Out of hours services Þórður G. Ólafsson1

Þórður G. Ólafsson2

 Population in Iceland:  Population in Reykjavik area: , 2/3  Working doctors in Iceland: 1120  Working GPs in Iceland: 228  Working GPs in Reykjavik area: Þórður G. Ólafsson3

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. Ólafsson4

Þórður G. Ólafsson5

 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  office visits  children (0-18 years)  7000 home visits  children (0-18 years)  telephone triage calls Þórður G. Ólafsson6

 Referrals to the national hospital  A study (5 years), 1 GP  2458 office visits: 3,2% referrals  265 home visits: 19,6% referrals Þórður G. Ólafsson7

% office visits % home visits Office visit dkr Home visit dkr Children (0- 18 years) 36%32%030 Adults56%24% Elderly >67 and invalid 8%44% Þórður G. Ólafsson8 Population ratio at Læknavaktin and payment in dkr per visit

Þórður G. Ólafsson9

 17 health centers in Reykjavik area: out of hours service.  Open working days 4pm – 6pm in most places  office visits  No home visits  No telephone advice  Just a GP and a receptionist Þórður G. Ólafsson10

 THE NATIONAL HOSPITAL:  Accident and emergency department  office visits out of hours  office visits 8am- 4pm  Childrens emergency department  office visits out of hours  office visits 8am- 4pm Þórður G. Ólafsson11

 Pediatricians health service  Open working days 5pm – 10pm and weekends 11am – 3pm  office visits  pediatricians participating  NB GPs have 70% of all the office visits OOH Þórður G. Ólafsson12

 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. Ólafsson13

 AT LÆKNAVAKTIN:  Special equipments and investigation material:  EKG,  tympanometer, audiometer,  pulsoxymeter, acute case, defibrillator,  blood sugar and hemoglobin meter, CRP,  multi stix, microscope,  oto-and opthalmoscope,  oxygen on mask, infusions set,  strep test, grav. test,  doptone Þórður G. Ólafsson14

Þórður G. Ólafsson15

 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. Ólafsson16

 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. Ólafsson17

 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. Ólafsson18

Þórður G. Ólafsson19

 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. Ólafsson20

 Not easy to speculate!  Service here and now when I want!  More service from doctors  Telephone service, doctors  Internet service! Þórður G. Ólafsson21

 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. Ólafsson22

Þórður G. Ólafsson23 Thank you for your attention! Takk fyrir!