Icelandic Health Care System Research Articles

Prevalence of Smoldering Multiple Myeloma: Results from the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) Study

Prevalence of Smoldering Multiple Myeloma: Results from the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) Study

Iceland screens, treats, or prevents multiple myeloma (iStopMM): a population-based screening study for monoclonal gammopathy of undetermined significance and randomized controlled trial of follow-up strategies

Monoclonal gammopathy of undetermined significance (MGUS) precedes multiple myeloma (MM). Population-based screening for MGUS could identify candidates for early treatment in MM. Here we describe the Iceland Screens, Treats, or Prevents Multiple Myeloma study (iStopMM), the first population-based screening study for MGUS including a randomized trial of follow-up strategies. Icelandic residents born before 1976 were offered participation. Blood samples are collected alongside blood sampling in the Icelandic healthcare system. Participants with MGUS are randomized to three study arms. Arm 1 is not contacted, arm 2 follows current guidelines, and arm 3 follows a more intensive strategy. Participants who progress are offered early treatment. Samples are collected longitudinally from arms 2 and 3 for the study biobank. All participants repeatedly answer questionnaires on various exposures and outcomes including quality of life and psychiatric health. National registries on health are cross-linked to all participants. Of the 148,704 individuals in the target population, 80 759 (54.3%) provided informed consent for participation. With a very high participation rate, the data from the iStopMM study will answer important questions on MGUS, including potentials harms and benefits of screening. The study can lead to a paradigm shift in MM therapy towards screening and early therapy.

Icelandic Healthcare System

Today the whole world continues to look at the surrounding reality through the prism of the coronavirus. A few months ago, in our relatively prosperous life without quarantine, the world-famous Bloomberg agency compiled another rating of countries according to the health index, on top of which were Spain and Italy. When compiling this rating, the average life expectancy of the population, the level of economic development, geographical location, prevalence of bad habits, the availability of clean drinking water, etc. were taken into account. The combination of these indicators provides data for the formation of a health index, which in Spain amounted to 92.8, and in Italy - 91.6. It is believed that the main factor contributing to the high health index in these countries is the favorable climate and the ability to keep to the Mediterranean diet, which is based on olive oil, seafood and a large amount of fruits and vegetables. However, as the tragic reality shows, countries with the best organization of the healthcare system in the world were not able to withstand the epidemic. What is the situation in the country that is the third of the top three in the ranking compiled by Bloomberg - Iceland? There is neither a favourable climate, nor olive oil, nor fresh shrimps, and the average temperature in the summer months there is +10°C. Nevertheless, in terms of life expectancy, this country left behind all the Scandinavian countries and came close to Singapore and Japan. And if we talk about the prevalence of coronavirus, then as of early April, as a result of testing of 4.7% of the population 1364 cases were found in the country, and the number of deaths was only 4. A mass examination of citizens, notably free of charge for everyone, immediate tracking of the routes of infection and isolation of the ill allowed the Icelandic authorities to take control of the situation from the very beginning of the epidemic, even without the introduction of strict restrictive measures [1].

Gastrointestinal bleeding in Iceland and in broader terms - a review

Gastrointestinal bleeding is a common cause for presentation in the emergency room and hospitalization. The bleeding is usually categorized to upper or lower gastrointestinal bleeding. The purpose of this review article is to provide an overview of the incidence of gastrointestinal bleeding, etiology, risk factors, role of antithrombotics, evaluation of the severity of bleeding, therapy and outcome. Emphasis will be put on gastrointestinal bleeding within the Icelandic health care system but also in broader terms.

‘Tiny Iceland’ preparing for Ebola in a globalized world

ABSTRACTBackground: The Ebola epidemic in West Africa caused global fear and stirred up worldwide preparedness activities in countries sharing borders with those affected, and in geographically far-away countries such as Iceland.Objective: To describe and analyse Ebola preparedness activities within the Icelandic healthcare system, and to explore the perspectives and experiences of managers and frontline health workers.Methods: A qualitative case study, based on semi-structured interviews with 21 staff members in the national Ebola Treatment Team, Emergency Room at Landspitali University Hospital, and managers of the response team.Results: Contextual factors such as culture and demography influenced preparedness, and contributed to the positive state of mind of participants, and ingenuity in using available resources for preparedness. While participants believed they were ready to take on the task of Ebola, they also had doubts about the chances of Ebola ever reaching Iceland. Yet, factors such as fear of Ebola and the perceived stigma associated with caring for a potentially infected Ebola patient, influenced the preparation process and resulted in plans for specific precautions by staff to secure the safety of their families. There were also concerns about the teamwork and lack of commitment by some during training. Being a ‘tiny’ nation was seen as both an asset and a weakness in the preparation process. Honest information sharing and scenario-based training contributed to increased confidence amongst participants in the response plans.Conclusions: Communication and training were important for preparedness of health staff in Iceland, in order to receive, admit, and treat a patient suspected of having Ebola, while doubts prevailed on staff capacity to properly do so. For optimal preparedness, likely scenarios for future global security health threats need to be repeatedly enacted, and areas plagued by poverty and fragile healthcare systems require global support.

