Borgerinddragelse af kronisk syge i Region Nordjylland: Patientinddragelse

Abstract

Der har de seneste år været øget fokus på at inddrage borgere i udviklingen og eksekveringen af offentlige politikker. I sundhedssektoren kommer denne udvikling til udtryk gennem et øget politisk fokus på patientinddragelse. I nærværende undersøgelse vil fokus være på, den lovgivning der omfatter patientinddragelse og de politiske tiltag der er etableret for at styrke patientinddragelsen. Ydermere vil fokus være på, hvordan kronisk syge patienter oplever at blive inddraget i egen behandling. I nærværende opgave er Region Nordjylland udvalgt som case, med henblik på at undersøge patientinddragelse i regionen. Det teoretiske afsæt for nærværende opgave er henholdsvis Vibeke Zoffmann’s Guided Egen-Beslutning, begrebet Empowerment samt Bell og Hindmoors fem modes of governance. Til at opnå en indsigt i de politiske patientinddragelsestiltag foretages en dokumentanalyse af Sundhedsloven, Sundhedsaftalen og Dialogpapir om øget inddragelse af patienter og pårørende. Derudover er der afholdt fem interviews af udvalgte informanter. De fem informanter har forskellige kroniske sygdomme og modtager forskellige former for behandling. Analysen er todelt, hvor dokumentanalysen udgør en strukturdel og de fem afholdt interviews udgør en aktørdel. Der kan med udgangspunkt i opgavens strukturanalyse konkluderes, at der er et politisk ønske om at sætte patienten i centrum af egen behandling. Både Sundhedsloven, Sundhedsaftalen og Dialogpapiret beskriver, at sundhedspersonalet skal inddrage patienterne og opbygge en gensidig relation. Det fremgår også ud fra strukturanalysen, at patienter skal inddrages gennem uddelegering af governanceopgaver og derigennem blive empowered. Der kan med udgangspunkt i opgavens aktøranalyse konkluderes, at informanterne har forskellige oplevelser af inddragelse samt forskellige behov herfor. Dette kan skyldes informanternes alder samt type og grad af sygdom. Overordnet føler informanterne sig helt eller delvist inddraget i deres behandling. Der er dog nogle informanter, som føler sig mere ekskluderet fra inddragelse. Nogle informanter oplever en tillidsfuld relation, mens andre oplever at personalet har mangel på tid og dermed ikke får opbygget en tæt relation. Det kan derfor ses ud fra struktur og aktøranalysen, at der er en forskel i forventningerne og oplevelserne af patientinddragelse.

In recent years, there has been an increased focus on involving citizens in the development and execution of public policies. In the healthcare sector, this development is reflected through an increased political focus on patient involvement. Thus, this thesis will deal with the legislation on patient involvement and policy measures established to strengthen patient involvement. Furthermore, this thesis will explore the experiences of being involved in their treatment in patients with chronic diseases. For this thesis, the Region of Northern Jutland has been selected as a case to investigate patient involvement in the region. The theoretical basis for this assignment is Vibeke Zoffmann's Guided Self-Decision, the concept of Empowerment, and Bell and Hindmoor's five modes of governance, respectively. To gain insight into the political patient-involvement initiatives, document analyses were performed on the Health Act, the Health Agreement, and Dialogue paper on increased involvement of patients and relatives. Also, five interviews were conducted by selected informants. The five informants had different chronic diseases and received different forms of treatment. The analysis is bipartite, where the document analyses form a structural part and the five interviews a stakeholder part. The structural analysis revealed a political desire to put the patients at the centre of their treatment. Both the Health Act, the Health Agreement, and the Dialogue Paper describe that healthcare professionals must involve the patients and build a mutual relationship. From the structural analysis, it also appears that patients must be involved through delegation of governance tasks and thereby empowered. The stakeholder analysis concluded that the informants had different experiences of involvement and needs for this. This may be due to the age of the informants as well as the type and degree of illness. Overall, the informants felt fully or partially involved in their treatment. However, some informants felt more excluded from involvement. Some informants experienced a trusting relationship, while others found the staff in time trouble and therefore unable to build a close relationship. Therefore, from the structure and stakeholder analyses, a difference in expectations and experiences of patient involvement was seen.

A master thesis from Aalborg University

Borgerinddragelse af kronisk syge i Region Nordjylland: Patientinddragelse

[Citizen Involvement of Chronically Ill the Region of Northern Jutland: Citizen Involvement]