title: General practitioners' perspectives on referring patients to decentralized acute health care.
abstract: Municipality acute wards (MAWs) have recently been introduced in Norway. Their mandate is to provide treatment for patients who otherwise would have been hospitalized. Even though GPs are key stakeholders, little is known about how they perceive referring patients to these wards. The aim of this study was to investigate GPs' perspectives on factors relevant for their decision-making when referring patients to MAWs.
  
  
  
  We used a qualitative approach, conducting semi-structured interviews with 23 GPs from five different MAW catchment areas in the southeastern part of Norway. The data were analysed using thematic analysis.
  
  
  
  The GPs experienced challenges in deciding which patients were suitable for treatment at a MAW, including whether patients could be regarded as medically clarified, and whether these services were sufficient and safe. GPs were also under pressure from several other stakeholders when deciding where to refer their patients. Moreover, the MAWs were viewed not merely as an alternative to hospitals, but also as a service in addition to hospitals.
  
  
  
  This study improves our understanding of how GPs experience decentralized acute health care services, by identifying factors that influence and challenge their referral decisions. For these services to be used as intended in the collaboration reform, integrating the perspectives of GPs in the development and implementation of these services may be beneficial.
authors.affiliation: Department of Research, Østfold Hospital Trust, Sarpsborg, Norway, dleo@online.no.
authors.forename: Ann-Chatrin L
authors.initials: AL
authors.lastname: Leonardsen
authors.affiliation: Faculty of Health and Social Studies, Østfold University College, Fredrikstad, Norway and.
authors.forename: Lilliana
authors.initials: L
authors.lastname: Del Busso
authors.affiliation: Faculty of Health and Social Studies, Østfold University College, Fredrikstad, Norway and.
authors.forename: Vigdis A
authors.initials: VA
authors.lastname: Grøndahl
authors.affiliation: Department of Research, Østfold Hospital Trust, Sarpsborg, Norway.|Department of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Waleed
authors.initials: W
authors.lastname: Ghanima
authors.affiliation: Department of Research, Østfold Hospital Trust, Sarpsborg, Norway.|Faculty of Health and Social Studies, Østfold University College, Fredrikstad, Norway and.
authors.forename: Lars-Petter
authors.initials: LP
authors.lastname: Jelsness-Jørgensen
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D018166:Health Care Reform; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009664:Norway; D061214:Patient Safety; D036301:Qualitative Research; D012017:Referral and Consultation
keywords: Access to care; community medicine; doctor–patient relationship; emergency medicine/urgent care; primary care; public health.