Résumé :
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Background : An important principle of the Norwegian public health care system is an equal access to health care, regardless of geographic location. In 2008 the overall prevalence of home mechanical ventilation (HMV) in Norway was 21/100 000. A national report found a difference between top- and bottom-county of 59 versus 5/100 000. The aim of this study is to find explanations for these differences. Methods : We gathered multidisciplinary respondents involved in HMV treatment from four Norwegian hospitals in four different counties to focus group interviews.The focus group moderator kept a small and homogeneous group focused on the discussion of HMV. Focus groups are useful for exchanging different point of views and obtaining in-depth information which can not be revealed by face to face interviews. The interviews were transcribed and analyzed using elements from Grounded Theory. Preliminary results : Prevalence rates in these counties ranged from59 to 31/100,000. The large geographical differences in the HMV treatment in Norway depend on several factors. Personal attitudes to HMV treatment among decision makers, and knowledge about this highly specialized treatment, appears to play an important role in the recruitment of new HMV patients. Hospitals with high treatment prevalence often have a one or a few, but very experienced and highly skilled enthusiasts, who through an organized and systematic cross-disciplinary collaboration identify and recruitmany patients. To inform and educate all levels of the health care system on HMV also seem to recruit many new patients. Conclusion : Personal attitudes and knowledge about HMV among the decision makers may explain why HMV is unevenly distributed. The most important factor is most likely the enthusiasm of a few experts in a few Norwegian hospitals. Norwegian health authorities prepare national guidelines to compensate for these differences.
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