Þórður G. Ólafsson 1

Primary health care in Iceland

Out of hours services

15.05.2009

Þórður G. Ólafsson 2

1. THE CURRENT SITUATION

15.05.2009

Þórður G. Ólafsson 3

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

15.05.2009

Population and doctors

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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.

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A. Organisation of the OOH- services

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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

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B. The year 2008

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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

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B. The year 2008

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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

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B. The year 2008

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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

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B. The year 2008

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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

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C. The GP´s role

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2. CHALLENGES

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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.

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A. Clinical

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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.

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B. Expectations in the community

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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.)

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C. Collaborations with other health care services

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3. THE FUTURE

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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.

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A. Medical perspective

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Not easy to speculate! Service here and now when I want! More service from doctors Telephone service, doctors Internet service!

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B. PATIENT PERSPECTIVE

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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.

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C. Organisational perspective

Þórður G. Ólafsson 2315.05.2009

Thank you for your attention! Takk fyrir!