Healthcare professionals' experiences and attitudes to care coordination across health sectors: an interview study.

BACKGROUND: The number of older people is increasing, resulting in more people endure chronic diseases, multimorbidities and complex care needs. Insufficient care coordination across healthcare sectors has negative consequences for health outcomes, costs and patient evaluation. Despite introducing initiatives to solve coordination challenges within healthcare, the need remains for more consistent solutions. In particular, improved care coordination would benefit older adults characterised by complex care needs, high use of healthcare resources and multiple care providers. AIMS AND OBJECTIVES: To identify and analyse healthcare professionals' perspectives and approaches to care coordination across sectors when older people are acutely hospitalised. DESIGN: Qualitative interview study. METHODS: Semi-structured, individual interviews with 13 healthcare professionals across health sectors and professions were conducted. The strategy for the qualitative analysis was inspired by Kirsti Malterud and labelled 'systematic text condensation'. This strategy is a descriptive and explorative method for thematic cross-case analysis of qualitative data. RESULTS: Four themes/categories emerged from the analysis; "Organisational factors", "Approaches to care", "Communication and knowledge", and "Relations". CONCLUSION: Different organisational cultures can discourage intersectoral care coordination. Approaches to care vary at all levels across health sectors and professions. Organisational, leadership and professional identity affect the working cultures and must be considered in the future recruitment and socialisation of healthcare staff. Our research suggests that combinations of healthcare standardisations and flexible, adaptive solutions are required to improve intersectoral care coordination.

Public health, surveillance policies and actions to prevent community spread of COVID-19 in Denmark, Serbia and Sweden.

Aim: This study investigates the non-medical public health and surveillance policies and actions for tackling the community spread of COVID-19 pandemic in Denmark, Serbia and Sweden during the first five months of the pandemic in 2020. Method: The study is inspired by a process-tracing design for case study with a focus on the non-medical measures and surveillance strategies implemented by the three countries. The comprehensive collection and study of national documents formed the basis of the document analysis. Results: The Danish strategy was to prolong the transmission period, preventing high numbers of infected cases from impacting their healthcare capacity. The government's strategy was characterized by strict governance elements, health guidelines and behavioural recommendations. In Serbia, the main strategy was to prevent the spread and control of the infectious disease by shifting all human and material resources towards the function of controlling the spread. Serbia applied the strictest measures in the fight against coronavirus in relation to other countries in the region and in Europe. The Swedish strategy focused more on recommendations than requirements to motivate the public to modify their behaviours voluntarily. Sweden's loose pandemic strategy implementation focused on voluntary and stepwise action rather than legislation and compulsory measures. Conclusions: The public health policies and actions implemented to prevent community spread of COVID-19 in Denmark, Serbia and Sweden varied during the first five months of the pandemic. The differences in their response were due to delays in implementation, inconsistencies in perspectives towards the outbreak and the capacity of each country in terms of their pandemic preparedness and response.

Relatives' negotiation power in relation to older people's acute hospital admission: A qualitative interview study.

BACKGROUND: Acutely admitted older people are potentially vulnerable and dependent on relatives to negotiate and navigate on their behalf. AIM: This study aimed to explore relatives' experiences of their interactions with healthcare professionals during acute hospital admission of older people to derive themes of importance for relatives' negotiations with these professionals. METHOD: A qualitative design was applied. Relatives of acutely admitted older people at two emergency departments in Denmark were interviewed (n = 17). The qualitative content analysis was guided by Graneheim and Lundman's concepts. RESULTS: The analysis derived four themes: (a) Mandate, (b) Incentive, (c) Capability and (d) Attitude to taking action. These four sources of relatives' negotiation power can be illustrated in the MICA model. CONCLUSION: Four themes were identified as important sources of relatives' negotiation power. Since the four sources of power potentially change according to the situation, relatives' negotiation power seems to be context dependent.

Patients' experiences of home-based psychotherapy via videoconference: A qualitative study.

The aim of this study is to explore adult outpatients' experiences with home-based psychotherapy via videoconferencing in a Danish mental health service. Participants found videoconferencing-based psychotherapy for preventive relapse sessions very useful, and they believed that it was possible to maintain a good therapeutic relationship via videoconferencing when they knew their therapist in advance. However, experiences with more in-depth psychotherapy are more unclear as some felt alienated and preferred other ways to communicate. In general, participants found videoconferencing-based psychotherapy to be less personal but worth considering when travel hassles outweigh the need for meeting in person.

