Helge Garåsen The Trondheim Model - NSDM

A study in Denmark has shown that acute admissions to nursing homes instead of general
hospital care were appropriate only in a very small number of cases (101-102).
There have also been studies of nurse led intermediate care versus standard care at general
hospitals (103-104). The conclusions so far are that nurse led intermediate care led to longer
hospital stays (103) and were significantly more expensive (104- 105). However, none of the
studies assessed whether patients were better prepared for discharge when using this model of
care.
2.9 Transferring duties from hospitals to primary care
Health and social care services are under severe financial pressure in most Western countries.
There are, at both national and international levels (106), discussions on how to provide care
for older people the next 20 years that will supply the high-quality outcomes sought when the
“baby-boomer” generation approaches the age of retirement (106).
A white paper from the NHS, in the UK, (107) discusses a new direction for care; e.g.
proposing:
- Better prevention
- More long term care has to be given in the home instead of at nursing homes
- More care undertaken outside general hospitals.
As in England, health professionals and politicians in Norway have for several years been
discussing how cooperation between primary and secondary care can reduce the pressure on
general hospital beds (108). However, most of the proposals so far have simply described how
to transfer tasks and duties from general hospitals to community care. Several elucidations
have been made by the central health administration in Norway (Ministry of Health and
Social- and Health Directorate) that have laid out care programs, and/or care guidelines,
developed by specialists and bureaucrats. However, these guidelines instructing primary care
givers how to treat patients; e.g. guidelines for treating schizophrenic patients (109) and
respirator patients (110) on primary level has been proposed without consultation with
primary level professionals.
Even though the intentions of different white papers were to provide better patients’ care,
there remain many uncertainties as to which form of care delivery is the most cost-effective.
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