Organisational and Professional Integration Between Specialist and Primary Healthcare Services: A Municipal Perspective.

Mona Jerndahl Fineide,Erna Haug,Catharina Bjørkquist

doi:10.5334/ijic.5606

Mona Jerndahl Fineide, Erna Haug + Show 1 more

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https://doi.org/10.5334/ijic.5606

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Abstract

Introduction:Care transitions between specialist and primary healthcare services for people with concurrent substance abuse and mental health problems are characterised by vulnerability and arbitrariness.Objectives:By studying factors that influence integration in a Norwegian context, this study aims to investigate, from a municipal perspective, why care transitions are still tricky after the introduction of the key Coordination Reform.Methods:This study has an explorative approach based on interviews with managers and front-line professionals in primary care. We applied the conceptual framework of functional and normative integration of the Rainbow Model.Results:The municipal actors emphasise that integration is hampered by limited cooperation with general practitioners in referrals to hospital, challenges of communication and loss of meeting points. They experienced close cooperation with sociomedical polyclinics for substance abuse, while challenges in cooperation with district psychiatric centres indicated an interdependence of functional and normative integration. Questioning hospital discharge of patients to primary care was a recurring theme for the municipal actors. Thus, the governing framework of the Coordination Reform has coexisted with fragmentation in organisational structures and divided professional cultures.Conclusions:The coexistence of the new and the old regimes seems to hamper functional and normative integration in care transitions.

Highlights

Care transitions between specialist and primary healthcare services for people with concurrent substance abuse and mental health problems are characterised by vulnerability and arbitrariness
FUNCTIONAL AND NORMATIVE INTEGRATION This study aims to investigate why care transitions continue to be challenging in spite of the new regime
The research design of this case study is based on the research question of how patient transitions between primary and specialist health services were experienced by managers and front-line professionals

Summary

Introduction

Care transitions between specialist and primary healthcare services for people with concurrent substance abuse and mental health problems are characterised by vulnerability and arbitrariness. People with concurrent substance abuse and mental health problems (dual diagnosis) are often in need of both specialist and primary healthcare services. This group has long been regarded as one of the most clinically complex [1, 2]. Inter-organisational coordination is crucial in order to create integrated services. Coordination can be described as continuous processes where different parts or elements are inter-related, prioritised and adapted to each other and can be organised in different ways [3, 4, 5]. Despite several reforms aiming to improve challenges of fragmentation, coordination has remained a problem [9, 10, 11]

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