'One feels somewhere that one is insignificant in that system' - older multimorbid patients' between lifeworld and system in healthcare.

BACKGROUND: When older multimorbid people are acutely hospitalized, continuity of care is a fundamental goal in the healthcare process. However, some acute hospitalized older multimorbid patients do not experience continuity of care. This phenomenon is explored using the theoretical framework of Jürgen Habermas "Theory of communicative action". METHODS: Acutely hospitalized patients over the age of 65 with two or more chronic conditions and who received home care services were invited to participate in two interviews: one at the emergency department and the other 4-12 weeks after discharge. These interviews formed the basis for an evaluation of patient experience of continuity of care, and the content of the interviews was analyzed using a structured matrix. RESULTS: Fifteen patients participated with seven patients evaluated to have continuity of care in their healthcare process. Eight patients were evaluated as not having experienced continuity of care in their healthcare process. The categories from the matrix highlighted a healthcare system that interfered with a patient's lifeworld with a lack of communication, different expectations, frustration regarding care, strained relations to health care providers and feelings of being objectified. CONCLUSIONS: We conclude that mutual understanding based on communicative action is essential when it comes to patients' experiences of continuity of care. Our results justify improving the mutual understanding between patients and professionals in transition between healthcare sectors. Future research should target whether an enhanced focus on communicative action and mutual understanding in particular between non-healthcare professionals and patients will improve the patients' perception of continuity of care.

Healthcare professionals' practice and interactions in older peoples' cross-sectoral clinical care trajectories when acutely hospitalized - a qualitative observation study.

BACKGROUND: Healthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals' identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals' practice. AIM: This study aimed to explore and analyse how healthcare professionals' interactions and practice influence older peoples' clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged. METHODS: This qualitative study arises from a hermeneutical stand within the interpretative paradigm. Focusing on the healthcare professionals' interactions and practice we followed the clinical care trajectories of seven older people (aged > 65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines. RESULTS: The analysis revealed four themes: 1)"The end justifies the means - 'I know what is best for you'", 2)"Basic needs of care overruled by system effectiveness", 3)"Treatment as a bargain", and 4)"Healthcare professionals as solo detectives". CONCLUSION: Dissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.

Older multimorbid patients' experiences on integration of services: a systematic review.

BACKGROUND: Half of the older persons in high-income counties are affected with multimorbidity and the prevalence increases with older age. To cope with both the complexity of multimorbidity and the ageing population health care systems needs to adapt to the aging population and improve the coordination of long-term services. The objectives of this review were to synthezise how older people with multimorbidity experiences integrations of health care services and to identify barriers towards continuity of care when multimorbid. METHODS: A systematic literature search was conducted in February 2018 by in Scopus, Embase, Cinahl, and Medline using the PRISMA guidelines. INCLUSION CRITERIA: studies exploring patients' point of view, ≥65 and multi-morbid. Quality assessment was conducted using COREQ. Thematic synthesis was done. RESULTS: Two thousand thirty studies were identified, with 75 studies eligible for full text, resulting in 9 included articles, of generally accepted quality. Integration of health care services was successful when the patients felt listened to on all the aspects of being individuals with multimorbidity and when they obtained help from a care coordinator to prioritize their appointments. However, they felt frustrated when they did not have easy access to their health providers, when they were not listened to, and when they felt they were discharged too early. These frustrations were also identified as barriers to continuity of care. CONCLUSIONS: Health care systems needs to adapt to people with multimorbidity and find solutions on ways to create flexible systems that are able to help older patients with multimorbidity, meet their individual needs and their desire to be involved in decisions regarding their care. A Care coordinator may be a solution.

Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study.

