Turning Points in Intermediate Patient Care Paths of Elderly: Constructive Reflections on Video Experiments with GPs and Municipalities

The Danish healthcare system has transformed toward shorter hospital stays and increased dependency on primary care in municipalities. General practitioners (GPs) are key to preventing the (re)admission of elderly patients to the hospital, but visits to elderly, bedridden patients are not always compatible with GPs’ office hours. This paper presents and discuss experiments with video in intermediate care paths for the elderly. The first experiment presents an ethical design guideline and playbook for cross-sectorial collaboration between a GP, home nurse and patient with video. The second experiment tries out video consultations with GPs in patient care paths. An ideographic, in-depth analysis of the communication and interaction between a 72- year-old male patient at a rehabilitation unit, his GP and municipality nurse give insights into clinical, organizational and technical aspects of video-mediated health care services.
The analysis is reflected and discussed from a systemic perspective: At the micro-level, patient empowerment and safety in the patient care path from the video consultation are possible but cognitively demanding and risky for the role
of the GP and the nurse. At the meso-level, interdisciplinary collaboration between the GP and the nurse depends on clarification of user roles, tasks and training in order for video to be efficient and safe. At the macro-level, the
development of a cross-sectorial learning strategy, as well as a more thorough analysis of the kind of medical attention needed, is helpful for dividing tasks and responsibilities in intermediate care paths.