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Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hospital referral in acute situations is a complex process with a significant impact on older adults. This study aims to explore the considerations of healthcare providers from both primary and secondary care when deciding whether or not to refer an older patient to the hospital in acute situations. By including perspectives of different health care providers, this study seeks to provide a more comprehensive understanding of the decision-making process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In February 2025, three online semi-structured focus group discussions were conducted with 16 primary and secondary healthcare providers. Three case studies (two hip fractures, one COPD exacerbation) guided the discussion. Data were analysed using a combination of inductive and deductive thematic analysis and were iteratively clustered and visualized around four key consideration factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty subthemes were identified and mapped onto four overarching main themes, corresponding to the four key consideration factors: patient-related (e.g. network, quality of life, patient and family preferences, emotional status and living situation), healthcare provider-related (e.g. professional attitude, collaboration and familiarity with patients), case-specific (e.g. age, medical history, activities of daily living (ADL) and mobility, cognitive functioning, frailty, prognosis, the acuity of situation, alternative treatment, and risk of complications) and structural factors (e.g. ability to arrange appropriate care and the patients\u2019 increasing care demand).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Decision-making in hospital referrals is not determined solely by the acute condition, but is a complex and dynamic process. This highlights the importance of strengthening interprofessional communication and collaboration, addressing the shortages in the availability of appropriate patient care, and extending advance care planning (ACP) practices by involving family members to support more patient-centred referral decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12875-026-03453-9","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:04:19Z","timestamp":1784556259000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Considerations in referring older patients to hospital in acute situations: a qualitative study based on the experiences of healthcare providers"],"prefix":"10.1186","volume":"27","author":[{"given":"Cindy","family":"Cardol","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britt","family":"Wagenaar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanneke","family":"Merten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"de Man","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"Hasselaar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"van Eikenhorst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cordula","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"issue":"5","key":"3453_CR1","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1258\/jrsm.2010.100104","volume":"103","author":"F Hajjaj","year":"2010","unstructured":"Hajjaj F, Salek M, Basra M, Finlay A. 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BMC Med. 2017;15(1):102.","journal-title":"BMC Med"}],"container-title":["BMC Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-026-03453-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-026-03453-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-026-03453-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:40:32Z","timestamp":1789627232000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12875-026-03453-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3453"],"URL":"https:\/\/doi.org\/10.1186\/s12875-026-03453-9","relation":{},"ISSN":["2731-4553"],"issn-type":[{"value":"2731-4553","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"assertion":[{"value":"10 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Our study was conducted in accordance with the Declaration of Helsinki (32). The Medical Research Ethics Committee of Amsterdam University Medical Centre declared that the Medical Research Involving Human Subjects Act did not apply (registration number 2023.0479). When a healthcare provider expressed interest in participating, an email with information about the study was sent. At the start of each focus group, the moderator asked if the participants had any questions regarding their participation. All participants provided explicit verbal informed consent to participate in the study and consented to the audio-visual recording of the focus group. Participating in the focus groups posed no risks. All participants received a voucher worth 25 euros as a token of appreciation for their participation.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All participants provided verbal informed consent for the publication of the data collected in this study.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"331"}}