BACKGROUND: Previous studies have found that residents of deprived neighbourhoods have an increased risk of perceived stress compared to residents with similar sociodemographic and socioeconomic characteristics in non-deprived neighbourhoods. While stress may provide an explanatory pathway linking neighbourhood deprivation to health-risk behaviour, only limited research has been undertaken on whether perceived stress influences health-risk behaviour in deprived neighbourhoods. Moreover, it is uncertain whether perceived stress has a negative effect on the associations between socioeconomic status and health-risk behaviours in deprived neighbourhoods. The overall aim of this study was to compare perceived stress in deprived neighbourhood with that in the general population, and to examine whether perceived stress was associated with health-risk behaviours (including their co-occurrence) in deprived neighbourhoods. A further aim was to examine whether perceived stress modified the associations between socioeconomic status and health-risk behaviours. METHODS: Four questions from the Perceived Stress Scale were used as indicators of perceived stress. Multiple logistic regression analyses were applied to cross-sectional data from 5113 adults living in 12 deprived neighbourhoods in Denmark. Data from 14,868 individuals from the nationally representative Danish Health and Morbidity Survey 2010 were used as a comparison group with regard to perceived stress. RESULTS: Residents of deprived neighbourhoods had higher odds of perceived stress than the general population. Associations between disposable income, economic deprivation, strain, and perceived stress were found in deprived neighbourhoods. Perceived stress was significantly associated with higher odds of health-risk behaviour, including a low intake of fruit or vegetables, daily smoking, physical inactivity, and the co-occurrence of health-risk behaviours, even after adjustment for demographic and socioeconomic characteristics. Perceived stress was more strongly associated with physical inactivity and having two or more health-risk behaviours among residents with medium/high socioeconomic status compared to residents with low socioeconomic status. CONCLUSIONS: Overall, the study showed a clear association between perceived stress and health-risk behaviour in deprived neighbourhoods. Future health promotion interventions targeting deprived neighbourhoods may benefit from incorporating stress reduction strategies to reduce health-risk behaviour. Further research is needed to fully understand the mechanism underlying the association between perceived stress and health-risk behaviour in deprived neighbourhoods.

Construction of meaningful identities in the context of rheumatoid arthritis, motherhood and paid work: A meta-ethnography.

AIMS AND OBJECTIVES: To derive new conceptual understanding about how women with rheumatoid arthritis manage their illness, motherhood and paid work, based on a comprehensive overview of existing knowledge, gained from qualitative studies. BACKGROUND: Rheumatoid arthritis affects several social aspects of life; however, little is known about how women with rheumatoid arthritis simultaneously manage their illness, motherhood and paid work. DESIGN: Qualitative metasynthesis. METHODS: A qualitative metasynthesis informed by Noblit and Hare's meta-ethnography was carried out, based on studies identified by a systematic search in nine databases. RESULTS: Six studies were included. Social interactions in the performance of three interdependent subidentities emerged as an overarching category, with three subcategories: subidentities associated with (1) paid work, (2) motherhood and (3) rheumatoid arthritis. Pressure in managing one of the subidentities could restrict the fulfilment of the others. The subidentities were interpreted as being flexible, situational, contextual and competing. The women strove to construct meaningful subidentities by taking into account feedback obtained in social interactions. CONCLUSIONS: The subidentities associated with paid work and motherhood are competing subidentities. Paid work is given the highest priority, followed by motherhood and illness is the least attractive subidentity. Because of the fluctuating nature of the illness, the women constantly reconstruct the three interdependent subidentities. RELEVANCE TO CLINICAL PRACTICE: When healthcare professionals meet a woman with rheumatoid arthritis, they should consider that she might not accept the subidentity as an ill person. Health professionals should not expect that women will prioritise their illness in their everyday life. This could be included in clinical conversation with the women.

The association between social position and self-rated health in 10 deprived neighbourhoods.

BACKGROUND: A number of studies have shown that poor self-rated health is more prevalent among people in poor, socially disadvantaged positions. The aim of the present study was to investigate the association between self-rated health and social position in 10 deprived neighbourhoods. METHODS: A stratified random sample of 7,934 households was selected. Of these, 641 were excluded from the study because the residents had moved, died, or were otherwise unavailable. Of the net sample of 7,293 individuals, 1,464 refused to participate, 885 were not at home, and 373 did not participate for other reasons, resulting in an average response rate of 62.7%. Multiple logistic regression models were used to estimate the associations between the number of life resources and the odds of self-rated health and also between the type of neighbourhood and the odds of self-rated health. RESULTS: The analysis shows that the number of life resources is significantly associated with having poor/very poor self-rated health for both genders. The results clearly suggest that the more life resources that an individual has, the lower the risk is of that individual reporting poor/very poor health. CONCLUSIONS: The results show a strong association between residents' number of life resources and their self-rated health. In particular, residents in deprived rural neighbourhoods have much better self-rated health than do residents in deprived urban neighbourhoods, but further studies are needed to explain these urban/rural differences and to determine how they influence health.

Barriers among Danish women and general practitioners to raising the issue of intimate partner violence in general practice: a qualitative study.

