Background The demand for and provision of health care is in constant change. People live longer and have more complex health requirements, challenging the functioning of the health care system in responding adequately to present and future needs. For persons with hand osteoarthritis (HOA), access to recommended treatment is poor (1) and what can be offered in primary health care is not optimal. A reorganization of the workforce through task- shifting can be a solution where the aim is to use existing human resources in health in more efficient ways. Through task- shifting, tasks and knowledge can be shifted between health professionals, between levels of the health care system, and from health professionals to service users, changing the current division of labor (2).
Objectives The aim of this study is to gain a broader understanding of the distribution of tasks among health professionals and service users in HOA care from the perspective of service users to guide future task- shifting initiatives.
Methods In- depth interviews with 21 service users with HOA were conducted, including 15 women and six men from 47 to 86 years of age. All had received services from primary and specialized health care services. A theme based semi- structured interview guide was used. All interviews were audio- recorded and subsequently transcribed verbatim. Reflexive thematic analysis was used to generate codes and develop three main themes.
Results Tasks by different professionals: service users describe general practitioners (GPs) as entry points to health service provision. Contact is initiated with the aim to have signs and symptoms recognized for referrals to diagnostic tests and specialized services. As such, tasks beyond referrals are not expected by service users in primary health care in their encounters with GPs. Upon entering specialized health care services, service users describe diagnostics and prescription of medication for pain as key tasks of the rheumatologists, highlighting the role of the rheumatologists in ruling out severe pathology. Service users attribute the tasks of providing information about the condition, exercises, and assistive devices to occupational therapists (OTs). A lack of familiarity with the OT- profession prior to consultations is also expressed. This shows how patients attribute different tasks to GPs, rheumatologists, and OTs based on experiences in consultations.
Profession secondary to competence about HOA and interpersonal skills: service users say they do not have preferences related to who executes what professional tasks in addressing their needs. On the contrary, service users highlight competence about HOA as a key factor independent of whether the health professional is a GP, rheumatologist, or OT, saying professional orientation is secondary to professional knowledge about HOA. At the same time, service users underline interpersonal skills of health professionals as another key element, further downplaying the specific professional background of health professionals and levels of the health care system in meeting service user needs.
Transfer of tasks to service users: service users experience that they are presented with few treatment options beyond self- management in encounters with health professionals, leaving service users to cater for their own needs through the self- administration of exercises, medicines, and assistive devices.
Conclusion In the division of labor, service users highlight the importance of professional knowledge and skills within the field and interpersonal skills independent of professional background and levels of the health care system. They also underline few treatment opportunities beyond self- management resulting in task- shifting to service users.
References Kloppenburg M, Kroon FP, Blanco FJ, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Annals of the Rheumatic Diseases 2019; 78:16-24.
European Commission Expert Panel on effective ways of investing in Health (EXPH). Task shifting and health system design, 26 June 2019.
Disclosure of Interests None declared
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