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Introduction: As a consequence of the new Danish Municipal Reform introduced in 2007, most of the former hospital training service has been transferred to the municipalities. This study investigates if Denmark had a disease-specific standardization of training before the reform., Material and Methods: All Danish hospitals and municipalities were invited to answer a questionnaire about professional guidelines and the use of tests in connection with training of mobility disabled people., Results: Among the 68 hospitals and 270 municipalities included, the total response rates were 69% and 84%, respectively. In all, 116 training units were identified in the hospitals: 24 neurologic; 34 orthopaedic; 22 rheumatologic; 19 geriatric; and 17 "general". The geriatric and neurologic specialities had more professional guidelines and used tests more frequently than the orthopaedic and rheumatologic specialities. The use of standardized test in the municipalities and within the geriatric speciality was similar. Differences in standardization between clinical specialities reflect differences in the working conditions regarding specific disease patterns., Conclusion: Before the introduction of the Municipal Reform, hospital training programs were standardized using speciality-specific guidelines and tests. Future investigations may show how this disease- and speciality-specific perspective on training is implemented under the new guidelines.

This article illustrates how a group of patients assess their own discharge from a neuromedical department. The length of notice about discharge is connected with the patient's experience of orientation and planning. The longer the notice, the greater the satisfaction with the orientation given by the doctor about the disease, the therapeutic possibilities and the prognosis and with the nursing staff as regards intake of medicine. Although the patient clientele has serious social problems, only one fourth had had contact with a social worker in connection with hospitalization. Over one third of the patients found that the first weeks after discharge constituted the most difficult period during the entire course of the disease and this may be connected with the fact that many of them experienced discharge as being badly planned. This shows that discharge is a stressing event in the course of an illness and that it requires more attention than it has hitherto received.

The object of this investigation is to illustrate the effect of intensive social assistance at and after discharge from hospital and, if possible, to present some practical proposals. The investigation was controlled: 100 patients domiciled in two communities in the catchment region of the hospital participated in the investigation. The patients were aged 25-75 years and they were discharged from a neuromedical inpatient department. These were subdivided at random into an intervention and a control group. The investigation comprises interviews with the patients, questionnaires to the general practitioners and the social and health authorities. Intervention was undertaken for five months in one of the groups in cooperation with the general practitioner. Although the intervention revealed that there were numerous unsolved problems and that patients with poor ability were left to themselves to a great extent, the intervention did not result in any measurable difference in patient satisfaction as compared with the control group. No readmissions occurred on account of social reasons in the intervention group. A series of planned forms of assistance did not function on discharge. The fact that patients are discharged earlier in the course of the condition than previously is considered to be the cause of a number of the unsolved problems. At the conclusion of the investigation, there were more numerous unsolved problems in the control group than in the intervention group and the need for advice and support, not only for the patients but also for the relatives, which was considerable after discharge, was documented. This need has not fulfilled and proposals are discussed.

This article accounts for how general practitioners and a group of neuromedical patients experience cooperation with hospital, social workers and the social authorities after discharge from hospital and their own wishes on this subject. The investigation reveals that communication is not optimal and that it should be intensified. The frequency of contact between the general practitioner and the patients is considerable and half of the patients desire follow-up treatment by the general practitioners. The majority of the general practitioners are willing to undertake follow-up treatment. The majority of the patients want their own general practitioner to be involved in solution of the social problems and the majority of the general practitioners want to be told by the social worker attached to the department about the problems which neuromedical patients may encounter on discharge from hospital. Less than half of the letters of discharge are sent to the patient's general practitioner within two weeks of discharge. By and large, the content of the letters of discharge is satisfactory with the exception about the information given to the patients. Although the patient clientele has serious social problems, cooperation between the general practitioner and the social authorities is defective. The general practitioners emphasize lack of special knowledge and defective understanding of the problems which neuromedical patients experience and defective interest in suggestions made by general practitioners to persons in the social administration. More than one third of the general practitioners would prefer cooperation with the social worker from the department during the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)