Published: 2018-08-24
ISBN: 978-91-7685-213-2
ISSN: 1650-3686 (print), 1650-3740 (online)
The Danish healthcare system has transformed toward shorter hospital stays and increased dependency on primary care in municipalities. General practitioners (GPs) are key to preventing the (re)admission of elderly patients to the hospital, but visits to elderly, bedridden patients are not always compatible with GPs’ office hours. This paper presents and discuss experiments with video in intermediate care paths for the elderly. The first experiment presents an ethical design guideline and playbook for cross-sectorial collaboration between a GP, home nurse and patient with video. The second experiment tries out video consultations with GPs in patient care paths. An ideographic, in-depth analysis of the communication and interaction between a 72-year-old male patient at a rehabilitation unit, his GP and municipality nurse give insights into clinical, organizational and technical aspects of video-mediated health care services. The analysis is reflected and discussed from a systemic perspective: At the micro-level, patient empowerment and safety in the patient care path from the video consultation are possible but cognitively demanding and risky for the role of the GP and the nurse. At the meso-level, interdisciplinary collaboration between the GP and the nurse depends on clarification of user roles, tasks and training in order for video to be efficient and safe. At the macro-level, the development of a cross-sectorial learning strategy, as well as a more thorough analysis of the kind of medical attention needed, is helpful for dividing tasks and responsibilities in intermediate care paths.
Video, Intermediate Care, Integrated Care, GP, Collaboration, User Involvement.
[1] DSR Analyse, NOTAT Flere korttidsindlæggelser blandt ældre patienter. January 2016 https://dsr.dk/sites/default/files/50/notat_flere_korttidsindlaeggelser_blandt_aeldre_patienter.pdf
[2] Defactum: Evaluering af fem indsatser i Region Midtjylland for den ældre medicinske patient. Region Midtjylland, Aarhus. Oktober 2016 http://www.defactum.dk/publikationer/ShowPublicationsAlphabetical?pageId=309986
[3] Vinge S, Buch MS, Kjellberg J, Kjellberg PK, Rasmussen SR, Wiuff MB, Forebyggelse af indlæggelser Oversigtsnotat om metoder, koncepter, evalueringer og effekter. DSI 2011 https://www.kora.dk/media/272122/dsi-3511.pdf
[4] Wiuff MB, Hansen EB, Kristensen TA, Madsen MH, Opfølgende hjemmebesøg i Region Hovedstaden. Kora 2017
[5] Hjertholm P, Clinical Activity in General Practice and Cancer. PhD dissertation, Faculty of Health Aarhus University 2015
[6] Purdy S, Avoiding hospital admissions. What does the research evidence say? King’s Fund, 2010
[7] D’Souza S, Guptha S, Preventing admission of older people to hospital. BMJ 2013;346: f3186. doi: 10.1136/bmj. f3186.
[8] Audit Commission, More for less: are productivity and efficiency improving in the NHS? 2009
[9] Udviklingens døgn, Aarhus Kommune, Region Midtjylland praksis. Udvalgte projekter, bilag 2, 2011, Aarhus Kommune, Aarhus
[10] National handlingsplan, Styrket indsats for den ældre medicinske patient. Regeringen 2016, http://www.sum.dk/~/media/Filer%20-%20Publikationer_i_pdf/2016/Styrket-indsats-for-denaeldre-medicinske-patient/National_Handlingsplan.pdf
[11] Nationale Strategi for telemedicine i Danmark 2012-2015. NSI Sundhedsstyrelsen 2011
[12] Strategien for digital sundhed 2018-2020. Sundheds- og Ældreministeriet, Finansministeriet og Danske Regioner, January 2018
[13] Wentzer, HS Opfølgende hjemmebesøg med video. Kora 2013
[14] Wentzer, HS Koordinering af teamsamarbejde i opfølgende hjemmebesøg med video – et eksperiment til innovation af tværsektorielle patientforløb. In: Sammenhænge i sundhedskommunikation. S Frimanm, M B. Sørensen & HS Wentzer, Aalborg Universitets Forlag, Aalborg 2015: 83-130
[15] Mol A, The Body Multiple: Ontology in Medical Practice. Duke University Press 2002
[16] Olesen F, Kroustrup J, AN T– Beskrivelsen af heterogene aktør-netværk. In: Introduktion til STS; Science, Technology, Society. Ed. CB Jensen et al. 2007: 63-91
[17] Kvale S, Interview. Introduktion til det kvalitative forskningsinterview. Hans Reitzels Forlag 1994
[18] Kushniruk A, Borycki E, Low-cost rapid usability engineering. Healthcare Quarterly 2006; 9(4): 98-100.
[19] Ricoeur P, Hermeneutics and the Human Sciences: Essays on Language, Action and Interpretation. Cambridge University Press 1981
[20] Ihde D, Expanding Hermeneutics – Visualism in Sciences. Northwestern University Press 1998
[21] Mattingly C, Moral selves and moral scenes: narrative experiments in everyday life. Ethos, International Journal of Anthropology 2012:301-327
[22] www.datatilsynet.dk
[23] Regionernes lønnings- og takstnævn, september 2017: Aftale om almen praksis. Danske Regioner, København, 2017
[24] Gadamer HG, The Enigma of Health. Stanford University Press 1996
[25] Kjeldsen SB, Ingen indikation for genoplivning. Sygeplejersken 2014;3:20-23. https://dsr.dk/sygeplejersken/arkiv/sy-nr-2014-3/ingenindikation-for-genoplivning
[26] Sundhedsstyrelsen, Vejledning om fravalg af livsforlængende behandling, herunder genoplivningsforsøg, January 2014
[27] Weatherall CD, Lauritzen HH, Hansen AT, Termansen T, Evaluering af fast tilknyttede lægeordning på plejecenter. SFI, https://www.sst.dk/da/udgivelser/2014/~/media/DDDFF580A76642FE8D95044073B39407.ashx (Access01032018)