BACKGROUND: Thirty-five percent of Danish women experience sexual or physical violence in their lifetime. However, health care professionals are not in the practice of asking about intimate partner violence (IPV) in Denmark. It is currently unknown what hinders general practitioners from asking about partner violence and how Danish women would perceive such an inquiry. This aspect has not previously been explored in Denmark. An exploratory study was conducted to examine what hinders general practitioners (GPs) from asking and what Danish women's views and attitudes are regarding being asked about IPV. METHODS: Data were collected through individual and group interviews with a sample of three GPs and a diverse sample of 13 women, including both survivors of partner violence and those without any history of partner violence. An interpretative analysis was performed with the data. RESULTS: This study provides important knowledge regarding the barriers and attitudes towards inquiry about IPV in primary care in Denmark. Results indicate that Denmark is facing the same challenges when responding to survivors of IPV as other similar countries, including Sweden, Norway, the UK, USA, and Australia. Danish women want general practitioners to ask about violence in a respectful and non-judgemental manner. However, general practitioners are resistant towards such an inquiry and would benefit from training regarding how to respond to women who have been exposed to IPV. CONCLUSIONS: It is acceptable to inquire about IPV with women in Denmark in a non-judgemental and respectful way. Informing about IPV prevalence is important prior to the inquiry. However, general practitioners require more awareness and training before a favourable environment for this change in procedure can be created. Further large-scale research is needed to support the evidence generated by this small study.

Association between patient activation level and functional outcomes in older adults with hip fractures.

BACKGROUND: Hip fractures can significantly impact older adults' mobility and function. Effective rehabilitation is crucial to help them regain independence and quality of life. However, little is known about the association between patient activation and hip fracture rehabilitation. This study aims to assess the association between the PAM-13 scores and the level of physical function, mobility, and activities of daily living in older adults following a hip fracture rehabilitation program. METHOD: An exploratory outcome study from a cluster-randomized stepped-wedge clinical controlled trial. Two hundred thirty-nine patients were classified into four Patient Activation Measure-Levels (PAM-13) according to their PAM-13 scores, reflecting their confidence and preparedness to manage their health. Level 1 represents the lowest level of confidence. The patient's mobility, function, and daily activities were evaluated at discharge and after 12 and 24 weeks. RESULTS: The cohort had a median age of 78; 67% were female, and 50% lived alone. There were no significant differences in demographics between the PAM-Levels. PAM-Level 1 patients had longer hospital stays and lower mobility scores than PAM-Level 4 patients. However, all patients improved over time, and higher initial PAM levels resulted in better outcomes. PAM-Level 1 patients improved in Time Up and Go score from a median score of 54 seconds to 14 seconds at 24 weeks, while PAM-Level 4 patients improved from 26 to 9 seconds. CONCLUSION: Our study found an association between PAM levels and functional outcomes in hip fracture rehabilitation. Patients with higher activation levels had better mobility and functional outcomes.

Opening the black box of registration practice for self-harm and suicide attempts in emergency departments: a qualitative study.

BACKGROUND: The World Health Organization has called for improved surveillance of self-harm and suicide attempts worldwide to benefit suicide prevention programs. International comparisons of registrations are lacking, however, and there is a need for systematically collected, high-quality data across countries. The current study investigated healthcare professionals' perceptions of registration practices and their suggestions for ensuring high-quality registration of self-harm and suicide attempts. METHODS: Qualitative interviews (N = 20) were conducted among medical secretaries, medical doctors, nurses, and registration advisers from psychiatric and somatic emergency departments in all regions of Denmark between September 2022 and March 2023. Content analysis was performed using NVivo. RESULTS: Despite great efforts to standardize and assure the quality of registration in Denmark, almost all the healthcare professionals perceived registration practice as inconsistent and unreliable. Codes are often misclassified or unused due to insufficient time, non-standardized training, or insufficient information. The interview informants suggested that coding guidelines should be simplified and made more visible, alongside technical solutions in the electronic health record system. CONCLUSION: The study findings resulted in eight overall recommendations for clinical practice that aim at improving the registration of patients presenting with self-harm or suicide attempts. This would be expected to help improve surveillance and prevention programs.

Relatives' negotiations with healthcare professionals during older people's admission in an emergency department: An ethnographic study.

