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What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance
BACKGROUND: Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards th...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112060/ https://www.ncbi.nlm.nih.gov/pubmed/33975573 http://dx.doi.org/10.1186/s12913-021-06444-x |
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author | Nystrøm, Vivian Lurås, Hilde Midlöv, Patrik Leonardsen, Ann-Chatrin Linqvist |
author_facet | Nystrøm, Vivian Lurås, Hilde Midlöv, Patrik Leonardsen, Ann-Chatrin Linqvist |
author_sort | Nystrøm, Vivian |
collection | PubMed |
description | BACKGROUND: Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians’ (PCPs’) perspectives on admission to a MAW as an alternative to hospitalisation. METHODS: The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. RESULTS: The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients’ condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients’ and relatives’ participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients’ wishes conflicted with what PCPs considered professionally sound. CONCLUSIONS: The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06444-x. |
format | Online Article Text |
id | pubmed-8112060 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-81120602021-05-12 What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance Nystrøm, Vivian Lurås, Hilde Midlöv, Patrik Leonardsen, Ann-Chatrin Linqvist BMC Health Serv Res Research Article BACKGROUND: Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians’ (PCPs’) perspectives on admission to a MAW as an alternative to hospitalisation. METHODS: The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. RESULTS: The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients’ condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients’ and relatives’ participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients’ wishes conflicted with what PCPs considered professionally sound. CONCLUSIONS: The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06444-x. BioMed Central 2021-05-11 /pmc/articles/PMC8112060/ /pubmed/33975573 http://dx.doi.org/10.1186/s12913-021-06444-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Nystrøm, Vivian Lurås, Hilde Midlöv, Patrik Leonardsen, Ann-Chatrin Linqvist What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance |
title | What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance |
title_full | What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance |
title_fullStr | What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance |
title_full_unstemmed | What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance |
title_short | What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance |
title_sort | what if something happens tonight? a qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112060/ https://www.ncbi.nlm.nih.gov/pubmed/33975573 http://dx.doi.org/10.1186/s12913-021-06444-x |
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