Helge Garåsen The Trondheim Model - NSDM

6.8 Discussion of the results
6.8.1. Study I – Paper I
When letters between primary level and secondary level, and vice versa, are missing vital
information, serious consequences for the patients can result; especially, if there are
uncertainties as to who is responsible for follow-up and what has to be followed-up. Older
patients, many with reduced mental capacity, are the group most dependent on a health care
system that is able to communicate and transfer duties in an exact and precise manner.
Specialists have a tendency to over-estimate the effect of their own speciality (148). However,
several studies in Norway, the Netherlands and the UK confirm that appropriate care can be
given at an intermediate level (48), at nursing homes or at general practitioner hospitals (43-
47,96). The hospital physicians in the panels in study I had a higher degree of confidence in
general hospital care than the general practitioners. The nurses, on the other hand, rated the
usefulness of an alternative nursing home care highest. This disagreement between the
professionals as to the benefits of general hospital admissions may be one of the greatest
challenges for the understanding of professional collaboration. A much better dialog must be
developed between health professionals, at primary and secondary level, to establish a
consensus as to the definition of proper care in order to avoid unnecessary referrals to general
hospitals and to secure a better follow-up after discharge.
In the present study there were no statistically significant associations between the quality of
referral and discharge letters and the assessment of the benefit of the general hospital stay,
other than ADL. A good description of ADL was strongly associated with a high benefit of
general hospital care (p