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Why does the provision of home mechanical ventilation vary so widely?

By Knut Dybwik, Terje Tollåli, Erik Waage Nielsen and Berit Støre Brinchmann


There is wide variation in the provision of home mechanical ventilation (HMV) throughout Europe, but the provision of home mechanical ventilation can also vary within countries. In 2008, the overall prevalence of HMV in Norway was 19.9/100,000, and there were huge regional differences in treatment prevalence. The aim of this study is to find explanations for these differences. We gathered multidisciplinary respondents involved in HMV treatment from five hospitals in five different counties to six focus group conversations to explore respondents' views of their experiences systematically. We based the analysis on grounded theory. We found that uneven distribution of “enthusiasm” between hospitals seems to be an important factor in the geographical distribution of HMV. Furthermore, we found that the three subcategories, “high competence,” “spreading competence,” and “multidisciplinary collaboration,” are developed and used systematically in counties with “enthusiasm.” This culture is the main category, which might explain the differences, and is described as “wise enthusiasm.” The last subcategory is “individual attitudes” about HMV among decision-making physicians. The most important factor is most likely the uneven distribution of highly skilled enthusiasm between hospitals. Individual attitudes about HMV among the decision makers may also explain why the provision of HMV varies so widely. Data describing regional differences in the prevalence of HMV within countries is lacking. Further research is needed to identify these differences to ensure equality of provision of HMV

Topics: Original Paper
Publisher: SAGE Publications
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Provided by: PubMed Central

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  1. (1998). Basics of qualitative research. Grounded Theory procedures and techniques, 2nd ed. Thousand Oaks,
  2. (2009). Clients’ experiences of living at home with a mechanical ventilator.
  3. (1996). Focus groups.
  4. (2003). for Home Mechanical Ventilation: Information in English.[document on the internet] [updated
  5. (2004). Home mechanical ventilation in Sweden–inequalities within a homogenous health care system. Respir Med
  6. (2000). Home mechanical ventilation in Sweden, with reference to Danish experiences.
  7. (2008). Keeping the spirit high: why trauma team training is (sometimes) implemented. Acta Anaesthesiol.Scand.
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  9. (1991). Life satisfaction of individuals with Duchenne muscular dystrophy using long-term mechanical ventilatory support.
  10. (2003). Long-term noninvasive mechanical ventilation for children at home: a national survey. Pediatr Pulmonol
  11. (2001). Long-term ventilation for patients with Duchenne muscular dystrophy: physicians’ beliefs and practices. Chest
  12. (2003). Meanings of living at home on a ventilator. Nurs Inq
  13. (2005). Patterns of home mechanical ventilation use
  14. (2009). Prevalence of home ventilation therapy in Norway. Tidsskr Nor Laegeforen
  15. (2001). Qualitative research: standards, challenges, and guidelines. Lancet
  16. (1995). Qualitative research. Introducing focus groups. BMJ
  17. (2002). Quality-of-life evaluation of patients with neuromuscular and skeletal diseases treated with noninvasive and invasive home mechanical ventilation. Chest
  18. (1997). The focus group kit.
  19. (2008). The Norwegian Council for Quality Improvement and Priority Setting in Health Care: Home Mechanical Ventilation. [document on the internet] [updated
  20. (1978). Theoretical sensitivity. Mill
  21. (2004). User perspectives on issues that influence the quality of daily life of ventilator-assisted individuals with neuromuscular disorders. Can Respir J

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