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The Finnmark general practitioner hospital study. Patient characteristics, patient flow and alternative care level
1Institute of Community Medicine, University of Tromsø, Norway.
Objectives:
In a study assessing the role of general practitioner hospitals (GPHs) in the health service two main questions were addressed: 1) Are general practitioner beds used for short-term medical observations, or as a supplement for long-term geriatric care? 2) What are the alternatives to stays in GPHs?
Design:
In a prospective design GPH stays during 8 weeks were recorded.
Setting:
15 GPH units in Finnmark county in Norway.
Subjects:
395 completed stays were recorded.
Main Outcome Measures:
The patients' sex, age and diagnosis, flow of patients, length of stays, bed occupancy rate, and doctors' assessments of alternative level of care.
Results:
60% of the patients were admitted from and discharged to their home after a mean stay of 6.8 days. The 19% who were transferred to higher level hospitals stayed significantly shorter than the rest (3.6 days), while 9% transferred from hospital stayed significantly longer (22.3 days). Of the 395 patients discharged 61% were assessed as candidates for higher level hospitals, if GPHs did not exist. 45% of the GPH stays seem to replace higher level hospital admissions.
Conclusion:
The GPHs have a pre-hospital "buffer" function by preventing patients with acute symptoms from being unnecessarily admitted to general hospitals through short-term observation stays. A post-hospital function was also demonstrated, since GPHs allow for long-term follow up stays for patients transferred from general hospitals.