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Unseen and unread decision letters in everyday care: a case study of medication management assistance in Norwegian municipal home healthcare
Marianne Kollerøs Nilsen 
,
Hege Sletvold ,
Sue Jordan,
Rose Mari Olsen
,
Hege Sletvold ,
Sue Jordan,
Rose Mari Olsen
Scandinavian Journal of Primary Health Care, Volume: 44, Issue: 1
Swansea University Author: Sue Jordan
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DOI (Published version): 10.1080/02813432.2026.2669814
Abstract
Background: Medication safety in home healthcare is critical for older adults with multimorbidity and polypharmacy. Norwegian municipalities allocate medication management support through legally binding individual decision letters intended to ensure transparency and guide care. Their practical role...
| Published in: | Scandinavian Journal of Primary Health Care |
|---|---|
| ISSN: | 0281-3432 1502-7724 |
| Published: |
Informa UK Limited
2026
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa71945 |
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2026-05-18T21:56:42Z |
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2026-06-12T13:21:18Z |
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<?xml version="1.0"?><rfc1807><datestamp>2026-06-11T12:49:14.9861801</datestamp><bib-version>v2</bib-version><id>71945</id><entry>2026-05-18</entry><title>Unseen and unread decision letters in everyday care: a case study of medication management assistance in Norwegian municipal home healthcare</title><swanseaauthors><author><sid>24ce9db29b4bde1af4e83b388aae0ea1</sid><ORCID/><firstname>Sue</firstname><surname>Jordan</surname><name>Sue Jordan</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2026-05-18</date><abstract>Background: Medication safety in home healthcare is critical for older adults with multimorbidity and polypharmacy. Norwegian municipalities allocate medication management support through legally binding individual decision letters intended to ensure transparency and guide care. Their practical role in everyday medication management remains unclear. This study explores how individual decision letters facilitate safe medication management practice in municipal home healthcare services. Methods: A qualitative multiple-case study was conducted across three rural municipalities. Data comprised 15 decision letters and 35 semi-structured interviews with nine patients, one general practitioner, four nurses, and two service allocators over 12 months. Reflexive thematic analysis was used to identify patterns in how the decision letters were interpreted and implemented in practice. Results: Decision letters were seldom read by patients or nurses and often used vague language that required interpretation. Nurses relied on supplementary structures – care plans, task lists, and verbal agreements – to operationalise medication support. Variability in interpretation and revision processes created uncertainty for patients and limited their ability to exercise their rights. Financial constraints further shaped service allocation. Conclusion: Decision letters function primarily as formal legal instruments rather than practical guides. Their limited clarity and accessibility reinforce reliance on informal systems and discretionary practices. Enhancing language precision, integrating letters with care plans, and involving patients in reassessments may improve medication safety and patient empowerment.</abstract><type>Journal Article</type><journal>Scandinavian Journal of Primary Health Care</journal><volume>44</volume><journalNumber>1</journalNumber><paginationStart/><paginationEnd/><publisher>Informa UK Limited</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0281-3432</issnPrint><issnElectronic>1502-7724</issnElectronic><keywords>Patient safety; home healthcare; medication management; decision letters; safety-ii; qualitative research; Norway</keywords><publishedDay>15</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2026</publishedYear><publishedDate>2026-12-15</publishedDate><doi>10.1080/02813432.2026.2669814</doi><url/><notes/><college>COLLEGE NANME</college><CollegeCode>COLLEGE CODE</CollegeCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This work was part of the MedSafe Old project, supported by the Research council of Norway under Grant No. 33655.</funders><projectreference/><lastEdited>2026-06-11T12:49:14.9861801</lastEdited><Created>2026-05-18T22:53:42.2839599</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Nursing</level></path><authors><author><firstname>Marianne Kollerøs</firstname><surname>Nilsen</surname><orcid>0000-0002-6824-8550</orcid><order>1</order></author><author><firstname>Hege</firstname><surname>Sletvold</surname><orcid>0000-0001-5937-2237</orcid><order>2</order></author><author><firstname>Sue</firstname><surname>Jordan</surname><orcid/><order>3</order></author><author><firstname>Rose Mari</firstname><surname>Olsen</surname><orcid>0000-0002-7009-8803</orcid><order>4</order></author></authors><documents><document><filename>71945__36933__d74d2e48a6854707923839150bfa786e.pdf</filename><originalFilename>71945.VoR.pdf</originalFilename><uploaded>2026-06-11T12:47:34.1796906</uploaded><type>Output</type><contentLength>1306944</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© 2026 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution License.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807> |
