Experiences with decentralized acute healthcare services from different stakeholders’ perspectives. A mixed methods study

Patients and General Practitioners (GPs) agree that municipal acute wards represent good services for the patients. Patients experience the service as safe, receiving treatment and care from competent nurses and doctors in a “home-like” environment. The GPs experience uncertainty whether the wards can offer diagnostics and treatment of the same quality as in hospital. Municipal acute wards (MAWs) were established as an alternative to hospitalization for patients deemed not in need of specialist healthcare services. Research on MAWs, and specifically on patients’ and GPs’ experiences with MAWs is lacking. The aims of the thesis were to investigate patients’ experiences with and perspectives on MAWs and potential predictors on these experiences, as well as GPs experiences with these services. Patients participated in a questionnaire study (n=479), as well as in interviews (n=27). 23 GPs were interviewed. Patient reported satisfaction to receive acute healthcare services in their local community, in a calm environment and by skilled nurses and doctors. The lack of diagnostic opportunities was experienced as a limitation, but even though patients felt safe and taken care of. Patients’ experiences from the MAWs were continuously compared to their present experiences with hospitalization, emphasizing an experience of a hurried hospital environment with limited time for the personnel to take care of the patients. The questionnaire study discovered areas that needed improvement, such as in relation to discharge and continuity. The only factor that negatively impacted patient experiences was comorbidity. GPs experience that patients are satisfied with the MAWs. Even though they find it difficult to judge whether the patients are stable enough to be referred to the MAW, especially due to the diagnostic limitations. GPs reported of limited time to assess the patients and decide where to refer him or her. GPs did not feel certain that MAWs were a safe alternative to hospitalization. Overall, the MAWs can be a good alternative to hospitalization for patients in a stable condition. When developing and refining such services it is important to include GPs perspectives on decentralized services