Bakgrund: Akuta försämringstillstånd i hemmet hos de mest sjuka äldre inträffar ofta. Det är inte ovanligt att flera olika vårdverksamheter är inblandade i vården kring denna grupp vilket ställer krav på en fungerande samverkan. Sjuksköterskor inom flera verksamheter möter de äldre vid akuta försämringstillstånd vilket skapar behov av en fungerande samverkan. Syfte: Syftet med studien var att belysa upplevelser av samverkan bland sjuksköterskor verksamma inom kommun, primärvård, ambulans och akutmottagning i samband med att de mest sjuka äldre blir akut försämrad i sitt hem. Metod: Kvalitativ metod med fokusgruppsintervjuer med sjuksköterskor som hade erfarenhet av samverkan kring de mest sjuka äldre vid akuta försämringstillstånd i hemmet. Intervjuerna analyserades enligt Burnard (1996) innehållsanalys i fyra steg. Resultatet: Analysen resulterade i två huvudkategorier samt sex underkategorier. Huvudkategorin Ensam i teamet presenteras i underrubrikerna Att företräda de mest sjuka äldre, Avsaknad av bedömning på plats och Interaktion med kollegor. Huvudkategorin Jakten på information presenteras i underrubrikerna Betydelsen av information om de mest sjuka äldre, Avsaknad av gemensamt IT-stöd och Behov av att dela information. Slutsats: Sjuksköterskorna upplever samverkan som en nödvändighet vid akuta försämringstillstånd av de mest sjuka äldre i hemmet. Samverkan visar sig dock vara kantad av barriärer. För att kunna bedöma och möta behoven hos de mest sjuka äldre i dessa situationer efterfrågar sjuksköterskorna en förändrad struktur för teamsamverkan, förbättrad kommunikation och informationsdelning. Detta skulle gagna samverkan och den personcentrerade vården. / Background: Reduced general condition at home among the most frail elderly are common. Collaboration of care is necessary as many different health care providers often are involved. Since nurses often meet the most frail elderly in their home in these situations they dependent ona well-functioning collaboration between the health care providers. Aim of this study was to elucidate nurses experiences of collaboration of care around the mostfrail elderly when reduced general condition at home. Method: Qualitative focusgroupinterviews with fifteen nurses from community based care,primary care, ambulance care and emergency care with experience of caring for the most frailelderly and collaboration of care in the elderly’s home. According to the qualitative contentanalysis described by Bernard (1996) the focusgroupinterviews were analysed. Result: The result consists of the two main categories Alone in the team and The pursuit forinformation and the six subcategories To represent the most frail elderly, Absence of medicalassessment, Interaction between colleges, The importance of information, Absence of shared ITsystem and The want of sharing information. Conclusion: Nurses consider collaboration of care as necessary amongst the most frail elderlywhen reduced general condition at home. The result indicate that collaboration of care is difficultto achieve. To meet the needs of the most frail elderly in these situations nurses desires a changein structure to provide for team collaboration, approvement in communication and in sharinginformation. According to nurses, this would benefit collaboration of care and the personcentered care.

Decades of research have shown that there are significant advantages to maintaining close communicative and collaborative relationships between primary care and behavioral health providers. Fiscal, structural, and systemic barriers, however, often restrict the degree to which such interprofessional collaboration can occur. In the present study the authors examined relationships between primary care clinics in the Appalachian region’s characteristics (i.e., clinic type, rurality, and clinic size), barriers (i.e., fiscal, structural, and systemic) reported to using increased collaboration, and the level of collaboration used at a particular clinic. For the present study 136 surveys were completed by providers working in primary care practices across the Appalachian region of Tennessee. The results showed that only about one fifth of the primary care clinics in Appalachian Tennessee reported engaging in moderate to high levels of primary care behavioral health (PCBH) collaboration (e.g., colocated or integrated models of care). Among community health clinics, however, nearly half reported moderate or high levels of collaboration. The findings of this study underscore the importance policy change (e.g., changes in reimbursement patterns, increases in incentives, introduction of PCBH models in training programs) in facilitating the uptake of high levels of PCBH collaboration in Appalachian Tennessee (especially in regards to nonpublicly funded clinics). Further, the methodology used in this study could provide policymakers and researchers in other regions of the U.S. with a means for obtaining baseline data regarding local trends in PCBH collaboration and could serve as first step in developing a standardized methodology for comparing the overall uptake of PCBH collaboration models across regions.