Out-of-hours service in rural areas - An observational study of accessibility, attitudes and quality standards among general practitioners in Iceland

Objectives - To examine the access, workload, duties, commitments and quali ty standards of primary care physicians (GPs) resulting from out-of-hours s ervice. 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 u sual circumstances (weather conditions) and within a distance of 10 km, 70% of them could reach the patient within 30 minutes of receiving the call. I n 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 th e patient (which could happen once a year). In the least populated district s, 84% of the GPs had to be on call 14 days or more per month. Serious emer gencies (involving special training such as cardiac resuscitation or trache al intubation) were relatively rare, and GPs expressed the necessity for re gular refresher courses in such fields. Conclusions - Modern telecommunication networks guarantee good access to ou t-of-hours service. The workload and on-call duties are great and do not co mply 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 need ed.