Att mötas utan att ses - om partnerskap och personcentrerad vård på distans

Abstract

The aim of this thesis was to evaluate and describe person-centred care over the telephone to people with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) and to elucidate informal carers’ experiences of support. The methods used in this thesis were related to the specific aims of the included studies. Study I was a randomised controlled trial that evaluated the effects of person-centred care delivered over the telephone to people with COPD or CHF. The evaluation showed that person-centred support over the telephone could mitigate the worsening of self-efficacy without increasing the risk of adverse events for this patient group. Study II aimed to contribute to future empirical analyses of partnership by outlining the social, moral, and cognitive forms of accountability to explore how participants engage in negotiating and establishing partnership in a person-centred care context. Study III was a phenomenological hermeneutical study to elucidate the meaning of the support given and received by informal carers of relatives with COPD or CHF. The meaning of support for these carers is twofold: it is a self-evident strive for the good life of their relatives, and it is a wish to be included as carers in partnership in interactions with healthcare providers. Study IV aimed to explore associations between self-efficacy, and health care and drug expenditure (i.e. direct costs) in patients with COPD or CHF using longitudinal statistical methods. The findings indicate that increased or sustained self-efficacy is associated with lower direct costs. The conclusion of this thesis is that remote person-centred care could, through the jointly achieved process of partnership, mitigate worsening self-efficacy in patients with COPD and CHF. Partnership may also be understood as cooperation between informal carers and their relatives and a wish among carers to be included and recognised by the healthcare system. This thesis is written in Swedish and includes a summary in English.