BACKGROUND: In 2002 the Norwegian Board of Health made a survey of the accessibility of general practitioners in Troms county in North Norway. MATERIAL AND METHODS: In a telephone interview one secretary in each surgery informed about telephone response time, planned time for telephone consultations, recorded numbers of urgent consultations, and waiting time to obtain a routine consultation. RESULTS: On average, the planned telephone time was two hours per week. Telephone time was in inverse proportion to the number of patients on the doctor's list. Rural doctors spent twice as much time as urban colleagues on the telephone with their patients. Doctors with lists between 500 and 1500 patients had a higher proportion of urgent consultations compared with doctors with shorter or longer lists. INTERPRETATION: Telephone response time below two minutes and waiting times for routine consultations below 20 days appear to be within acceptable norms. When patient lists are above 1500, doctors' capacity to offer telephone contact and emergency services to their patients seems reduced.
To identify emergencies in rural dwellers during electrocardiographic examination using a tele-electrogram (ECG) analysis (Easy ECG) system.
The easy ECG system connected 4 therapeutic-and-prophylactic institutions of a rural area and the town of Uryupinsk with the Research Institute of Cardiology, Russian Cardiology Research-and-Production Complex (Moscow). A total of 1,027 ECGs were recorded and analyzed in March 25, 2013 to November 11, 2013.
Based on complaints, data of physical examinations, and results of ECG analysis, the investigators detected 188 (18.3%) emergency cases; 39 (3.8%) rural dwellers were first diagnosed as having emergencies. There were new found cases of acute coronary syndrome (n = 2), focal cicatricial changes (n = 11), including focal injury in the presence of left bundle-branch block (LBBB) (n = 2), and ischemic cardiomyopathy (n = 1) due to prior extensive myocardial infarction (as high as 28.2%). The frequent finding was intraventricular blocks (46.1%), including LBBB (n = 4) and right bundle-branch block (n = 1) (as high as 12.8%); the signs of left ventricular hypertrophy were encountered in 12 cases, as well as in 2 cases in the presence of LBBB (as high as 38.5%).
The findings show the value of bedside recording of ECG with its remote analysis in the absence of special diagnostic services. Each of the detected electrocardiographic syndromes is a risk factor of cardiac death.
There are few Norwegian recommendations for quality and efficacy of ambulance performance. A report commissioned by the Ministry of Health and Social Affairs concluded that the ambulance service was the weakest link in the chain of survival. The report proposed standards for response intervals in emergencies: 90% of the population in cities and urban areas should be reached by an ambulance within eight minutes. In rural areas, 90% should be reached within 25 minutes.
This study describes the ambulance response interval for the 2,589 red code emergencies in the 15 municipalities in Vestfold County in 1998, a county with a population of 208,687, or 97.5 inhabitants per square kilometre, with seven ambulance stations. A retrospective analysis was made of data for the year 1998.
The proposed standard was not reached in any municipality in the county. The city of Tønsberg had the best performance, but even here only 48.9% of the population were reached by ambulance within eight minutes. The worst performance was found in the rural municipality of Tjøme; here, only 63.3% were reached within 25 minutes.
Achieving the standards proposed will require a major restructuring of existing ambulance services.
Congestive heart failure (CHF) is increasingly recognized as an important cause of morbidity and mortality. Previous studies in urban settings have shown that patients frequently are not receiving recommended therapy. There is a paucity of studies that have evaluated CHF management in a rural setting. We therefore reviewed hospital and outpatient care in this setting as an initial step toward improving CHF care.
A retrospective chart review was used to examine the care of all 34 patients hospitalized for CHF from 2000-2001 in a small rural hospital, to assess the need for improved CHF management.
The median age of the patients was 78 yr, and a number of them had many co-morbid cardiovascular risks. Similar to other studies, only 23% of patients were prescribed recommended doses of angiotensin-converting enzyme (ACE) inhibitors. Use of beta-blockers was far below expected rates. Although there was follow-up care for nearly all patients (97%), few patients had echocardiography performed (38%) or had their medications altered in the outpatient setting.
There is a need for improved management of CHF in the rural setting. Approaches to improving CHF care should use the continuity of care advantage provided by primary care physicians to optimize outpatient medical treatment regimens and improve access to diagnostic services such as echocardiography.