The goal of transmural care is to bridge the gap that exists between general primary care and specialized hospital care. In many cases it means that care that is traditionally performed within the hospital, is now substituted to the home care. Therefore, transmural care adds to the strains in the home care field. In the words of the Dutch National Council for Public Health transmural care is:
'Care, geared to the needs of the patient, provided on the basis of cooperation and coordination between general and specialized caregivers, with shared responsibility and specification of delegated responsibilities '.
Transmural care overlaps with the concepts of 'shared care', used in the United Kingdom and 'integrated care delivery', emerging in the United States. Starting in 1990, many transmural initiatives have been taken in which home-based and hospital-based providers work together in project teams to improve quality and efficiency in care delivery. Transmural care may be grouped into seven categories.
The first one is 'home care technology'. It indicates that by the introduction of new techniques it is possible to provide traditional medical specialty care in the home setting. Examples are: patients who need intravenous pain treatment for cancer, or antibiotics to treat cystic fibrosis.
The second category is 'before- and after-care in the primary care setting'. The obvious goal of this group of transmural care is to make an efficient use of the hospital resources. This can be done by having GPs perform extensive diagnostic work-ups before referring a patient to the hospital. Furthermore, by using minimally invasive surgical techniques it is possible for an increasing amount of uncomplicated surgery to be performed in day care settings. In this case the GP and the district nurse provides pre- and postoperative care.
