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Læknablaðið - 01.03.2017, Síða 26

Læknablaðið - 01.03.2017, Síða 26
134 LÆKNAblaðið 2017/103 Heimildir 1. Saltman R, Rico A, Boerma W. Primary care in the driver's seat? Organizational reform in European primary care. Maidenhead: McGraw-Hill 2005. 2. Allen J, Gay B, Crebolder H, Herman J, Svab I, Ram P. The European definition of general practice/family medicine. Í: Evans. P, (ed.). WONCA European, Barcelona 2002. 3. Toon PD. Justice for gatekeepers. Lancet 1994; 343: 585-7. 4. Bodenheimer T. The American health care system - Physicians and the changing medical marketplace. N Engl J Med 1999; 340: 584-8. 5. Boerma WG, van der Zee J, Fleming DM. Service profiles of general practitioners in Europe. Brit J Gen Pract 1997; 47: 481-6. 6. De Maeseneer JM, De Prins L, Gosset C, Heyerick J. Provider continuity in family medicine: does it make a difference for total health care costs? Ann Fam Med 2003; 1: 144-8. 7. Engström S, Foldevi M, Borgquist L. Is general practice effective? A systematic literature review. Scand J Prim Health 2001; 19: 131-44. 8. Macinko J, Starfield B, Shi LY. Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv 2007; 37: 111-26. 9. Starfield B, Lemke KW, Bernhardt T, Foldes SS, Forrest CB, Weiner JP. Comorbidity: implications for the import- ance of primary care in ‘case’ management. Ann Fam Med 2003; 1: 8-14. 10. Delnoij D, Van Merode G, Paulus A, Groenewegen P. Does general practitioner gatekeeping curb health care expenditure? J Health Serv Res Po 2000; 5: 22-6. 11. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005; 83: 457-502. 12. Starfield B. Primary care: Balancing health needs, services, and technology. Oxford University Press, New York 1998. 13. Lög nr. 43/1984 um ráðstafanir í ríkisfjármálum. 14. Chaix-Couturier C, Durand-Zaleski I, Jolly D, Durieux P. Effects of financial incentives on medical practice: results from a systematic review of the literature and methodological issues. Int J Qual Health C 2000; 12: 133- 42. 15. Gosden T, Williams J, Petchey R, Leese B, Sibbald B. Salaried contracts in UK general practice: a study of job satisfaction and stress. J Health Serv Res Policy 2002; 7: 26-33. 16. Docteur E, Oxley H. Health-care systems: Lessons from the Reform Experience. OECD, Paris 2003. 17. Greß S, Delnoij DM, Groenewegen PP. Managing primary care behaviour through payment systems and financial incentives. Primary care in the driver's seat. 2006: 184-200. 18. Crombie D, Van der Zee J, Backer P. The interface study. Occas Pap R Coll Gen Pract 1990; 48: 4-7. 19. Boerma WG. Profiles of general practice in Europe: an international study of variation in the task of general prac- titioners. Nivel, Utrecht 2003: 32-43. 20. Digby A. The evolution of British general practice 1850- 1948. Oxford University Press, New York 1999. 21. Solberg I, Tómasson K, Aasland O, Tyssen R. Cross- national comparison of job satisfaction in doctors during economic recession. Occup Med 2014; 64: 595-600. 22. Hetlevik Ø, Gjesdal S. Personal continuity of care in Norwegian general practice: a national cross-sectional study. Scand J Prim Health 2012; 30: 214-21. 23. Scott A, Sivey P, Ouakrim DA, Willenberg L, Naccarella, L, Furler J, et al. The effect of financial incentives on the quality of health care provided by primary care physici- ans. Cochrane Database Syst Rev 2011; 9: CD008451. 24. Willems DL. Balancing rationalities: gatekeeping in health care. J Med Ethics 2001; 27: 25-9. 25. Visser MR, Smets EM, Oort FJ, de Haes HC. Stress, satis- faction and burnout among Dutch medical specialists. Can Med Assoc J 2003; 168: 271-5. 26. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet 2009; 374: 1714-21. 27. Gosden T, Forland F, Kristiansen I, Sutton M, Leese B, Giuffrida A, et al. Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Database Syst Rev 2000; 3: CD002215. 28. Halldórsdóttir S. Fyrirbærafræði sem rannsóknaraðferð. Í: Halldórsdóttir S, (ritstj.). Handbók í aðferðafræði rann- sókna. Háskólinn á Akureyri, Akureyri 2013: 281-99. 29. van Dijk CE, Verheij RA, Spreeuwenberg P, van den Berg MJ, Groenewegen PP, Braspenning J, et al. Impact of remuneration on guideline adherence: empirical evidence in general practice. Scand J Prim Health 2013; 31: 56-63. 30. Grytten J, Skau I, Carlsen F. Brukertilfredshet i allmenn- legetjenesten før og etter fastlegereformen. Tidsskr Nor Laegeforen 2004; 124: 652-4. 31. Halvorsen PA, Steinert S, Aaraas IJ. Remuneration and organization in general practice: do GPs prefer private practice or salaried positions? Scand J Prim Health 2012; 30: 229-33. 32. Baker R. Characteristics of practices, general practitioners and patients related to levels of patients' satisfaction with consultations. Brit J Gen Pract 1996; 46: 601-5. 