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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

Does the structural organisation of care affect pathways in municipal services for older people with mental health/substance use disorders?

Alternative title: Hvordan påvirker den strukturelle organiseringen av kommunale tjenester pasientforløp for eldre med psykiske lidelser og/eller rusproblemer?

Awarded: NOK 15.7 mill.

The general direction of current policy is increasingly to provide public service while patients live at home. The 2012 Coordination Reform is one example of how responsibilities are transferred from hospitals to municipalities. Evaluation of the reform suggests, however, that municipalities are not prepared well enough to meet the needs of our aging population. Among those deemed ?worst off? are older people with complex mental health and/or substance abuse disorders. Research suggests that municipal services lack sufficient competency to care for this group. Moreover, increased caseloads means tough prioritization in front-line practice. Little is known, however, about the micro-level decisions and prioritisation of the needs of this group of older people. Moreover, the impact of structural factors, including how national policy impacts practitioners? day-to-day practice through the organisation of local services, has not been investigated. In this study we aim to address these knowledge gaps. Our target population is older people with mental health and/or substance abuse disorders. Specifically, we seek to answer the following questions about municipal services to older people with mental health (excluding dementia) and/or substance use disorders: - How do GPs detect, treat, and collaborate regarding this patient group and does the Regular GP Scheme affect this? - Does the functional split between purchasing and provision of municipal services impact prioritisation of care delivered to this group? - How do GPs and municipal providers perceive family carer involvement and are national guidelines for such involvement implemented? - What are the implications of GP and municipal services on the structural vulnerabilities of older immigrants with mental health and/or substance abuse disorders? - How can the findings from our research be implemented through services and education? Progress, Autumn 2021: Our first four research questions have been operationalised into one Post-doc and three PhD-projects. In collaboration with a range of municipalities and organisations, we have completed most of the planned data collection, and analyses are underway. In that work we are supported by a Reference Group, which consists of representatives of those providing and using service, researchers and those involved with professional development and service design. The Work Package concerning older immigrants have sparked considerable media interest, and several newspaper articles have been published.

The general direction of current policy is to increasingly provide public service locally while patients live at home. The 2012 Coordination Reform is one example of how responsibilities are shifting onto municipalities. Evaluation of the reform suggests, however, that municipalities are insufficiently prepared to meet the needs of our aging population. Among those deemed 'worst off' by the reform are older people with complex mental health and/or substance abuse disorders. Research suggests that municipal services lack sufficient competency and that increased caseloads means tough prioritization in front-line practice. Little is known, however, about the micro-level decisions and prioritisation of the needs of this group of older people. Moreover, the impact of structural factors, including how national policy impacts practitioners' day-to-day practice through the organisation of local services, has not been investigated. In this study we aim to address these knowledge gaps. Our target population is older people with MH/SUD, excluding patients with a primary diagnosis of dementia for whom separate policies for care pathways are in place. Five work packages seek to answer the following questions about municipal services for this group: WP1: How do GPs detect, treat, and collaborate regarding this patient group and does the Regular GP Scheme affect this? WP2: Does the functional split between purchasing and provision of municipal services impact prioritisation of care delivered to this group? WP3: How do GPs and municipal providers perceive family carer involvement and do they implement national guidelines for such involvement? WP4: What are the implications of GP and municipal services on the structural vulnerabilities of older immigrants with MH/SUD? WP5: What are the implications of this research and how can it be implemented through services and education?

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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester