Health and social care professionals’ work to achieve coherent rehabilitation pathways for people with Inflammatory Arthritis: a qualitative interview and observational study

Background:
20-40% of people with inflammatory arthritis (IA) do not tolerate or do not have sufficient effect of their medication and experience substantial impact of their disease. They need rehabilitation to develop or restore functioning and become able to live an independent and meaningful life (1). Rehabilitation and the organisation of health and social care services are characterised by a high degree of complexity and many different professionals working across different departments, primary and secondary sectors.
Objectives:
To investigate how health and social care professionals across different departments, levels and sectors work to achieve coherent rehabilitation pathways for people with IA
Methods:
In total, 26 professionals across primary and secondary health and social care participated in semi-structured interviews. These professionals were all pointed out by people with IA because they had made a significant difference to achieve coherent rehabilitation pathways for them. In addition, participant observations and informal interviews with the healthcare professionals were conducted during the rehabilitation stay. Formula stories (2) and institutional ethnography (3) guided the interpretation of data. In the findings, the term people is changed to users to underline their interactions with the professionals.
Results:
The analysis derived three themes:
1) Interactions with users: the professional's interactions with users were predominantly characterized by the ideal of focusing on the individual human being with respect for individual’s norms, values and wishes. However, this ideal was challenged when their professional knowledge contradicted the user's norms, values and wishes.
2) Dependent interactions between professionals: expresses dependency of collaboration between professionals both internally within the same department or organization but also across organizations and sectors. Dependency on information about the user to carry out examinations, deliver care or treatment or dependency on referrals to legitimize the efforts the professionals considered necessary for the user.
3) The significance of organisation within institutional frameworks for the professionals’ work: the professionals experienced that they were not always able to meet the users demand for care due to organizational requirements for efficiency, economic cost reductions and documentation. These issues led to lack of time to prepare, implement, and follow up on communication with users and other professional partners.
Conclusion:
The professionals want to meet the individual with a person-centred approach but sometimes they find it difficult to combine this with their own professional knowledge and values. The professionals are dependent on collaboration with other professionals across departments and sectors. This study shows that the institutional and organizational framework can hinder rather than promote the professionals' intentions to create coherent rehabilitation.

References:
1. Hjortbak BR et al. Udfordringer til rehabilitering i Danmark [Challenges in rehabilitation in Denmark]. 2011.
2. Loseke DR. The Empirical Analysis of Formula Stories. In: Holstein J, et al (ed): Varieties of Narrative Analysis. SAGE; 2012.
3. Smith DE. Institutional ethnography. AltaMira Press; 2005.