‘Being a useful puppet’ A study of municipal medication-assisted rehabilitation in Norway

The issue addressed by this study is informed by the experiences of employees in community services in medication-assisted rehabilitation (MAR) in relation to current practices. The study was carried out in a Norwegian municipality with 53,000 inhabitants. An electronic questionnaire with multiple choice answers and options for freetext responses was issued to 11 municipal employees and 13 general practitioners (GPs). The municipal employees perceive the current MAR system as deficient. The diversity of the patients gives rise to great variation in professional experience. Cooperation and follow-up is to a very great extent dependent on the individual concerned. The respondents also state that the medical aspect of MAR work has become overly predominant, and call for a more systematic approach to improve common professional understanding, division of responsibility and coordination. The material suggests that each general practitioner attends to too few MAR patients to be able to accumulate sufficient expertise in treatment and care pathways. Current practice, where general practitioners often feel themselves as ‘being useful puppets in the MAR system’, is regarded with relatively high dissatisfaction. Respondents in this Norwegian study assert the need to consider a more centralised form of organisation releasing general practitioners from MAR responsibility. In the analysis, the focus was on how municipal employees and general practitioners interpret MAR. This lead to various reflections and issues of concern arising out of the materials obtained