BACKGROUND: Relatives are recognised as important for older patients' care and treatment. Variations in relatives' opportunities to negotiate the quality and continuity of older people's care and treatment can potentially lead to inequality in older people's access to care and treatment. AIM: This study aimed to examine relatives' opportunities and strategies for negotiation with health care professionals (HCPs) during the admission of older people to emergency departments in Denmark. MATERIALS AND METHODS: We planned a qualitative ethnographical study employing a hermeneutic approach. Observations focused on social situations and interactions between relatives and HCPs. The analysis was guided by qualitative content analysis. RESULTS: The analysis derived one main theme, attitude to action, containing three subthemes: frustration obtaining access, presenting the case and a powerful relationship. Being active appeared to be essential to achieving possibilities for negotiation with HCPs. DISCUSSION: Inspired by Bourdieu, habitus, doxical values and institutional logics of relatives seem to affect their opportunities to negotiate with HCPs during older people's admission to an emergency department. CONCLUSION: Active and proactive relatives seem to have better opportunities to negotiate with HCPs during older people's acute hospital admission than reactive, passive and hesitant relatives. The logic of public management and the medical profession seem to dominate and influence doxa in the EDs and put special demands on the relatives. This imbalance constitutes a risk of inequality in older people's access to health.

Effectiveness of dementia education for professional care staff and factors influencing staff-related outcomes: An overview of systematic reviews.

BACKGROUND: Care staff often lack knowledge, confidence, skills, and competency to provide optimal care for people with dementia. Dementia education can increase staff competency and wellbeing along with the actual care of people with dementia. Several factors can affect the effectiveness of dementia education; however, it is not yet established which factors are most important. OBJECTIVE: The aim of the overview of systematic reviews is to investigate the effectiveness of dementia education for care staff on staff-related outcomes and influencing factors, identify needs for future research, and provide practical recommendations for effective dementia education. METHODS: Systematic searches were conducted in PubMed, Cinahl, and PsycInfo accompanied by manual citation and reference searches. For inclusion, reviews must report on either effectiveness of one staff-related outcome or on factors influencing the effectiveness of dementia education for care staff. Quality assessments were conducted using AMSTAR2. After data extraction, results on effectiveness were structured according to satisfaction, learning, behavior, and results. Results on contributing factors to effectiveness were categorized into program, personal and organizational factors. All results were qualitatively summarized and reported according to the PRISMA statement. RESULTS: Seventeen systematic reviews of low to medium quality were included. Dementia education positively affects knowledge, self-efficacy, and attitudes towards dementia and people with dementia. Care staff experienced improvements in communication and behavior management and reduction in behavioral symptoms of dementia of people with dementia was seen as well. Most reviews found no changes within restraints, medication, staff well-being and job satisfaction. Factors contributing to effectiveness are relevant and directly applicable content, active learning methods, classroom teaching combined with practical experience, theory-driven approaches and feedback sessions. Finally, the instructor needs to be experienced within dementia and sensitive to the needs of participants. CONCLUSION: There is no one-size-fits-all in dementia education: however, perceived relevance and applicability are key elements for effective dementia education. Due to low quality of primary studies, further research of high methodological quality is needed on effectiveness of dementia education on staff behavior, wellbeing, and job satisfaction as well as on influencing factors and their impact on mechanisms of change.

Definitions and incidence rates of self-harm and suicide attempts in Europe: A scoping review.

INTRODUCTION: European countries use various terminologies for self-harm and attempted suicide, which are sometimes used interchangeably. This complicates cross-country comparisons of incidence rates. This scoping review aimed to examine the definitions used and the possibilities to identify and compare incidence rates of self-harm and attempted suicide in Europe. METHODS: A literature search was conducted in Embase, Medline and PsycINFO for studies published from 1990 to 2021, followed by grey literature searches. Data were collected for total populations originating from health care institutions or registries. Results were presented in tabular form supplemented by a qualitative summary by area. RESULTS: A total of 3160 articles were screened, resulting in 43 studies included from databases and further 29 studies from other sources. Most studies used the term 'suicide attempt' rather than 'self-harm' and reported person-based rates with annual incidence rates from age 15+. None of the rates were considered comparable due to different reporting traditions related to classification codes and statistical approaches. CONCLUSION: The present extensive literature on self-harm and attempted suicide cannot be used to compare findings between countries because of the high degree of heterogeneity among studies. International agreement on definitions and registration practices is needed to improve knowledge and understanding of suicidal behaviour.

