ABSTRACT

Specialisation in care and welfare services often leads to inflexible boundaries between organisations and professions, resulting in fragmented and ineffective care, not least in the areas of severe mental illness and substance abuse. Collaborative models such as case management, multidisciplinary teams and coordinated care plans are used in many countries to address this problem. In a parallel development, demands have been made that individual users/patients should have more influence over their own care. In Sweden, legislation requires the social service and health care to draw up Coordinated Individual Plans (CIP) to clarify responsibility, improve the care process and increase users’ involvement in their own care. This article explores the impact of coordinated care plans, using the Swedish CIP as an example. What can we learn about conditions for integrated care according to the degree of collaboration, involvement for the individual user and supporting structures? The authors have studied 25 case files in a local authority. Findings indicate a low to moderate degree of collaboration and few indications of meaningful user involvement. Further studies are needed concerning factors hindering CIP from achieving a higher degree of collaboration and fully including the intentions and wishes of the individual.

摘要

护理和福利服务的专业化往往导致组织和专业之间的界限不灵活，导致护理分散和无效，尤其是在严重的精神疾病和药物滥用领域。许多国家使用案例管理、多学科团队和协调护理计划等协作模式来解决这个问题。在平行发展中，已经提出了个人用户/患者应该对他们自己的护理产生更大影响的要求。在瑞典，立法要求社会服务和医疗保健部门制定协调个人计划 (CIP)，以明确责任、改进护理流程并增加用户对自身护理的参与。本文以瑞典 CIP 为例探讨协调护理计划的影响。根据协作程度、个人用户的参与和支持结构，我们可以了解综合护理的条件吗？作者研究了地方当局的 25 个案例档案。调查结果表明协作程度从低到中，很少有迹象表明有意义的用户参与。需要进一步研究阻碍 CIP 实现更高程度合作的因素，并充分考虑个人的意图和愿望。