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Primary health care in Iceland

Primary health care in Iceland. Out of hours services. 1. THE CURRENT SITUATION. Population and doctors. Population in Iceland: 315.000 Population in Reykjavik area: 190.000, 2/3 Working doctors in Iceland: 1120 Working GPs in Iceland: 228 Working GPs in Reykjavik area: 120.

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Primary health care in Iceland

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  1. Primary health care in Iceland Out of hours services Þórður G. Ólafsson

  2. 1. THE CURRENT SITUATION Þórður G. Ólafsson

  3. Population and doctors • Population in Iceland: 315.000 • Population in Reykjavik area: 190.000, 2/3 • Working doctors in Iceland: 1120 • Working GPs in Iceland: 228 • Working GPs in Reykjavik area: 120 Þórður G. Ólafsson

  4. A. Organisation of the OOH- services 1. Reykjavik (capital city) area, 2/3 of total population a) The central GPs on call service (LÆKNAVAKTIN, legevakten) b) 17 health centers c) 1 pediatricians health service d) National hospital in 2 places: Accident and emergency department. Childrens emergency department Psyciatry dep; Gynecology/obstetrics etc. 2. The rural part of Iceland On call services, mostly GPs in the health centers. Direct contact to the GP. Þórður G. Ólafsson

  5. Þórður G. Ólafsson

  6. B. The year 2008 • The central GPs on call service (LÆKNAVAKTIN, legevakten) • Open 5pm – 8am working days and 24 hours weekends and holidays • 80 GPs, 16 nurses,8 receptionists, 4 drivers • 63.000 office visits • 23.000 children (0-18 years) • 7000 home visits • 2.300 children (0-18 years) • 70.000 telephone triage calls Þórður G. Ólafsson

  7. B. The year 2008 • 17 health centers in Reykjavik area: out of hours service. • Open working days 4pm – 6pm in most places • 58.000 office visits • No home visits • No telephone advice • Just a GP and a receptionist Þórður G. Ólafsson

  8. B. The year 2008 • THE NATIONAL HOSPITAL: • Accident and emergency department • 34.500 office visits out of hours • 26.200 office visits 8am- 4pm • Childrens emergency department • 6.108 office visits out of hours • 6.121 office visits 8am- 4pm Þórður G. Ólafsson

  9. B. The year 2008 • Pediatricians health service • Open working days 5pm – 10pm and weekends 11am – 3pm • 11.000 office visits • 20-22 pediatricians participating • NB GPs have 70% of all the office visits OOH Þórður G. Ólafsson

  10. C. The GP´s role • AT LÆKNAVAKTIN: • 1. Office work (usually not accidents or emergency) • 2. Home visits • 3. Teach and backup the telephone nurses • 4. Refer to the National hospital • 5. Refer to the patients GP next day • 6. Follow up some cases the next days from the health center Þórður G. Ólafsson

  11. 2. CHALLENGES Þórður G. Ólafsson

  12. A. Clinical • To provide well trained specialists in general practice for office work and home visits. • To provide well trained nurses to give telephone advice and triage for office and home visits, ambulance etc. • Clear working rules and information for the health care staff. • Regular educational programs (emergency, lab., common problems training etc). • Good service, short waiting time. Þórður G. Ólafsson

  13. B. Expectations in the community • We have not done any studies on that. • People want to see their own GP but they don´t get appointment when they “need”. • We hear that many with minor complaints want to see a doctor after work. • People wants the doctor to have good communicational skills. That he listens, does careful examination and explains the problem. • People don’t like a long waiting time. • The price must be reasonable for the service. Þórður G. Ólafsson

  14. C. Collaborations with other health care services • Department doctors in the National hospital. • Accident and emergency department • Ambulance staff (paramedics) • Emergency telephone line (112) • GPs next day after duty • Labarotorium next days (bact lab, Xray etc.) Þórður G. Ólafsson

  15. 3. THE FUTURE Þórður G. Ólafsson

  16. A. Medical perspective • GPs doing more time consuming work (gyn., lab., small accidents) with doctor assistants. • Doctors direct in telephone triage f.ex. during the night. • GPs getting more gate keeping role and lead triage for the hospitals. • Central telephone triage (nurses/GPs) for the whole population of Iceland. Þórður G. Ólafsson

  17. B. PATIENT PERSPECTIVE • Not easy to speculate! • Service here and now when I want! • More service from doctors • Telephone service, doctors • Internet service! Þórður G. Ólafsson

  18. C. Organisational perspective • Large, central OOH services with well trained GPs. (less burnout).Run by the GPs themselves. Outside the hospitals. • Short (2 hours) OOH service at the health centers. • Pediatricians OOH health service • More cooperation between GPs and the hospital emergency and accident service • Expansion of central telephone triage led by the GPs. Þórður G. Ólafsson

  19. Thank you for your attention! Takk fyrir! Þórður G. Ólafsson

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