Prioriteringar i vårdflöden för äldre: en förstudie

Background

This report is the result of a limited project with the aim of examining priority setting in care for the elderly in which multiple care providers are involved. The main issues dealt with the kind of prioritizing that is done daily and the motivations or considerations that the priorities are based on. The health care services provided to the elderly are based on an organization’s or society’s motivations and values but can also be based on the individual care provider’s own comprehension. Before the relevance of selected services can be assessed we need insight into how priorities are set and on which values they are based, in other words, the priority setting process requires transparency. This pilot study is an attempt to penetrate the priority setting process and thereby function as a point of departure for continued studies of how elderly care can be provided –based on elderly people’s experience and wishes.

Aim

The aim of this pilot study is to obtain knowledge of what characterizes an elderly person’s path through the flow of care services, which decisions are made and on what grounds. Based on these questions, new areas are identified that require in-depth study and analysis in order to develop issues and methodologies for coming projects dealing with priority setting in the flow of care for the elderly from the user perspective.

Method

A strategic selection of eleven people, employed in both municipal and county council elderly care have been interviewed with the aid of hypothetical case descriptions. The interviews have been supplemented with questions such as if their own organization has any policy documents, guidelines or informal regulations (known by everyone but not in writing) for care and treatment of particular health conditions. Existing policy documents/guidelines have been collected and comprise part of the empirical material for the pilot study. Each interview has been analyzed using the method content analysis.

Results

The study showed that the priority setting described was seldom about choices between patient categories. Instead choices were described as being made between different forms of health care and between different rehabilitation efforts. The choices that were most often described were if the patient should be offered hospital care or care at home and if the patient should be offered rehabilitation in the form of training or rehabilitation, primarily, in the form of aids. The analysis showed that the decision was based on considerations related to the patient, personnel and/or the organization. In a normal case, the decision was based on a combination of these considerations. The pilot study provides a complex picture of the considerations personnel based their prioritizing on. One finding is that decisions on care and rehabilitation are not only based on factors related to the individual patient but also on factors related to personnel and the organization where the decision is made. The report recommends a general discussion about priority setting among personnel who work with elderly persons by examining how to apply the human dignity principle when, e.g. the elderly person’s social network is considered as a factor when prioritizing between training or not. The report recommends a discussion on the choice of gauge for assessing the effect of different treatments.