1. Out of hours services 15.05.2009 Þórður G. Ólafsson1

2. 15.05.2009 Þórður G. Ólafsson2

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 Þórður G. Ólafsson3

4. 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. 15.05.2009 Þórður G. Ólafsson4

5. 15.05.2009 Þórður G. Ólafsson5

6.  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 15.05.2009 Þórður G. Ólafsson6

7.  Referrals to the national hospital  A study 2002-2006 (5 years), 1 GP  2458 office visits: 3,2% referrals  265 home visits: 19,6% referrals 15.05.2009 Þórður G. Ólafsson7

8. % office visits % home visits Office visit dkr Home visit dkr Children (0- 18 years) 36%32%030 Adults56%24%112164 Elderly >67 and invalid 8%44%5680 15.05.2009 Þórður G. Ólafsson8 Population ratio at Læknavaktin and payment in dkr per visit

9. 15.05.2009 Þórður G. Ólafsson9

10.  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 15.05.2009 Þórður G. Ólafsson10

11.  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 15.05.2009 Þórður G. Ólafsson11

12.  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 15.05.2009 Þórður G. Ólafsson12

13.  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 15.05.2009 Þórður G. Ólafsson13

14.  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. 15.05.2009 Þórður G. Ólafsson14

15. 15.05.2009 Þórður G. Ólafsson15

16.  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. 15.05.2009 Þórður G. Ólafsson16

17.  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. 15.05.2009 Þórður G. Ólafsson17

18.  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.) 15.05.2009 Þórður G. Ólafsson18

19. 15.05.2009 Þórður G. Ólafsson19

20.  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. 15.05.2009 Þórður G. Ólafsson20

21.  Not easy to speculate!  Service here and now when I want!  More service from doctors  Telephone service, doctors  Internet service! 15.05.2009 Þórður G. Ólafsson21

22.  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. 15.05.2009 Þórður G. Ólafsson22

23. 15.05.2009 Þórður G. Ólafsson23 Thank you for your attention! Takk fyrir!