导致医疗保健利用率增加、生活质量下降以及社会挑战。精神疾病、药物滥用、成瘾和无家可归等情况频繁同时出现，凸显了这些需求的复杂性。医疗保健与社会服务之间的协作对于提供综合护理至关重要，但往往受到立法限制和协调护理方面的困难所阻碍。尽管综合护理已被证明能改善结果，但持续存在的挑战影响着工作人员在为有复杂需求的成年人提供日常护理工作中的表现。因此，本研究的目的是描述卫生和社会护理工作人员与有复杂需求的成年人合作的经历，重点关注促进或阻碍协作以及个人参与的因素。
本研究采用描述性定性设计。通过对17名卫生和社会护理工作人员进行四次焦点小组访谈收集数据，并使用定性内容分析法进行分析。
数据分析得出三个一般类别：（i）当局之间的协作复杂，（ii）根据个人需求开展工作面临挑战，（iii）在困难条件下的参与。
本研究凸显了与有复杂需求的成年人合作时面临的挑战和促进因素。立法、财务和组织方面的差异阻碍了协作，但跨专业论坛和协作会议促进了协作。建立不受官僚限制的信任关系对于提供以患者为中心的护理很重要。然而，由于个人参与能力有限以及工作人员在平衡尊重自主权与为个人利益行事时面临的复杂性，促进有意义的参与仍然具有挑战性。纳入有复杂需求的成年人、他们的亲属以及管理层的观点的进一步研究，可能会增进对协作、参与和组织障碍如何影响综合医疗保健和社会服务提供的理解。
