PubMed · 12806666
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Steinar Westin. 2003-05-15. [Does the list patient system function?].. https://pubmed.ncbi.nlm.nih.gov/12806666/
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PURPOSE: To review the current international rehabilitation and healthcare climate and describe a new model of service delivery aimed at enhancing the continuity of care for people with spinal cord injury (SCI). METHOD: An extensive literature review was undertaken and a new model of service delivery conceptualized and implemented in the Australian context of SCI rehabilitation. RESULTS: This new model of service delivery aims to improve the rehabilitation continuum for people with SCI by reducing the time spent in hospital, increasing consumer control over the rehabilitation environment and enhancing community re-integration. The new model recognizes the changing nature of the healthcare system, the legislative frameworks within which rehabilitation services are provided and the increasing role of the consumer. CONCLUSIONS: Models of rehabilitation that address the need for shorter periods of hospitalization and attempt to improve client outcomes are integral to ensure sustainable rehabilitation services in the future.
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PURPOSE: Political and other considerations are increasing the profile of 'community rehabilitation' but there is little agreement on the nature of community rehabilitation or its benefits and disadvantages. This paper clarifies some of the underlying conceptual and evidential matters in the context of the WHO International Classification of Functioning model of disablement. CLASSIFICATIONS: Rehabilitation services can be classified by their specialist skills (e.g. spinal injury services, wheelchair services), by the geographic location of the service (e.g. inpatient stroke service), by the organization managing the service (e.g. social services rehabilitation service), or by location of service delivery. There is no useful consistent comprehensive classificatory system, and all classificatory labels may carry hidden implications. EVIDENCE: The evidence suggests that rehabilitation is more effective when given in the patient's own environment. It also suggests that most so-called community rehabilitation teams are relatively short-lived and are not multi-disciplinary and not expert. SOLUTION: We should work towards a network of rehabilitation teams, some specialized in specific diseases or interventions, and some in longer-term involvement with patients in the community with special emphasis on increasing social participation and ensuring good support. At all times we should balance the advantages of delivering the service in the patient's home against the obvious problems concerning practicality and the equitable use of scarce specialist staff time.