Programme implementation
infidelity
Some of the intervention components took a long time to implement in the municipalities. Most of the patients, relatives, district nurses and GPs in the three intervention municipalities did not use the seven-day telephone consultation offer in the first period of the study. The degree of usage and implementation could be assumed to have varied in and between municipalities. Additionally, the municipalities should have provided extra resources and time for the included patients to facilitate the post-discharge follow-up visits and video conferences. The video conference was a challenge for the district nurses and the involved patients. Technical difficulties, along with audio and visual challenges faced by patients, may have reduced the effect of the conference. In addition, scheduling conferences was difficult due to the high workloads among district nurses. Hence, some of the video conferences and physical visits were cancelled.The GPs and district nurses were not thoroughly informed and instructed about the seven-day consultation offer’s purpose, benefit and usage. Thus, it was not fully implemented. This resulted in uncertainty about the post-discharge treatment responsibility among district nurses and GPs, and the consultation offer was not used as often as anticipated. This may have resulted in readmissions where it could have been prevented by communication between the GP, district nurse and the geriatrician.Unfortunately, intervention fidelity was impossible to assess due to missing data entry. Therefore, we do not know the degree to which the intervention components were delivered as intended. If infidelity was present, it may have resulted in non-significant findings that were not due to the study design but rather to the intervention delivery [The Medical Research Council’s [