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Irgens E.L.1, Henriksen N.1, Moe S.1
1UiT The Arctic University of Norway, Department of Health and Care Sciences, Tromsoe, Norway
Background: Physiotherapy is an important intervention in all phases of rehabilitation following acquired brain injury. Recent health care reforms in Norway and other welfare countries aim for both quality improvements and cost reductions due to demographic challenges and continuous growth of public health care services. These reforms encompass earlier hospital discharge, emphasis on interprofessional collaboration and increased responsibility and work load in the primary health care. Many research projects on coordinated care are specialist health care driven, with less emphasis on both the transitional phase from hospital rehabilitation and challenges experienced in the primary health care.
Purpose: To investigate physiotherapists` (PTs`) communication and transition practice from specialist to primary health care in the field of neurological rehabilitation.
Methods: Ten persons with acquired brain injury were followed from in-hospital rehabilitation to continued rehabilitation at the municipal level. We conducted individual interviews with PTs in both specialist and primary health care, including a 3-month follow-up interview of PTs at the primary care level. The empirical material was analyzed using an interpretive approach and systematic text condensation, and critically discussed among the authors and in research group meetings to ensure that aspects of relevance were pursued. Non-participant video-observations of physiotherapy treatment sessions and physician and interdisciplinary discharge summaries were used to validate the PTs` statements.
Results: The initial specialist health care rehabilitation was characterized by close interprofessional collaboration and team-work, whereas both the transitional process from hospital to home and further rehabilitation efforts in primary health care were characterized by less communication and cooperation between health care professionals. Discharge papers often contained interprofessional summaries of the hospital stay, but further contact between health professionals were characterized by profession-to-profession transfer of knowledge due to both professional opinions and lack of resources related to secondments and ambulation. The PTs described an extended responsibility in municipal rehabilitation following acquired brain injuries, as number of health professionals were fewer. This left several areas of importance unattended unless the remaining professional groups identified and addressed these issues. The PTs expressed concerns related to areas whereby responsibility was unresolved, such as cognitive and visual deficits, and identified these areas of the rehabilitation as less familiar for the PTs.
Conclusion(s): The results of this study reveal a lack of integration of current knowledge on coordinated care within the field of neurological rehabilitation, and emphasize a need to increase interprofessional collaboration and communication in transition from hospital to home, and in further rehabilitation efforts in primary care.
Implications: A stronger interprofessional collaborative practice both in transition from hospital to home and in further rehabilitation in primary care might facilitate a process taking into account and integrating more aspects of ABI rehabilitation. Further studies to explore the potential of ambulatory specialist health care services in rural areas and increased emphasis on collaboration and communication across professional boundaries in both the transitional phase and in primary care rehabilitation are needed.
Funding acknowledgements: The Norwegian Fund for Post-Graduate Training in Physiotherapy
Topic: Professional practice: other
Ethics approval: Approved by the Data Protection Official for Research, Norwegian Social Science Data Services. Ethical approval was not required.
All authors, affiliations and abstracts have been published as submitted.
