Evidensbaseret Kroniker Omsorg

4 grundlæggende elementer er vigtige i omsorgen for personer med kroniske tilstande i følge et nyt studie. Det er  komklussionen i et såkaldt “systematisk review”, hvor forskerne har samlet, gennemgået og opsummeret den tilgængelige videnskabelige viden på området.

De 4 områder er

  1. Personens tilstand (herunder helbred, funktion og medicin)
  2. Mål og bekymringer (behov, værdier, ønsket effekt)
  3. Interventioner
  4. Evaluering (opnåede den pågældende det ønskede, deltagelse)

 

Praktisk og politisk

KOL, diabetes, kroniske smertetilstande, depression… listen er lang over kroniske tilstande, og afhængig af alder, vil mellem 30 og 80% af personer i disse grupper have mere end en af tilstandende. I Danmark udlægges omsorgen og behandlingen af personer med kroniske tilstande i stort omfang, både fra en politisk og praktisk tilgang, til borgernær omsorg. Det vil i praksis sige kommuner og almen praksis, der sammen med personen med den eller de kroniske tilstande, skal få det bedst mulige ud af tilstanden for den enkelte. Der er jo ikke tale om et behandlingsforløb, for kroniske tilstande er…kroniske.

Både for den enkelte og fra samfundet er der god mening i den model. Imidlertid kræver den, for at fungere optimalt, en fælles tilgang og forståelse mellem alle aktører. En person med en kronisk tilstand besøger regelmæssigt 4 til 9 sundhedsprofessionelle, hvortil kommer kontakter med socialsektoren. Derfor bliver en fælles forståelse og tilgang til tilstanden mere og mere vigtig, så den sygdomsramte og og professionelle aktører kan holde overblik og fokus, og så der ikke spildes resourcer på unødige tiltag eller noget andre har gjort. Her kommer en fælles “omsorgs plan” ind. Det var lige præcis det, forskerne i det nye studie ville undersøge, ved at se hvilken videnskaelig viden, der foreligger på området. Her kom de frem til de fire emner.

Den sygdomsramte’s tilstand

Basal viden om hvordan den pågældendes tilstand er ved start er vigitg. Dette indbeærer vigtige måleparametre, samt olysninger om demografi, medicin, sygehistorie osv.

Denne viden danner basis for alle de følgende trin, både til at identificere mål for forbedring, effekt af interventioner og for evalering af insats.

Mål og bekrymring

Som ramt af en eller flere kroniske tilstande, er der nok at bekymre sig om. Disse bekymringer, hvad enten der er social eller sundhedsmæssig karakter, kan sommetider være svære at få frem. Det er vigtigt at identificer disse bekymringer, så de kan blive håndteret og ikke stå i vejen for den enkeltes egen indsats og engagement. Det er ligeså vigtigt, at alle porfessionelle også kender til disse.

Det hænger sammen med målsætning. Når først mål er identificeret, er det lettere at navigere. Ganske som når vi stiller GPS i bilen. Når alle, også den sygdomsramte, er klar på de mål man har sat, bliver alle beslutninger og evalueringer af effkt meget lettere. Man ved jo hvor man skal hen.

Den grundlæggende tilstand fra punkt 1, kan anvendes som afsæt for målsætning. Her er det vigtigt at inddrage den sygdomsramte både i afdækning af tilstand, og i at sætte konkrete mål, for hvad der ønskes opnået

Interventioner

De behandlinger og andre interventioner, der skal sættes igang, hviler på de to første punkter. Hvad er basis og hvad skal opnåes. Dette indebærer naturligvis ogs en klar identifikation af hvem, der gør hvad.

Det indebærer naturligvis også den sygdomsramte, og understøttelse af egen omsorg har i undersøgelser vist, at kunne føre til bedre tistand, færre kontakter med “systemet”, og reduktion i medicin. Altså bespsparelser både menneskeligt og økonomisk.

Evaluering

Dokumentation af forløb og evaluering af indsats er vigtig. Blev målene opnåede, og hvis ikke hvorfor lykkedes det ikke, og hvad er alternativet. Hvordan var engagementet, og hvad forventes fremover.

Evaluering kan også ses fra et “helikoptor perspektiv”, hvor det ikke drejer sig om den enkelte, men kvalitssikring af den samlede indsats på området. “Big data” er jo en samling af “small data”.

Der er et link til den omtalte artikel her, artiklen kan downloades gratis. 

Der er meget mere om måling, kommunikation og samarbejde på vores hjemmeside

Klik her for at kontakte os for for yderligere information eller for at aftale et møde

229 tanker om “Evidensbaseret Kroniker Omsorg

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