An Issue of Trust: Exploring Different Aspects of the Municipal Acute Ward as an Alternative to Hospitalization

Abstract

The main aim of this PhD project was to provide knowledge about various aspects of the Municipal Acute Wards (MAWs) as an alternative to hospitalization. The PhD project included three studies: The first study explored 21 Primary Care Physicians’(PCPs) perspectives on the MAW as an alternative to hospitalization. Findings indicated that PCPs at the out-of-hours service were skeptical to refer patients to a MAW, due to lower medical competence and less diagnostic possibilities compared to in the hospital. However, they perceived that the “diagnostic loop” made it safer to refer patients to a MAW. The second study explored characteristics of 16 786 patients admitted to the MAWs in the period 2014-2020. This study showed that mainly older persons were admitted to the MAW. Patients treated in a MAW mainly needed basic medical treatment, care, and nursing. The results showed that patients were transferred to the hospital when they needed more advanced medical treatment, such as intravenous medication. The third study aimed to assess the quality of healthcare services in MAW compared to those in the hospital. In total, 164 patients were randomized to a hospital or a MAW. Findings from this study indicated that the patients experienced equally positive patient experiences after treatment in a MAW compared to in the hospital. There was a significant larger positive change in self-assessed health -related quality and self-assessed health status for patient allocated to a MAW. Findings in this thesis indicate that despite the PCPs skepticism, the MAWs may provide proper and quality healthcare services in the interface between specialist and primary healthcare. However, the results indicate that there may be a need to adjust the intentions with the MAWs in order to fulfil a future need in healthcare services.