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2026-06-11T12:49:14.9861801 v2 71945 2026-05-18 Unseen and unread decision letters in everyday care: a case study of medication management assistance in Norwegian municipal home healthcare 24ce9db29b4bde1af4e83b388aae0ea1 Sue Jordan Sue Jordan true false 2026-05-18 Background: Medication safety in home healthcare is critical for older adults with multimorbidity and polypharmacy. Norwegian municipalities allocate medication management support through legally binding individual decision letters intended to ensure transparency and guide care. Their practical role in everyday medication management remains unclear. This study explores how individual decision letters facilitate safe medication management practice in municipal home healthcare services. Methods: A qualitative multiple-case study was conducted across three rural municipalities. Data comprised 15 decision letters and 35 semi-structured interviews with nine patients, one general practitioner, four nurses, and two service allocators over 12 months. Reflexive thematic analysis was used to identify patterns in how the decision letters were interpreted and implemented in practice. Results: Decision letters were seldom read by patients or nurses and often used vague language that required interpretation. Nurses relied on supplementary structures – care plans, task lists, and verbal agreements – to operationalise medication support. Variability in interpretation and revision processes created uncertainty for patients and limited their ability to exercise their rights. Financial constraints further shaped service allocation. Conclusion: Decision letters function primarily as formal legal instruments rather than practical guides. Their limited clarity and accessibility reinforce reliance on informal systems and discretionary practices. Enhancing language precision, integrating letters with care plans, and involving patients in reassessments may improve medication safety and patient empowerment. Journal Article Scandinavian Journal of Primary Health Care 44 1 Informa UK Limited 0281-3432 1502-7724 Patient safety; home healthcare; medication management; decision letters; safety-ii; qualitative research; Norway 15 12 2026 2026-12-15 10.1080/02813432.2026.2669814 COLLEGE NANME COLLEGE CODE Swansea University Another institution paid the OA fee This work was part of the MedSafe Old project, supported by the Research council of Norway under Grant No. 33655. 2026-06-11T12:49:14.9861801 2026-05-18T22:53:42.2839599 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Nursing Marianne Kollerøs Nilsen 0000-0002-6824-8550 1 Hege Sletvold 0000-0001-5937-2237 2 Sue Jordan 3 Rose Mari Olsen 0000-0002-7009-8803 4 71945__36933__d74d2e48a6854707923839150bfa786e.pdf 71945.VoR.pdf 2026-06-11T12:47:34.1796906 Output 1306944 application/pdf Version of Record true © 2026 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution License. true eng http://creativecommons.org/licenses/by/4.0/ |
| title |
Unseen and unread decision letters in everyday care: a case study of medication management assistance in Norwegian municipal home healthcare |
| spellingShingle |
Unseen and unread decision letters in everyday care: a case study of medication management assistance in Norwegian municipal home healthcare Sue Jordan |
| title_short |
Unseen and unread decision letters in everyday care: a case study of medication management assistance in Norwegian municipal home healthcare |
| title_full |
Unseen and unread decision letters in everyday care: a case study of medication management assistance in Norwegian municipal home healthcare |
| title_fullStr |
Unseen and unread decision letters in everyday care: a case study of medication management assistance in Norwegian municipal home healthcare |
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Unseen and unread decision letters in everyday care: a case study of medication management assistance in Norwegian municipal home healthcare |
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Unseen and unread decision letters in everyday care: a case study of medication management assistance in Norwegian municipal home healthcare |
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24ce9db29b4bde1af4e83b388aae0ea1 |
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24ce9db29b4bde1af4e83b388aae0ea1_***_Sue Jordan |
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Sue Jordan |
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Marianne Kollerøs Nilsen Hege Sletvold Sue Jordan Rose Mari Olsen |
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Scandinavian Journal of Primary Health Care |
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44 |
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2026 |
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Swansea University |
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0281-3432 1502-7724 |
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10.1080/02813432.2026.2669814 |
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Informa UK Limited |
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Faculty of Medicine, Health and Life Sciences |
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School of Health and Social Care - Nursing{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Nursing |
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Background: Medication safety in home healthcare is critical for older adults with multimorbidity and polypharmacy. Norwegian municipalities allocate medication management support through legally binding individual decision letters intended to ensure transparency and guide care. Their practical role in everyday medication management remains unclear. This study explores how individual decision letters facilitate safe medication management practice in municipal home healthcare services. Methods: A qualitative multiple-case study was conducted across three rural municipalities. Data comprised 15 decision letters and 35 semi-structured interviews with nine patients, one general practitioner, four nurses, and two service allocators over 12 months. Reflexive thematic analysis was used to identify patterns in how the decision letters were interpreted and implemented in practice. Results: Decision letters were seldom read by patients or nurses and often used vague language that required interpretation. Nurses relied on supplementary structures – care plans, task lists, and verbal agreements – to operationalise medication support. Variability in interpretation and revision processes created uncertainty for patients and limited their ability to exercise their rights. Financial constraints further shaped service allocation. Conclusion: Decision letters function primarily as formal legal instruments rather than practical guides. Their limited clarity and accessibility reinforce reliance on informal systems and discretionary practices. Enhancing language precision, integrating letters with care plans, and involving patients in reassessments may improve medication safety and patient empowerment. |
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2026-12-15T06:02:36Z |
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11.109323 |