Healthcare provision tailored to the target group
The health service must be organised in a way that facilitates the prioritisation of prevention, investigation, treatment and follow-up of somatic diseases in these patient groups. This requires closer cooperation between the different services, and a strong emphasis on tailoring services to the needs of individual patients. Society invests considerable resources in treating these groups. For example, around 70 % of people with severe substance use disorders in Norway are receiving some form of treatment, which is high in an international context. When highlighting somatic health problems, better organisation of the services is therefore just as important as increasing resources.
What does tailoring the services to the needs of these groups entail? Many of them are able to navigate and engage with the health service in the same way as others, and for them, the problem may primarily be getting the health service to recognise their somatic needs. Others struggle to navigate the complex support system, and can easily fall through the cracks. Attending treatment appointments, taking prescribed medication, digital communication and paying for services become a challenge: not out of ill will but due to the nature of their disorders and social circumstances, such as poverty. In such cases, they can easily lose out on treatment opportunities that others receive.
Modern health services are, and must remain, specialised. It is therefore necessary to create pathways into and through treatment systems that are tailored for these patients, ensuring they receive as much help as they need. In Norway, everyone, with some exceptions, has the same right to health care. However, the health service has to realise that it is their responsibility, not the patient's, to tailor the treatment to reach the target groups. Health care must not take the form 'one size fits all'. Cooperation must therefore be tailored to the patient's needs and be sufficiently flexible to reach the intended recipients.
There are good examples of such cooperation in Norway, two of which are opioid agonist treatment (OAT) and Flexible Assertive Community Treatment (FACT) teams. In OAT, treatment groups are established for each patient, and the patient, the GP, a designated representative from primary health care and social services, and a representative from the OAT team in the specialist health service work together on the long-term treatment and rehabilitation of the patient. FACT teams are multidisciplinary and aim to provide structured, comprehensive treatment to a group of patients with mental disorders, often combined with substance use problems. The teams consist of health and social care personnel from both primary care and the specialist health service. They must also include personnel with service user experience, peer-support workers and a psychologist or psychiatrist. Somatic health is often followed up by the GP in collaboration with the FACT team.
In these models, comprehensive and holistic treatment is provided over a long period, often spanning many years. The treatment addresses the underlying substance use and/or mental disorder, as well as somatic health problems and general follow-up and rehabilitation. What distinguishes these models from others is that each team possesses expertise in both psychiatric and addiction medicine, while the general medical treatment is overseen by the team's doctors or GPs within a binding collaboration model that includes both the specialist health service and primary care.