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Vaktir í heilsugæslunni

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Authors
Gísli Ólafsson
Jóhann Ág. Sigurðsson
Issue Date
1997-05-01

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Other Titles
Out of hours service in the Icelandic primary health care sector: an observational study
Citation
Læknablaðið 1997, 83(5):294-301
Abstract
Background: Decisive changes have occurred in out of hours service in recent years, prompted by technological and methodological progress, improved communications and public demand. Concurrently, physicians' leisure time has come under increasing pressure. Aims: To examine the workload, duties and com¬mitments of primary care physicians (GPs) resulting from out of hours service. Further, to assess the organisation and quality of out of hours service and possible differences between urban and rural areas. Material and methods: A postal survey containing 58 questions was sent to all primary health care physicians holding posts for at least six months on March 1st 1996. Of a total of 143 GPs, answers were returned from 100 (70%). Results: All GPs on call (100%) were equipped with radios, mobile phones or pagers. They estimated that in 95% of the cases they could be contacted within five minutes jn an emergency. In an emergency and bad weather conditions 82% of doctors in urban areas could attend their patients within 30 minutes, and 100% within 60 minutes. Similar figures for rural areas were 10% within 30 minutes and 18% within 60 minutes. In the least populated districts 84% of the practitioners had to be on call 14 days or more per month. Serious emergencies (involving special training such as cardiac resuscitation or tracheal intubation) were relatively rare, and GPs expressed the necessity for regular refreshing courses in such fields. Conclusions: Access to doctors is good in this country. Workload and on-call duties are significantly heavier here than abroad, to some extent owing to outdated organisation. Various possibilities exist for improvement in the quality and reliability of out of hours service, but to be effective they must be supplemented by professional counselling and support, and facilities for further training in these fields.
Inngangur: Tækni, þekking, bættar samgöngur og kröfur almennings hafa breytt vaktþjónustu verulega á síðustu árum. Samtímis hafa aukist óskir lækna um að frítími þeirra sé virtur í raun. Tilgangur: Að athuga álag, skyldur og bindingu heilsugæslulækna vegna vakta. Ennfremur að meta skipulag og gæði þjónustimnar og hugsanlega mismunun vaktþjónustu milli landshluta. Efniviður og aðferðir: Allir fastráðnir heilsugæslulæknar 1. mars 1996, sem jafnframt höfðu verið í starfi sex mánuði eða lengur (samtals 143 læknar). Sendur var spurningalisti með 58 spurningum. Alls svöruðu 100 eða 70%. Niðurstöður: Allir vaktlæknar (100%) höfðu fjarskiptabúnað til afnota. Læknar töldu að í 95% tilvika væri hægt að ná í þá innan fimm mínútna í bráðatilvikum. Í slæmu veðri gátu 82% lækna í þéttbýli verið komnir til sjúklings í bráðatilvikum innan 30 mínútna og 100% innan 60 mínútna. Við svipaðar aðstæður í dreifbýli gátu aðeins 10% verið innan 30 mínútna og 18% innan 60 mínútna. í minnstu læknishéruðunum þurftu 84% lækna að standa vaktir í 14 daga eða lengur á mánuði. Alvarleg bráðatilvik, sem krefjast sérhæfðrar kunnáttu og færni, svo sem endurlífgun með hjartahnoði og ísetning barkarennu, voru mjög sjaldgæf. Læknar telja því nauðsynlegt að þeir sæki reglulega sérstök námskeið eigi þeir að geta viðhaldið þekkingu sinni og færni á þessu sviði. Ályktanir: Aðgengi að læknum er gott hér á landi. Álag og vaktaskyldur lækna eru mun meiri en tíðkast víða erlendis, sem að hluta stafar af úreltu fyrirkomulagi. Bæta má gæði og öryggi vaktþjónustunnar á ýmsum sviðum, en til þess aö svo megi verða þurfa læknar að fá faglegar ráðleggingar, aðstoð og tíma til viðhaldsmenntunar á þessu sviði.
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