A qualitative study of purchaser unit employees' experiences of patient pathways from specialist healthcare to primary healthcare in Norway

Introduction: Understanding the purchaser-provider split model in the patient pathway is important. The purchaser is a key player in managing the flow between specialist and municipal healthcare services. A smoother patient transfer has been a priority in Norway, but also challenging. Accordingly, this study aims to describe and explain how the purchasers operate as liaisons during patient transfers from specialist to primary healthcare services. Methods: Eleven interviews were conducted with employees at purchaser units in primary healthcare in Norway. The interviewees' professional backgrounds were in nursing and physiotherapy, as well as casework, and management. The interviews took place in 2018-2019 and analyzed with Graneheim and Lundman's content analysis strategy. Results: The interviewees' views reflected the changes they experienced in the wake of healthcare reforms in specialist healthcare services and municipal healthcare institutions. Three themes emerged from the analyses: (1) increased efficiency requirements after the Coordination Reform, (2) better reporting systems and the need for role clarifications in contact with hospitals, and (3) the need for good assessments for safe transfer to the municipality. Discussion: Purchaser unit employees' experiences with patient pathways point towards a need for certain changes. There is a need for increased efficiency requirements for purchasing units, even with new electronic tools, as well as a growing need for better reporting systems and a common understanding between the service levels about what patients can expect in the municipalities.