Helge Garåsen The Trondheim Model - NSDM

and flexible inputs from multi-professional teams. The plan with intermediate care seems to
be either to send the patient home as quickly as possible or to keep the patient out of general
hospitals (168).
There have been discussions in Britain about the goal of intermediate care; is it primarily a
patient-focused or organisation-focused care form (34,164)? There are at the same time great
concerns about the increasing costs of health care (1), and policies to shift the balance from
secondary to primary care have therefore been a common theme in health service reforms
(172).
It is a challenge to ensure that services are safe, effective and reliable when providing
alternatives to general hospital care. It has been proven that comprehensive geriatric
assessments with comprehensive therapeutic plans are effective means of identifying medical
problems when associated with strong long-term management (169). Older patients, more
than any other patients, need to be admitted to general hospitals to ensure correct diagnosis
for diseases and geriatric assessments in the acute phase of their diseases (10-14,168,173).
However, long-term management can be provided at intermediate level; either at a community
hospital as shown in study II, or at home (163).
Probably the most important factor when providing intermediate care is the close
communication with the patients and his networks combined with holistic, patient-focused
intervention programmes provided by a multiprofessional team led by a skilled physician or
nurse.
Is the circle complete? The old general practitioner hospitals (“sykestuer”) in Norway, which
had more than 1000 beds in the sixties, provided, to some extent, this kind of care (46). Care
was provided close to home where the local physicians and the local health teams, who knew
the patients and their families, followed the patients closely instead of admitting them to
general hospitals far away from home. May be, there will be a renaissance for these general
practitioners hospitals (= community hospitals). However this time, not only as a place where
patients could be admitted instead of general hospitals, but also as a place providing stepdown
care where older people can be treated and rehabilitated after having been properly
diagnosed at a general hospital and before returning back to their own homes.
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