Table 4.

Cultural differences found between specialist care and primary care for patients with home care needs

Activity	Specialist care	Primary care
Planning	Short perspective – major changes in a short time	Long perspective – small changes over time
Assessment	Diagnosis with advanced technology	Functional ability, patient preferences and degree of self-management
Diseases	Attention to one disease at a time	Simultaneous attention to all of the diseases patients have; a majority of patients have multiple diseases
Clinical guidelines	Strong adherence to clinical guidelines	Clinical guidelines for multi-morbidity hardly exist
Patient role	Passive; health personnel decide what has to be done	At home the patient decides; focus is on resuming daily activities
Decision making	Often in teams, many involved, and in a confirmed hierarchical structure	Often by health personnel alone or by few; more autonomous