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Out-of-hours service in rural areas. An observational study of accessibility, attitudes and quality standards among
1Department of Family Medicine, University of Iceland, Reykjavik.
Objectives:
To examine the access, workload, duties, commitments and quality standards of primary care physicians (GPs) resulting from out-of-hours service.
Setting:
All GPs (n = 96) in rural Iceland.
Main Outcome Measures:
Answers to a postal survey.
Results:
The participation rate was 80%. The GPs estimated that in 97% of the cases they could be contacted within 5 minutes in an emergency. Under usual circumstances (weather conditions) and within a distance of 10 km, 70% of them could reach the patient within 30 minutes of receiving the call. In severe weather conditions, 50% of the GPs in smaller districts (650-6000 inhabitants) estimated that it could take up to 5 hours or more to reach the patient (which could happen once a year). In the least populated districts, 84% of the GPs 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 refresher courses in such fields.
Conclusions:
Modern telecommunication networks guarantee good access to out-of-hours service. The workload and on-call duties are great and do not comply with European Union (EU) recommendations regarding minimal rest time. If GPs in rural areas are to be expected to provide frontline health care, including in severe emergency situations, regular training courses are needed.
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