Best practice and needs for improvement in the chain of care for persons with dementia in Sweden : a qualitative study based on focus group interviews

Background: Persons with dementia receive health care and social services from a wide range of professional care providers during the disease trajectory, presenting risks of miscommunication, duplication and/or missed nursing interventions. Accordingly, the aim of this study was to investigate professional care providers’ views on conditions for best practice in terms of collaboration and improvement needs in the chain of care from early to end-of-life stage for persons with dementia in Sweden. Methods: The study had a qualitative design based on three focus group interviews. A strategic sample of 23 professional care providers was included. Data were subjected to content analysis based on the three stages of dementia (early, moderate, end-of-life). Results: The results were divided into five categories: Diagnosis is a prerequisite for specialized dementia care, Creating routines in the chain of care, Competent staff a prerequisite for high-quality care, Day care facilitates transition in the chain of care and Next-of-kin participation is a prerequisite for continuity in the chain of care. It was clear that, according to the participants, best practice in dementia care in Sweden is not achieved in every respect. It appeared that transitions of care between different organizations are critical events which need to be improved. The further the disease progresses, the less collaboration there seems to be among professional care providers, which is when the next of kin are usually called upon to maintain continuity in the chain of care. Conclusions: The results indicate that, according to the care providers, best practice in terms of collaboration is achieved to a higher degree during the early stage of dementia compared with the moderate and end-of-life stages. Lack of best practice strategies during these stages makes it difficult to meet the needs of persons with dementia and reduce the burden for next of kin. These are experiences to be taken into account to improve the quality of dementia care. Implementation research is needed to develop strategies for best practice on the basis of national knowledge-based guidelines and to apply these strategies in the moderate and end-of-life stages

Interprofessional Collaboration in Swedish health and social care from a care manager’s perspective : [Interprofessionell samverkan i svensk hälso- och sjukvård och social omsorg ur biståndshandläggares perspektiv]

The aim of this study was to study interprofessional collaboration in health and social care for older people and persons with disabilities from a care manager's perspective. The empirical data was collected at a workshop held during a national conference for care managers and through focus group interviews in two Swedish municipalities. The results showed that the care managers collaborated in different ways with many different professionals from different organisations. The care and discharge planning meetings emerged as the most typical situation where care managers collaborated with different health care professionals. Interprofessional collaboration was seen as a means for care managers to fulfil their assignment and carry out their work. The care manager role encompassed role strain, a relatively weak professional identity, and differences in professional status among those involved in interprofessional collaboration.Syftet med studien var att studera interprofessionell samverkan i hälso- och sjukvård och social omsorg för äldre personer och personer med funktionsnedsättningar ur biståndshandläggares perspektiv. Empiriska data samlades in vid en workshop i samband med en nationell konferens för biståndshandläggare samt genom fokusgruppsintervjuer i två kommuner i Sverige. Resultatet visade att biståndshandläggare samverkar på flera varierande sätt och med olika yrkesgrupper från flera organisationer. Vård- och omsorgsplaneringsmöten framträdde som den mest typiska situationen där biståndshandläggare samverkar med andra yrkesgrupper inom vård och omsorg. Interprofessionell samverkan sågs som viktig för att biståndshandläggarna skulle kunna fullfölja sin uppgift och utföra sitt arbete. Biståndshandläggarrollen kännetecknas av motstridiga rollförväntningar och en relativt svag professionell identitet. Skillnader i professionell status bland de involverade påverkade samverkan