Bedömning i samverkan - en väg till remission vid schizofreni

Abstract

Background: The process from assessment of symptoms and function to various efforts in psychiatric outpa-tient care is still a "black box". Our knowledge of the connection between processes in care and the patient's status is limited. This dissertation studies the importance of thoughtful assessments, treatments and collab-oration in the care of patients with schizophrenia. One point of view is that the first step in the chain; the assessment, can fulfill a larger and more important function than previously demonstrated. The main sub-jects in the thesis are the patient and their Case Manager. Purpose: The overall purpose was to investigate the process from assessment to collaboration with patients and healthcare professionals in the psychiatric outpatient care. The objective was to illustrate specialist nurses' experiences of coordinated care planning in outpatient care (I); to examine how self-assessments of perceived disorders and quality of life in patients with schizophrenia, co-varied with the nurse's assessments of symptoms, function and life situation (II); investigate if repeated annual semi-structured interviews, including self-assessments of patients with schizophrenia, will reduce differences in assessments between patients and their Case Managers (III); to identify Case Manager's perception of factors that promote remission in patients with schizophrenia (IV). Method: The thesis consists of four sub-projects, of which two studies are qualitative (I and IV) and two are quantitative (II and III). In Study I, interview data was collected through focus groups and in Study IV individual interviews were conducted. Data were analyzed with inductive (I) and abductive (IV) qualitative content analysis. Data collection in studies II and III were conducted through self-estimates, semi- structured interviews and assessments using evidence-based estimation tools. Data were analyzed with descriptive and relationship-seeking statistics in the form of correlations and regressions (stepwise). Results: The thesis points out the value of continuity in care and treatment and the importance of collaboration between patients and care professionals. The result shows that repeated semi-structured assessments increase the co-variation between patients and CM. The result highlights several success factors that are considered to contribute to a functioning collaboration with the patient. A tentative conclusion is that the methodology surrounding the measurements and the dialogue between CM and patient favors this collaboration and that the patient's ability to achieve remission increases. Only then, the necessary treatment efforts can be ensured, provided that the management contributes with adequate support and resources. Conclusion: The thesis highlights the importance of repeated assessments of current status, symptoms and function in patients with schizophrenia as a basis for communication and collaboration between the patient and the healthcare team, as well as a possible path to remission.