33. Weiss GL, Ramsey CA. Regular source of primary medical care and patient satisfaction. QRB Qual Rev Bull 1989; 15: 180-4. 34. Shi L, Starfield B, Politzer R, Regan J. Primary care, self- rated health, and reductions in social disparities in health. Health Serv Res 2002; 37: 529-50. 35. Williams SV. The impact of DRG-based prospective payment on clinical decision making. Med Decis Making 1985; 5: 23-9. 36. Starfield B. Refocusing the system. N Engl J Med 2008; 359: 2087-91. ENGLISH SUMMARY Introduction: Most GPs in Iceland are public employees on fixed salaries which is very different from their Norwegian colleagues. The aim of this study was to explore the experience of Icelandic GPs who have also worked as GPs in Norway and compare their experience of working in these two neighboring countries. Material and methods: Data were collected through interviews with 16 GPs that during the study period 2009-2010 were all working in Iceland. Two to ten years had passed since their return from Norway. We used qualitative methodology, the Vancouver-School of doing phenomen- ology. This methodology seeks to increase understanding of human phenomena for the purpose of improving healthcare services. Results: The doctors discussed the benefits of the different systems of delivering medical services. They saw the advantages of the Norwegian healthcare system mostly in that all Norwegians have their own GP, thus achieving a good overview of the health problems of each individual. The GPs are gatekeepers for medical services which potentially reduces duplication of medical services. The participants also noted more effici- ent medical services in Norway than in Iceland. What characterizes Icelandic healthcare outside the hospital from their perspective is direct patient contact with specialists without referrals from GPs and incomp- lete registration system of patients and much use of emergency services in Iceland. Conclusion: Participants agreed upon stronger primary healthcare system in Norway compared to Iceland. Moreover, a good job situation in primary care is needed in Iceland to appeal to junior doctors. When changes are made to the Icelandic healthcare system it is important to acknowledge the experience of neighboring countries in terms of advancing health care system reforms. General practice in Iceland and Norway: GPsˡ experience of different primary health care systems Héðinn Sigurðsson1,4, Sunna Gestsdóttir2, Kristján Guðmundsson3, Sigríður Halldórsdóttir4 1Glaesibaer Health care centre, 2School of Education, University of Iceland, 3Reykjalundur rehabilitation centre, 4School of Health Sciences, University of Akureyri. Key words: general practitioner, primary care, job situation, health service research, qualitative research. Correspondence: Héðinn Sigurðsson, hedinn.sigurdsson@heilsugaeslan.is R A N N S Ó K N • Marktækt betri árangur við að hætta að reykja en með notkun búprópíons, nikótínplástra (21 mg) eða lyfleysu í vikum 9-12 og vikum 9-241 • Ekki marktækt aukin áhætta á taugageðrænum aukaverkunum* samanborið við notkun lyfleysu við að hætta að reykja, óháð sögu um geðraskanir1 • Hjálpar til við að hætta að reykja með því að hindra verkun nikótíns og draga úr þörf fyrir reykingar2,3,4 • Þolist vel og hentar flestum fullorðnum reykingamönnum sem vilja hætta að reykja1,3 Hætt að reykja: Bentu sjúklingum þínum á árangur meðferðar með CHAMPIX® Nikótínlaus leið til að hætta að reykja 3 Fylgstu með reynslu sjúklinga þinna, svo þú sjáir árangurinn Ábending: Notað hjá fullorðnum til að hætta reykingum3. Upplýsingar um CHAMPIX® (vareniclin) er að finna í blaðinu. Heimildir: 1. Anthenelli RM, et al. Lancet 2016, 22. apr. doi: 10.1016/S0140-6736(16)30272-0 [Rafræn útgáfa áður en prentuð útgáfa kom út]. 2. Jorenby DE, et al. JAMA 2006;296:56-63. 3. CHAMPIX Samantekt á eiginleikum lyfs, júlí 2016. 4. West R, et al. Psychopharmacology 2008;197:371-377. 5. Pisinger CH. Behandling af tobaksafhængighed - Anbefalingar til en styrket klinisk praksis. 2011 Sundhedsstyrelsen. *16 meðalalvarlegar og alvarlegar taugageðrænar aukaverkanir, þ.m.t.: kvíði, þunglyndi, óeðlileg líðan, fjandsamleg hegðun (teljast mjög alvarlegar aukaverkanir), æsingur, árásargirni, ranghugmyndir, ofskynjanir, manndrápshugsanir, oflæti, ofsahræðsla, vænisýki, geðrof, sjálfsmorðshugsanir, sjálfsmorðshegðun og sjálfsvíg (teljast meðalalvarlegar eða alvarlegar aukaverkanir). PF I-1 6- 12 -0 1 PP -C H M -D N K- 00 62 Tóbaksfíkn er ástand sem hægt er að líkja við langvinnan sjúkdóm. Yfirleitt er ávanabinding mikil, sambærileg við áfengissýki eða misnotkun vímuefna.5

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