Organisational and Professional Integration Between Specialist and Primary Healthcare Services: A Municipal Perspective

Care transitions between specialist and primary healthcare services for people with concurrent substance abuse and mental health problems are characterised by vulnerability and arbitrariness. By studying factors that influence integration in a Norwegian context, this study aims to investigate, from a municipal perspective, why care transitions are still tricky after the introduction of the key Coordination Reform. This study has an explorative approach based on interviews with managers and front-line professionals in primary care. We applied the conceptual framework of functional and normative integration of the Rainbow Model. The municipal actors emphasise that integration is hampered by limited cooperation with general practitioners in referrals to hospital, challenges of communication and loss of meeting points. They experienced close cooperation with sociomedical polyclinics for substance abuse, while challenges in cooperation with district psychiatric centres indicated an interdependence of functional and normative integration. Questioning hospital discharge of patients to primary care was a recurring theme for the municipal actors. Thus, the governing framework of the Coordination Reform has coexisted with fragmentation in organisational structures and divided professional cultures. The coexistence of the new and the old regimes seems to hamper functional and normative integration in care transitions.