| dc.description.abstract | I 2001 ble fastlegeordningen innført i Norge. Et av målene med ordningen var å redusere antallet henvendelser til legevakt. I Norge er kommunen ansvarlig for gi sine innbyggere tilgang til akutt legehjelp på døgnbasis. Det gjøres ved å organisere legevakt, der fastleger arbeider i turnusordning utenom vanlig kontortid. Legevaktdistriktene i Norge er en stor og heterogen gruppe. Variasjonen gjør at det blir vanskelig å trekke konklusjoner ut i fra undersøkelser i enkelte kommuner og distrikter, for deretter å applisere konklusjonene mot legevakt i Norge som en helhet. Det pågående Vakttårnprosjektet har til formål å skaffe tilveie data fra en representativ gruppe av norske legevaktdistrikter. Slik vil man kunne utarbeide større kunnskap og forståelse om norske legevakters og legevaktdistrikters utvikling og utfordringer. En svakhet ved Vakttårnprosjektet er at det ikke vil kunne gi informasjon om legevakt i de største byene i Norge, der forholdene er en god del annerledes enn ved distriktslegevaktene.
I mitt litteraturstudium har jeg fokusert på hvilken effekt innføring av fastlegeordningen har hatt på legevaktsøkingen i Norge. Gjennom analyse av åtte artikler fra ulike legevaktdistrikter har jeg prøvd å svare på følgende problemstilling: Hvordan har fastlegeordningen påvirket legevaktsøkingen i Norge, og hvorfor velger noen pasienter å oppsøke legevakten fremfor sin fastlege?
Innføringen av fastlegeordningen gav ingen voldsom endring i legevaktsøkingen i Norge. Tre studier analyserte hvilken effekt ordningen hadde hatt på legevaktsøkingen, men resultatene var ikke sammenfallende. Noen kommuner opplevde nedgang i antall legevakthenvendelser etter 2001, men ikke alle stedene synes dette utelukkende å skyldes innføring av fastlegeordning. I én kommune, Rådøy, var det allikevel opplagt at nedgangen i antallet legevakthenvendelser var begrunnet i innføring av fastlegeordning. I andre kommuner fant man ingen påvirking på legevaktsøkingen overhodet. Fastlegeordningens påvirkning på antall som søker legevakt har derfor vært varierende i ulike legevaktdistrikter, noe som forsterker oppfatningen av norske legevaktdistrikter er en heterogen gruppe.
En del av pasientene som oppsøker legevakten har forsøkt å kontakte sin fastlege i forkant. Andelen pasienter som har kontaktet fastlegen på forhånd varierer, men årsaken til at de ender opp på legevakten er stort sett sammenfallende. Hyppigst skyldes det at de ikke får time hos fastlegen eller at fastlegen ikke er tilgjengelig på telefonen. En del pasienter oppsøker legevakten direkte, uten å ha forsøkt å kontakte fastlegen først. Da oppgir mange som årsak at de ble syke utenom fastlegens åpningstid eller at de hadde skade som naturlig hører hjemme hos legevakten. En del oppgir at de synes det er tungvint å kontakte fastlegen. Dette kan skyldes at de ikke ønsker å gå til legen i egen arbeidstid, at de må ringe på ugunstige tider for å få øyeblikkelig-hjelp-time hos fastlegen eller at de fra tidligere har dårlig erfaring med å få kontakt med fastlegen. Pasientene velger derfor å oppsøke legevakten fremfor å ta kontakt med fastlegen. Dårlig tilgjengelighet i allmennhelsetjenesten synes å være en viktig grunn til at pasienter oppsøker legevakten fremfor fastlegen. Øket tilgjengelighet hos fastlegene kan derfor være med på å redusere antallet henvendelser til legevakten. | nor |
| dc.description.abstract | Background
In 2001, Norwegian primary care physicians started working with personal patient lists after the introduction of "fastlegeordningen". One of several targets was to reduce the number of patients in the out-of-hour emergency medical service. In Norway, the local municipalities are responsible providing their inhabitants with 24-hours emergency medical service. This is done by organizing a so called "legevakt", where the local primary care physicians work in rotation to ensure that there s always someone available for emergency calls when out of normal working hours. The districts of the out-of-hour service are organized differently throughout the country, and they are a numerous and heterogeneous group.
Material and methods
In my literature study, I have mainly focused on the correlation and differences in patient contacts to primary care physicians and the emergency primary health care. By analyzing eight articles from different districts in Norway in the last decade, I studied how the introduction of patient lists ("fastlegeordningen") in 2001 affected the number of patient contacts in the emergency medical service. Also, I tried to find what reasons make patients seek the emergency primary health care services instead of their own primary care physician.
Results
After the introduction of patient lists in 2001, there was no large scale reduction in the total number of patient contacts in the emergency health care. A total of three studies had tried to see if any effects could be found. Although some districts experienced reduced number of patient contacts to their emergency primary care service, it was not always that the reductions came as an immediate response to the introduction of "fastlegeordningen". In Stavanger, the reductions were found to be part of larger trends with increasing availability in the primary health care service. In a study from Rådøy however, a significant reduction in contacts to the emergency service was found immediately after introducing patient lists. In other districts, it was difficult to see that patient lists had any effect on the out-of-hours service at all. The variation in the effect emphasizes the great number of ways that the Norwegian "legevakt"-districts are organized and run, and that one can not expect them to react in the same way or as one homogenous group.
Some of the patients that contact the out-of-hours service have tried to get in touch with their primary care physician prior to this. The percentage varies, but the main reasons why they ended up at the out-of-hours service in the end are usually similar. Most often, the reason is that they were not able to get a consultation with their own doctor, or that they didn t get hold of him or her on the phone. Among the patients that seek the out-of-hours service without trying to contact their own doctors first, the main reason to seek the out-of-hour service is that they were ill after normal working hours or that their injury naturally belonged in an emergency room.
Interpretation
The effect of introducing patient list in the Norwegian primary health care service was only analyzed in three studies, and their results did not concur. These studies are not enough to draw conclusions on behalf on Norwegian emergency primary health care districts as a group. However, one can conclude that the introduction of "fastlegeordning" reduced the number of patient contacts to the out-of-hour services in some districts, but not in all. The ongoing Watchtower study, organized by National Centre for Emergency Primary Health Care, Bergen, Norway, is working to obtain data from a larger group of "legevakt"-districts, which will increase our knowledge and understanding of Norwegian out-of-hours emergency services present and future challenges. A weakness with the Watchtower study is that it does not include any of the larger cities in Norway, which means that it primarily will describe the "legevakt" in rural districts. The emergency service in the cities differ from the rural districts in many ways, for instance in population, patient volume and organization. One will therefore need data selectively from the large cities, as well as from the Watchtower study.
The patients who seek out-of-hour primary care services often do this as a result of low availability or difficulties getting in touch with their primary care physician. When they are having trouble getting help from their own doctor, they seek the out-of-hour service instead. Increased availability in the primary health care service should reduce the number of patient contacts at the out-of-hours emergency primary care service. | eng |