One patient, two worlds - coordination between nursing home and hospital doctors.

Abstract

Increasingly poor health in the nursing home population and transfer of responsibilities to the municipal health services place great demands on collaboration between primary and secondary health services. The article presents the opinions of nursing home and hospital doctors with regard to treatment of nursing home patients and their descriptions of the coordination between doctors at the two levels. This qualitative study was conducted in a Norwegian county in 2011 – 12. The results are based on manifest content analysis of ten focus group interviews with a total of 46 nursing home doctors, and eight focus group interviews with 41 hospital doctors from the medical departments in the public county hospital. From their respective standpoints, both groups of doctors were concerned about unnecessary admissions and overtreatment in hospitals. They had widely differing approaches to patient treatment and communicated that little coordination took place in the treatment of nursing home patients. Both groups described strikingly little communication between the doctors in the context of transfer between the levels. Preconceived notions, negative experiences and lack of communication may reduce trust and prevent proper dialogue about patients. This may cause both over- and undertreatment, as well as give rise to erroneous expectations. The municipal health services and the hospitals share the responsibility for appropriate coordination and treatment of individual patients from nursing homes.