Handovers in primary healthcare in Norway: A qualitative study of general practitioners' collaborative experiences

Worldwide demographic development increases the pressure on healthcare services. In Norway, municipal acute wards (MAWs) have been established as a 24-hr acute healthcare service as a primary healthcare alternative to hospitalisation. General practitioners (GPs) are key holders of referrals to different healthcare service levels, yet studies of GPs' experiences with these wards are sparse. Suboptimal handovers could lead to hospital readmissions, avoidable morbidity and even mortality. The aim of this study was to explore GPs' experiences with patient handovers to MAWs as well as to hospitals. A qualitative study including semi-structured interviews with 23 GPs in a county in south-eastern Norway was conducted. Data were analysed using thematic analysis. The results show that GPs preferred to collaborate with others in their own profession for patient handovers. The GPs had positive collaborative experiences with MAW doctors, while collaboration with doctors in hospitals was viewed more negatively, particularly as GPs had the impression that hospital doctors felt they had superior medical competence. After patient transfer, GPs felt uncertainty related to their own responsibilities for the patient. This study contributes new knowledge about GPs' experiences with collaboration and distribution of responsibility between primary and tertiary healthcare services. This information is essential when developing acceptable alternatives to general hospitals.