Rehabilitation Settings

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Original Editors - Kirenga Bamurange Liliane and Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Vidya Acharya, Kim Jackson, Tarina van der Stockt, Kirenga Bamurange Liliane, Oyemi Sillo, Lucinda hampton and Ashmita Patrao      

Introduction

Rehabilitation is a multidisciplinary process that helps individuals to develop or strengthen their physical, mental and social skills. WHO defines rehabilitation as a set of measures that assist individuals who experience or are likely to experience disability, to achieve and maintain optimum functioning in interaction with their environment. It also reduces disability in individuals with health conditions in relation with their environment. Health conditions can include not only disease (acute or chronic), disorders, injuries or trauma; but may also include other circumstances such as pregnancy, ageing, stress, congenital anomaly or genetic predisposition. Environments refer to the physical, social, and cultural contexts in which individuals and their communities live.

In the ICF framework model, the personal and environmental components play a big role as, together, they comprise a person's context that need to be considered in conjunction with rehabilitation. Rehabilitation refers also to appropriate measures including through peer support, to enable persons with disabilities to attain and maintain their maximum independence. Rehabilitation has been found to be beneficial in reducing length-of-stay in hospitals and decreasing re-admissions, thus mitigating the negative social and health risks associated with prolonged hospitalizations. Anybody may need rehabilitation at some point in their lives, following an injury, surgery, disease or illness, or because their functioning has declined with age.

Rehabilitation Settings

Rehabilitation services are available in different settings and vary worldwide, depending on countries. Rehabilitation is highly person-centered, meaning that the interventions and approach selected for each individual depends on their goals and preferences. Even though there might be a slight difference in settings, medical rehabilitation and therapy are usually provided in different places depending on the severity of the conditions. They can be provided in the following settings as well:

For Acute Onset Conditions

• Hospitals for acute Onset condition

For Subacute Rehabilitation

• Specialized wards or hospitals
• Rehabilitation Centres
• Nursing Homes
• Hospice
• Prisons
• Residential Educational Institutions
• Clinics

For Long-term Rehabilitation

• Primary Heath Care Centres
• Schools
• Workplaces
• Home-care Therapy Services

Rehabilitation can be provided in many different settings, from inpatient or outpatient hospital settings, to private clinics, or community settings including an individual’s home.

Primary Health Care

As health care systems attempt to meet the needs of populations living longer and with more complex health needs, and with health service delivery being shifted to the community, there has been an increasing emphasis on primary health care. Primary health care is used to describe the first contact a person has with the health system when they have a health problem or issue that is not an emergency. It is the part of the health system that people use most and may be provided, for example, by a general practitioner (GP), dentist or pharmacist. A primary healthcare service may diagnose and treat common health conditions within their area of expertise. They have the ability to assess the urgency of the condition and, direct to the patient by providing referrals to other medical specialists if needed. Studies have shown that primary care providers benefit the healthcare system as a whole by offering enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary Health Care is an approach to health care that moves beyond traditional primary care to address health concerns at an early stage, emphasize health promotion and illness prevention through health and wellness programmes, and ensure that individuals receive accessible health and social services in their community.vii

Benefits of Rehabilitation in Primary Healthcare

Primary health care is where the diagnosis of a large majority of health conditions, the identification of problems in functioning, and referral to other service delivery platforms need to occur.  The following benefits can be listed among others:

• Better quality of life.
• Reduction of the prevalence and minimization of the disabling effects of chronic conditions among adults and children.
• Facilitation of the continuity of care that supports full recovery.
• Helps to lessen the risk of preventable complications and secondary conditions.
• It can also help to avoid costly hospitalizations and re-admissions

Early access to rehabilitation through integration in primary health care helps to optimize outcomes, mitigate disability and improve people’s ability to live independent lives. WHO’s emphasis on universal health coverage and its recent launch of the Rehabilitation 2030 Call for Action are encouraging steps towards the goal of strengthening rehabilitation within the health system and in particular in primary health care.

Secondary Health Care

When your primary care provider refers you to a specialist, you are then in secondary care. Secondary care simply means you will be taken care of by someone who has more specific expertise about your condition.

Secondary Health Care is the specialist treatment and support provided by doctors and other health professionals for patients who have been referred to them for specific expert care, most often provided in hospitals. Secondary healthcare includes a wide range of specialists such as psychiatrists, cardiologists, obstetricians, dermatologists, pediatricians and gynecologists

Tertiary Health Centre

This is a specialized consultative health care for inpatients. The patients are admitted into these centres on a referral from primary or secondary health professionals. Tertiary health care is provided in a facility that have personnel and facilities for advanced medical investigation and treatment. Services provided include cancer management, neurosurgery, cardiac surgery and a host of complex medical and surgical interventions. Advanced diagnostic support services and specialized intensive care which cannot be provided by primary and secondary health centers are available at the tertiary health centers. Tertiary services include specialized consultative health care, usually based at national level and provided in hospitals on an inpatient basis (based on definitions in the health component of the community-based rehabilitation guidelines.

Community Rehabilitation

Acute medical illness can be associated with a temporary reduction in our ability to carry out the normal activities of daily living. Therefore rehabilitation is often needed during recovery from an acute medical illness so that patients can return to the same level of functioning and independence. Community rehabilitation is a viable alternative to hospital inpatient treatment for selected patients, and would be the preferred option to maintain patients’ independence. Rehabilitation in the community should be offered to patients as an alternative to routine hospital inpatient rehabilitation, depending on their clinical condition and after discussion of risks and benefits.

Resources

References