The objective of this study was to evaluate the diagnosis and treatment of acute sinusitis at three health care centers in northern and eastern Iceland.
Information on all those diagnosed with acute sinusitis (ICD 10 J01.0, J01.9) in the year 2004 at the communal health care centers in Akureyri, Husavik and Egilsstadir was obtained retrospectively from computerized clinical records. Key factors used for diagnosis and treatment were recorded. In order to obtain an equal distribution in population size only about one-third of the diagnoses made in Akureyri were included in the search (the first ten days of every month).
The search yielded a total of 468 individuals. The average incidence of acute sinusitis was found to be 3.4 per 100 inhabitants per year. Adherence to clinical guidelines (albeit from other countries) regarding diagnosis of bacterial sinusitis was nearly nonexistent. There were considerable differences found between health care centers as to whether x-rays were used for diagnostic purposes. Blood tests were hardly used at all. The disease was diagnosed over the telephone in 28% of the cases (Husavik 38%, Akureyri 32%, Egilsstadir 10%). Over 90% of all individuals diagnosed with acute sinusitis received antibiotics, regardless of symptom duration. The antibiotics most often prescribed were Doxycyclin and Amoxicillin.
The incidence of acute sinusitis in these three communities seems to be similar to other western countries. Acute bacterial sinusitis seems to be overdiagnosed and the use of antibiotics is in no context with clinical guidelines. Our results support the hypothesis that physicians tend to regard acute sinusitis as a bacterial disease, and treat it accordingly.
To study how general practitioners diagnose and treat adult patients with community acquired pneumonia (CAP) and evaluate outcomes.
Retrospective chart review for one year on patients 18 years and older diagnosed with CAP in three different primary care centers in Iceland.
A total of 215 patients were diagnosed with CAP. Of those 195 were both diagnosed and treated in the primary health care and 20 patients were referred for specialized care. Mean age was 50.3 years (SD= 21.0) and 126 (65%) of the patients were women. Most patients had been ill for less than a week and did not have a previously diagnosed lung disease. Cough was the most common symptom (71%) and 96% had abnormal chest auscultation. Vital signs were frequently not recorded. A chest radiograph was done in third of the cases and showed abnormality in over 80%. Most patients (94%) were treated with antibiotics usually extended spectrum penicillin. Phone consultations were the most common form of communication after diagnosis and about 12% of subjects had their antibiotics changed and about 10% had a chest radiograph done after diagnosis had been made. There was no mortality from CAP during the study period.
CAP was diagnosed clinically and managed in primary care in most cases. CAP was more common in women and a minority of patients had underlying lung diseases. Vital sign measurements were used less than expected. Broad spectrum antibiotics were widely used for treatment. CAP had no mortality.
INTRODUCTION: Formal referrals to medical specialists have not been required in Iceland since 1984. In 2006, however, referrals were required for patients to receive reimbursement for cardiologists fees. We studied patients' experiences and opinions on the referral process and explored the potential for quality improvement related to the increase in written communication between referring GPs and cardiologists. MATERIAL AND METHODS: Based on the electronic medical record system, referrals from GPs at Efstaleiti Health Care Center in ReykjavÃ?Âk to cardiologists between 1 June 2006 and 1 April 2007 were analyzed. A total of 344 patients were referred in this period. 245 agreed to participate in a questionnaire study about their opinions on the referral system and 209 (85%) completed the questionnaire. Relevant data on previous contacts with the health care center and received consultants reports from the years 2005-7 were extracted from the record system. RESULTS: Participating patients had a mean age of 72 years, male/female ratio 1:1. Ninety percent (95% C.I. 86-94) regarded the new referral system as more expensive and troublesome, but 89% (95% C.I. 85-94) wanted their cardiologist to send a formal report to the referring GP. The number of reports from cardiologists to the health centre's GPs increased from 43 in 2005 to 326 in 2007. CONCLUSION: Implementation of a referral system led to some dissatisfaction among the patients. On the other hand, it led to a major increase in the information exchange between GPs and cardiologists, in clear accordance with patients' wishes. It would be of interest to study the impact of the increased information flow influenced on the health care delivered.
Elderly people are a rising population in Iceland. With higher age the likelihood of drug consumption increases and thus drug therapy problems. Pharmaceutical care has been established abroad, where the pharmacist works in collaboration with other healthcare professionals to reduce patients' drug therapy problems. The aim of this research was to study the number and types of drug therapy problems of older individuals in primary care in Garðabær, by providing pharmacist-led pharmaceutical care in collaboration with general practitioners.
Five general practitioners selected patients, 65 years and older, and asked the pharmacist to provide them with pharmaceutical care service. The pharmacist provided pharmaceutical care using a well-defined process.
A total of 100 patients participated in the research, 44 men and 56 women. On average the pharmacist identified two drug therapy problems per patient. The most frequent drug therapy problem was related to noncompliance (30.1%), next was adverse drug reaction (26.7%) and the third was unnecessary drug therapy (18.2%). Almost all pharmacist comments were accepted by the general practitioners (90.3%).
Our results reveal that a pharmacist providing pharmaceutical care makes, on average, two comments regarding each drug therapy. In almost all cases the general practitioners accept the comments.
OBJECTIVE: Use of the levonorgestrel emergency contraception (EC) pill has become more common after being made formally available in pharmacies without prescription. It was investigated how pharmacists in the capital area of Reykjavik supply EC to clients. MATERIAL AND METHODS: A total of 46 pharmacists of all working ages and both genders were asked to answer a questionnaire concerning how they sold the emergency contraception pill over the counter (84.8% reply rate). RESULTS: Four of five used