Abstract
Background: Intermediate care in primary care settings occurs widely in different shapes and forms and is mainly intended to provide an alternative to hospital care for older people. In the international context, the Nordic states are often looked to because of their model of universal welfare and integrated municipal health and long-term care services. In Denmark and Norway, nationwide municipal acute intermediate care services have been implemented in the last decade, following national healthcare reforms.
Objective: The main objective is to map the similarities and differences in organisation and structure of municipal based intermediate services in two Nordic welfare states, Denmark and Norway. Secondary objectives are (i) to describe the challenges the different services aim to address and (ii) to assess the mechanisms in which the different types of intermediate services seek to address these challenges. This will, in turn, contribute to conceptual clarification, facilitating future comparative studies in the field.
Design and methods: This a study is a descriptive-comparative analysis of intermediate care in Denmark and Norway. We applied a narrative approach to search for statistics, health policy documents, scientific articles, statistics and reports. An analytic framework was designed to identify main characteristics of intermediate care, inspired by a Delphi study defining characteristics of intermediate care models and a study comparing international models of integrated care.
Results: In the research literature, intermediate care services are often divided into ‘admission avoidance’ and ‘early supported discharge’ (ESD). Intermediate care services in Denmark and Norway can be further divided into ‘acute’ and ‘non-acute’ services. In 2022, Denmark had 3.223 intermediate care beds and Norway had 10.061 intermediate care beds. The main target population is people who would benefit from short-term care after or instead of hospitalisation and people who are not safe staying at home. In both countries, non-acute intermediate care beds have no national guidelines and are often used for early discharge from hospital. The implementation of acute intermediate care is based on mandatory guidelines in both countries. In Norway, municipal acute beds for admission avoidance are obligatory, whereas in Denmark, acute beds are optional. However, Danish municipalities are obligated to have acute care teams, which serve both an admission avoidance and ESD function.
Conclusion: Municipal intermediate care services are used to maintain people with complex health needs in the community setting, to support early discharge from hospital and to avoid hospital admission. Our study shows that Danish and Norwegian municipal intermediate care can be divided into acute and non-acute services. The implementation of Norway and Denmark’s acute intermediate care services has been driven by national health authorities, whereas the different non-acute intermediate care beds shows a more diverse landscape of services with no formal national policy or guidelines. To ensure the quality of different intermediate care services and resource utilisation it is important to increase research and policy attention in this field.