National sections

Quality development in family medicine in Iceland.

Gunnar H. Gudmundson MD CCFP, Chair, Quality Development Committee, Icelandic College of Family Physicians

In the last few years there has been an increasing discussion on quality development in healthcare in Iceland, especially among family physicians who initiated this discussion and activities associated with it. Quality development activities go back almost 20 years in family medicine in Iceland. In 1975 at Egilsstadir in east Iceland a project was started to change all medical records to the SOAP format and to use computers in health centres. This has been a real success, so now most health centres are computerised. A few years ago we had a College working party publish a report on the requirements we need for a software programme in family practice. We have been working with a computer company on making software that will be used in all health centres in Iceland. The software is already being used in some health centres as a trial, before being put into general use. The first version of the software is very promising and hopefully it will be used in all health centres starting from next year. It should be mentioned that the software requirements have been translated into English.In 1986 our College published the first edition of guidelines on practice management. These guidelines were revised and published again in 1992. The guidelines have been translated into English too. We also did a survey on how well family physicians in Iceland adhere to our guidelines. We were very pleased to find that the great majority of members at our College were adhering to them very well.Family physicians in Iceland are now increasingly aware of the need to use quality development in their daily practice. In 1992 a working group of the College published a report on the future direction of quality development in family medicine. The report emphasises how we want quality development to be worker centred, practice based and the initiative of healthcare workers. The Quality Development working parly of our College has organised visits, whereby members from the quality development committee have visited the eight districts of Iceland to offer help and expertise to family physicians, and to encourage discussion on quality development. Some of our colleagues have already started with small projects on quality development. One Icelandic family physican, Dr Sigurdur Helgason, has been encouraging his colleagues to look at their prescribing habits, as well as forming a number of working groups to look at various drugs. His main focus has been on an eradication therapy for Helicobacter Pylori, with promising results. This work has been carried out with the support of the Icelandic health authorities.On a few occasions our College has organised a 'brainstorm meeting', whereby a core group of family physicians have spent a weekend in a cottage in the countryside discussing the subject of quality development. We actually have such meetings annually, not least they have provided the opportunity for 'bonding' between Icelandic family physicians.Our College has had a member in a quality circle of health professionals in the Reykjavik area meeting once a month on quality development. These quality circles were founded by the Quality Management Society of Iceland, which has its origins in industry. Now we have a sector for healthcare, of which a member of our College was chairperson for two years.The Continuing Medical Education (CME) Committee of our College has recently introduced a point system, whereby the members of our College are asked to provide evidence of 50 points a year or 150 points for three years in CME, according to special rules. This activity is in its third year now, so soon we plan to do a study on the participation of Icelandic family physicians. We hope that this will at least encourage our colleagues to be more selective in their educational activities.Two years ago our College issued a booklet on objectives for postgraduate training in family medicine, which is itself a statement regarding the content of family practice. In the booklet there is a special chapter on quality development. This is the first set of objectives set forward by any speciality in Iceland.Our College has been part of the European Working Party on Quality Development (EQuiP) from the beginning of 1991, with two delegates from Iceland. This cooperation has been very fruitful for Icelandic family medicine. Icelandic family physicians are now well aware of EQuiP and its work, and our College has been very supportive of our involvement there.Finally, we have recently formed a national network of Icelandic family physicians for the eight districts of Iceland. This is a group of 14 family physicians who have already met twice and who hope to be able to encourage our colleagues to take part in various quality development activities, in addition to being a resource for those who need support or information on quality development.