Publications by authors named "Rikke Aarhus"

5 Publications

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Exploring the triggering process of a cancer care reform in three Scandinavian countries.

Int J Health Plann Manage 2021 Nov 21;36(6):2231-2247. Epub 2021 Jul 21.

Department of Strategy and Entrepreneurship, Norwegian Business School, Oslo, Norway.

Cancer incidence is increasing, and cancer is a leading cause of death in the Scandinavian countries, and at the same time more efficient but very expensive new treatment options are available. Based on the increasing demand, high expectations and limited resources, crises in public legitimacy of cancer care evolved in the three Scandinavian countries. Similar cancer care reforms were introduced in the period 2007-2015 to address the crisis. In this article we explore processes triggering these reforms in countries with similar and well-developed health care systems. The common objective was the need to reduce time from referral to start treatment, and the tool introduced to accomplish this was integrated care pathways for cancer diagnosis, that is Cancer Patient Pathways. This study investigates the process by drawing on interviews with key actors and public documents. We identified three main logics in play; the economic-administrative, the medical and the patient-related logic and explored how institutional entrepreneurs skillfully aligned these logics. The article contributes by describing the triggering processes on politically initiated similar reforms in the three countries studied and also contributes to a better understanding on the orchestrating of politically initiated health care reforms with the intention to change medical practice in hospitals.
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November 2021

Dynamics of a specialized and complex health care system: Exploring general practitioners' management of multimorbidity.

Chronic Illn 2020 Jun 4:1742395320928403. Epub 2020 Jun 4.

Public Health and Rehabilitation Research, DEFACTUM, Aarhus, Denmark.

Objective: To explore general practitioners' (GPs') experiences of cooperation with hospital-based physicians regarding multimorbid patients and to identify challenges as well as strategies in managing such challenges. Three medical practices in a provincial town in Denmark.

Study Design: A qualitative methodological design was used with explorative data collection among GPs. Participant observation, qualitative interviews and a focus group interview were conducted. Interpretive description was used as the analytical framework. The GPs appreciated cooperating with physicians in optimizing treatment of multimorbid patients. However, three main challenges were experienced: insufficient communication and coordination; unclear divisions of roles and responsibilities; and differences in the way of approaching patients. The GPs navigated these challenges and complexities by taking advantage of their personal relationships and by developing creative and patient-centred ad hoc solutions to difficulties in cross-sectorial cooperation. A hospital initiative to support care for multimorbid patients has not been adopted by the GPs as a preferred strategy.

Conclusions: The structures of the health care system severely challenged cooperation regarding multimorbid patients; nevertheless, these GPs were aware of the advantages of cooperation, and their mainstay strategy in this involved personalized solutions and flexibility.
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June 2020

Coordinating objects of care: Exploring the role of case managers as brokers in cancer patient pathways.

Eur J Cancer Care (Engl) 2019 May 14;28(3):e13017. Epub 2019 Feb 14.

Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus C, Denmark.

Objective: Healthcare systems increasingly make use of case managers to handle organisational complexity. In Danish cancer patient pathways, case managers handle the complexities of cancer diagnostics and treatment while adhering to pathway guidelines. This article explores how case managers handle their various responsibilities and focuses on the micro-politics of case management.

Methods: An ethnographic study was carried out in three Danish cancer patient pathways. Interactions between patients and healthcare professionals were observed, including professionals with case management tasks. We interviewed 13 cancer diagnostic patients in their homes and 26 healthcare professionals during work hours, among other things about case management.

Results: We found that the work of case managers differs between cancer patient pathways and settings but overall emphasises coordination of patient trajectories and being contact person. We argue that case managers, embodying the figure of the broker, handle their responsibilities by coordinating the following co-existing objects of care, each with different goals: the diseased body, the person, the organisation and the cancer patient pathway.

Conclusion: We conclude that case managers, in addition to being a response to the complexity of healthcare services, impact the implementation of cancer patient pathways and influence cancer diagnostic activities.
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May 2019

Reconfiguring diagnostic work in Danish general practice; regulation, triage and the secretaries as diagnostician.

Anthropol Med 2019 Aug 31;26(2):213-227. Epub 2017 Jul 31.

Research Unit for General Practice, Institute of Public Health, Aarhus University , Aarhus , Denmark.

Health care systems as well as bodies of medical knowledge are dynamic and change as the result of political and social transformations. In recent decades, health care systems have been subjected to a whole assemblage of regulatory practices. The local changes undertaken in Denmark that are being explored here are indicative of a long-term shift that has occurred in many welfare states intended to make public services in the Global North more efficient and transparent. Departing in prolonged field work in Danish general practice and the anthropological literature on audit culture, this paper suggests that the introduction of regulatory practices has enhanced the need for triage as a key organising principle. The term triage literally means separating out and refers to the process of sorting and placing patients in time and space. The paper suggests that an increasing introduction of triage feeds into a reconfiguration of diagnostic work, where the clinical setting is gradually becoming more intertwined with the governing domains of policy, and the work of the secretary is gradually becoming more intertwined with that of the doctor. Finally, the paper argues that an increasing regulation of general practice poses an ethically charged challenge to existing welfare politics of responsibility between the state and the public, as it makes it increasingly difficult to negotiate access to care.
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August 2019

[An interdisciplinary journal club improves hospital staff competence and commitment].

Ugeskr Laeger 2015 Feb;177(6)

KIF-enheden, Diagnostisk Center, Regionshospitalet Silkeborg, Falkevej 1-3, 8600 Silkeborg.

The demands of the health-care sector for quality and evidence-based knowledge require nurses, secretaries and allied health-care professionals to keep up to date professionally. An interdisciplinary journal club (IJC) provides a self-reported improvement in the competence of critical reading as well as increasing knowledge about research designs and research methods. Furthermore, IJC leads to an increased sense of community, understanding of an interdisciplinary culture and appears to strengthen the foundations for cooperation across disciplines.
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February 2015