OP0296-HPR HEALTH AND SOCIAL CARE PROFESSIONALS’ WORK TO ACHIEVE COHERENT REHABILITATION PATHWAYS FOR PEOPLE WITH INFLAMMATORY ARTHRITIS - A QUALITATIVE INTERVIEW AND OBSERVATIONAL STUDY

Background

20-40% of people with inflammatory arthritis (IA) do not tolerate or do not have sufficient effect of their medication and experience substantial impact of their disease. They need rehabilitation to develop or restore functioning and become able to live an independent and meaningful life (1). Rehabilitation and the organisation of health and social care services are characterised by a high degree of complexity and many different professionals working across different departments, primary and secondary sectors.

Objectives

To investigate how health and social care professionals across different departments, levels and sectors work to achieve coherent rehabilitation pathways for people with IA.

Methods

In total, 26 professionals across primary and secondary health and social care participated in semi-structured interviews. These professionals were all pointed out by people with IA because they had made a significant difference to achieve coherent rehabilitation pathways for them. In addition, participant observations and informal interviews with the healthcare professionals were conducted during the rehabilitation stay. Formula stories (2) and institutional ethnography (3) guided the interpretation of data. In the findings, the term people is changed to users to underline their interactions with the professionals.

Results

The analysis derived three themes:

1) Interactions with users: the professional’s interactions with users were predominantly characterized by the ideal of focusing on the individual human being with respect for individual’s norms, values and wishes. However, this ideal was challenged when their professional knowledge contradicted the user’s norms, values and wishes.

2) Dependent interactions between professionals: expresses dependency of collaboration between professionals both internally within the same department or organization but also across organizations and sectors. Dependency on information about the user to carry out examinations, deliver care or treatment or dependency on referrals to legitimize the efforts the professionals considered necessary for the user.

3) The significance of organisation within institutional frameworks for the professionals’ work: the professionals experienced that they were not always able to meet the users demand for care due to organizational requirements for efficiency, economic cost reductions and documentation. These issues led to lack of time to prepare, implement, and follow up on communication with users and other professional partners.

Conclusion

The professionals want to meet the individual with a person-centred approach but sometimes they find it difficult to combine this with their own professional knowledge and values. The professionals are dependent on collaboration with other professionals across departments and sectors. This study shows that the institutional and organizational framework can hinder rather than promote the professionals’ intentions to create coherent rehabilitation.

References

[1]Hjortbak BR et al. Udfordringer til rehabilitering i Danmark [Challenges in rehabilitation in Denmark]. 2011.

[2]Loseke DR. The Empirical Analysis of Formula Stories. In: Holstein J, et al (ed): Varieties of Narrative Analysis. SAGE; 2012.

[3]Smith DE. Institutional ethnography. AltaMira Press; 2005.

Acknowledgements

Thanks to Tine Mechlenborg for designing the study and colleting the main part of data and to Camilla Vestergaard Aarøe for collecting some data

Disclosure of Interests

None declared

Uncertainties in atmospheric dispersion modelling during nuclear accidents

Predictions of the atmospheric dispersion of radionuclides accidentally released from a nuclear power plant are influenced by two large sources of uncertainty: one associated with the meteorological data employed, and one with the source term, i.e. the temporal evolution of the amount and physical and chemical properties of the release. A methodology is presented for quantitative estimation of the variability of the prediction of atmospheric dispersion resulting from both sources of uncertainty. The methodology, which allows for efficient calculation, and thus is well suited for real-time assessment, is applied to a hypothetical accidental release of radionuclides.

SAT0610-HPR COHERENT REHABILITATION – EXPERIENCES OF PEOPLE WITH INFLAMMATORY ARTHRITIS

Background:

20-40% of patients with inflammatory arthritis (IA) do not tolerate or do not have sufficient effect of the medication and experience considerable problems in their everyday lives. For these patients multidisciplinary rehabilitation and coherence in healthcare are of utmost importance (1). However, only little is known about coherence in healthcare among patients with inflammatory arthritis

Objectives:

To explore how persons with IA experience coherence in their rehabilitation pathways

Methods:

Semi-structured individual interviews with 11 persons with IA who had experience with rehabilitation across primary and secondary health care. Interviews were conducted in the patients’ home before admission to an inpatient rehabilitation stay, during the admission and 2-3 weeks and 4-6 months after discharge. In addition, participant observations and informal interviews were performed during admission. The analysis involved case descriptions (2) and interpretation in a thematic analysis (3).

Results:

The analysis derived a main theme“a person centered approach”, representing the importance for the person to meet professionals who listen and acknowledge the persons own views rather than focusing on the “system”, regulations and standards. In addition, 4 sub-themes were identified: 1)“empowerment and disempowerment”,covering how most patients want to be in control and take action but they may lack the energy and ability to express their needs and thus give up; 2)“Lack of communication and coordination”, involving processes between the staff in the same department, between departments or sectors. Patients feel forced to take on coordinating tasks themselves, which they do not feel qualified to perform; 3)“Interventions meant as help may be felt as restrictions”, which encompass i.e. free physical therapy delivered at times not appropriate for the patient and types of support which can lead to a feeling of social control, and finally, 4)“The system is difficult to get through”.Information about possible support are provided at random and some ask for a coordinating person.

Conclusion:

Facilitators for coherent pathways among people with IA encompass dedicated professionals working with a person-centered approach aiming to empower people. This encompass to provide relevant knowledge and enable the person to ask for the right type of help. A coordinator may facilitate coherence.

References:

[1]Aiello M, Mellor JD. Integrating health and care in the 21st century workforce. Journal of Integrated Care. 2019;27(2):100-10.

[2]Breimo JP. Bundet av bistand. En institusjonell etnografi om organisering av rehabiliteringsprosesser [Captured by Care. An Institutional Ethnography on organizing of Rehabilitation Processes]: Universitetet i Nordland; 2012.

[3]Braun V, Clarke V, Hayfield N, Terry G. Thematic Analysis. In: Liamputtong P, editor. Handbook of Research Methods in Health Social Sciences. Singapore: Springer; 2019.

Acknowledgments:

Funding from Region of Southern Denmark, Hans Christensens memorial foundation and Knud and Edith Eriksens memorial foundation

Disclosure of Interests:

Helle Feddersen: None declared, Jens Soendergaard: None declared, Bettina Munksgaard Schmidt: None declared, Lena Andersen: None declared, Jette Primdahl Speakers bureau: BMS and Pfizer

Studies on the action of lysozyme in immune immobilizaion of Treponema pallidium (Nichols strain)

The action of antibodies and of the haemolytic complement system does not induce immune immobilization of Treponema pallidum, but only destroys superficial wall structures of these Gram-negative organisms. In sensitized and complement coated treponemes the immobilization is a result of the lysozyme interaction with the mucopeptide layer of the cell wall. In a lysozyme-free medium, immunologically damaged treponemes are able to repair the defects in the outer layers of their cell wall structures. Furthermore, it is shown that the long lag period in immune immobilization of T. pallidum can only partly be explained by the interaction of lysozyme with the treponemes.