From fear to control: Older adults' thoughts and feelings about empowerment-oriented rehabilitation after a hip fracture.

BACKGROUND: It is essential to focus on how older adults remain active and regain control of their daily lives after hip fractures. 'Rehabilitation of Life' is an empowerment-orientated hip fracture intervention focused on continuous rehabilitation and care between sectors in Denmark. We aimed to understand and explore older adults' experience participating in the intervention 'Rehabilitation of Life' and how this relates to their sense of empowerment. METHOD: Qualitative data were generated from 16 semi-structured interviews with patients experiencing a hip fracture and subsequent rehabilitation in the program "Rehabilitation of Life' The data was analysed using Graneheim and Lundman's concept-guided qualitative content analysis method. RESULTS: The analysis revealed five themes that the participants emphasised as vital to their rehabilitation: getting information and care when hospitalised, early visits from healthcare professionals after returning to their homes, the social aspect of training together with others, rehabilitation provision by skilled and empathic staff, and acceptance of a new me. The five themes indicated that adults aged >65 years generally experienced rehabilitation after hip fractures as motivating and reassuring. CONCLUSION: Social support and peer programs can significantly improve the rehabilitation of older adults with hip fractures. The Rehabilitation of Life intervention has shown that promoting successful rehabilitation requires patient-centred strategies that encourage collaboration between different sectors. To increase patients' empowerment and engagement in their health journey, it is important to consider changes in patients' behaviour, increase their autonomy and ensure their independence after rehabilitation.

Factors that determine mental health professionals' decision to support home-based video consultations - A qualitative study.

Introduction: Using videoconferencing for consulting with patients in the mental health services has been shown in interventions to be similarly effective as when meeting in person. In practice, it often makes more sense to use video consultations with patients in a more flexible way than interventions permit. The aim of this study was to investigate what constitutes a professional video consultation from the perspectives of mental health professionals and explore what is of importance for the establishment and realization of video consultations in practice. Materials and methods: A Grounded Theory methodology approach based on Corbin and Strauss was used. Data collection consisted of participant observations of introductory events followed by individual interviews with mental health professionals who had used video consultations with patients. Findings: Mental health professionals believed that a professional video consultation was one that was not inferior to an in-person consultation but offered something else, such as more and easier access, accommodating patients' needs and wishes. At the same time, it should not interfere with the treatment quality, e.g., by hampering communication and therapeutic tasks. The expected treatment quality was based on an individual assessment of the patient and varied from clinician to clinician. The implementation process and support which the organization provided affected the clinicians' attitudes as well as the clinicians' experiences and hence how the clinicians assessed the quality of the service. Conclusion: Perceived usefulness, patient demands, and close IT support will positively impact the establishment and realization of video consultations whereas high workload and technical problems would hamper it.

Arrangements of wash toilets and ageing bodies - an exploratory study.

PURPOSE: The purpose of this study is to study how a specific assistive technology, namely wash toilet systems, are used and which values they enact for their users. MATERIALS AND METHODS: The study is primarily based on ten semi-structured interviews conducted with older adults who were offered a wash toilet as an element in the welfare service of a large Danish municipality. RESULTS: The study shows how, in various ways, specific aspects of wash toilet systems are associated with specific aspects of human physiology. Essential challenges to older adults that implicate the use of wash toilet systems either relate to 'arms that cannot reach behind', or the leakage of urine and eventually faeces. Furthermore the study shows that values enacted by wash toilet systems differ in the various arrangements, e.g., enabling social relations, being a part of something, being self-reliant or independent, preserving intimacy limits, or just 'be pleased with'. CONCLUSIONS: The wash toilet systems are woven into several different arrangements of the ageing body, wheelchairs, walkers, care personnel, spouses, diapers, etc. being situated in differently spaced bathrooms in different homes and different municipalities. We propose that the abandonment of focus on abstract policy values in favour of an emphasis on the actual arrangements of technology and the human body in old age will, in fact, be beneficial to our understanding of how welfare technology can contribute to enhanced citizenship.Implications for rehabilitationAn implication of this study for rehabilitation is not to take for granted how a wash toilet system will interact in arrangements with older adults, but attend to the potentially various/many ways the system can create value for the user in the actual arrangement it is part of.Another implication of the study is that it is always an empirical question whether self-reliance - which is often an aim of implementing assistive technologies - is an effect of a specific arrangement of a wash toilet system and the human body in old age.