Einkarekstur eða ríkisrekstur í heilsugæslu: Samanburður á kostnaði og ánægju með þjónustu

Skipulag heilbrigðisþjónustu er meðal erfiðustu viðfangsefna stjórnvalda. Líkt og aðrar þjóðir sem reka félagslegt heilbrigðiskerfi standa Íslendingar frammi fyrir spurningunni um hvert eigi að vera hlutverk einkarekstrar innan heilsugæslunnar. Markmið rannsóknarinnar var tvíþætt: að bera saman einkarekstur og ríkisrekstur 17 heilsugæslustöðva á höfuðborgarsvæðinu og greina ánægjukannanir þeim tengdar. Við upphaf Íslandsbyggðar verður til lögbundin samhjálp þar sem kveðið er á um skyldur samfélagsins við þá sem þarfnast hjálpar og með lögum um heilbrigðisþjónustu árið 1973 féll íslenska heilbrigðiskerfið undir norræna velferðarsamfélagið með jöfnu aðgengi og þéttu öryggisneti. Rannsóknin sýnir að einkareknu heilsugæslustöðvarnar voru með lágan kostnað á hverja verkeiningu en þó ekki þann lægsta. Fjórar til sjö ríkisreknar stöðvar voru með lægri kostnað á hvern skráðan einstakling en þær einkareknu. Kostnaður á hverja stöðu læknis var hæstur hjá annarri einkareknu stöðinni. Þjónustukannanir sýndu að enginn munur var á ánægju með gæði þjónustu milli þessara tveggja ólíku rekstrarforma. Þá ályktun má draga af þessari rannsókn að ekki sé hægt að fullyrða að einkarekstur í heilsugæslu bæti meðferð opinbers fjár eða auki gæði þjónustunnar.

General practitioners' perceptions of the current status and pharmacists' contribution to primary care in Iceland.

Background For the past several years pharmacists' responsibilities have expanded globally from traditional tasks of dispensing medications to collaborating with other health care professionals in patient care. Similar developments have not occurred in outpatient settings in Iceland. Objective The aim of this study was to explore Icelandic general practitioners' views on the current status of primary care, their perceptions of pharmacists as a health care profession, and their attitudes towards future GP-pharmacist collaboration in primary care in Iceland. Setting Twelve primary care clinics in Iceland. Methods Semi-structured in-depth interviews were conducted with general practitioners from different primary care clinics in Iceland. A purposive and snowball sampling technique was used to select participants. All interviews were recorded and transcribed verbatim. The transcripts were categorized by themes and then analyzed using conventional content analysis. Main outcome measure General practitioners' attitudes towards pharmacists. Results Twenty general practitioners from twelve different primary care clinics in Iceland were interviewed. There are several unmet needs regarding medicines and patient monitoring in the Icelandic health care system. General practitioners suggested ways in which these gaps may be addressed and pharmacist-led clinical service was one of the suggestions. Currently, their communication with pharmacists in the primary sector solely surrounds practical non-clinical issues. Due to increasing polypharmacy and multimorbidity, they suggested that pharmacists should be more involved in patient care. Conclusions General practitioners believe that pharmacist-led clinical service can increase the quality of patient therapy. To improve communication between these health care providers, pharmacists must also re-professionalize (strengthening the profession´s status through new responsibilities and tasks), not having a conflict of interest and showing that they have expertise in patient care.

Of seint, óljóst og veikt: Hvernig og hvers vegna hugmyndin um fyrsta viðkomustaðinn í heilbrigðiskerfinu hefur misst marks

This research is about ideas, interests and institutions in health care in Iceland. It describes how the idea of primary care centres as the first point of patients´ contact in health care, on one hand, and the idea of patients´ freedom to choose where to seek medical care, on the other, have been the competing views shaping the system for almost fifty years. The research seeks to shed lights on why the authorities have not succeeded in making primary care become the first point of contact in health care. It aims to create a better understanding about why and how such a gap between objectives and outcomes in public policy emerges. This study draws on published and unpublished findings from the author´s earlier research on the Icelandic health care system, and interviews with medical doctors, civil servants and politicians. Theories on policy implementation are applied in order to bring out a theoretical perspective on government´s policy implementation. Furthermore, the research brings out how issues in health care reach government´s agenda and why government´s attempts at change do sometimes succeed, but most often don´t. It concludes that better access to primary care services emphasized by the early 1970s legislation was first and foremost aimed at people living outside the two main urban areas. On the other hand, the idea of patients´ first point of contact as a goal of government policy emerged too late, its aim and implementation was too ambiguous and the tool of government applied too weak.

Patient satisfaction with care and interaction with staff in the Acute Cardiac Unit at Landspitali - The National University Hospital of Iceland

The Icelandic health care system ranks favourably in international comparison but patients' experience of interaction with the health service has not been well studied. The goal of this study was to examine the satisfaction of patients admitted to the Acute Cardiac Unit (ACU) at Landspitali - The National University Hospital of Iceland. A questionnaire based on the Patient Satisfaction Questionnaire III was mailed to patients admitted to the ACU between 1 January and 29 February 2012. Questions were presented as statements and participants asked to respond how strongly on a scale from 1 to 5 they agreed or disagreed with each statement. Data analysis was performed using descriptive statistics, Cronbach´s alpha for internal consistency of scales and principal components analysis, Wilcoxon-Mann-Whitney and Kruskal-Wallis tests for comparison of groups and Pearson and Spearman correlation coefficients for correlation between variables. The questionnaire was mailed to 485 individuals of whom 275 (57%) responded. The median age of the participants was 62 (range, 19-95) years and 132 (48%) were women. Internal consistency of the scales was mostly high (Cronbach's alpha 0.62-0.91) and principal components analysis revealed one main factor. The mean score of the questionnaire was 6.8 ±1.0 and 91%, and 86% of the participants were pleased with their interaction with physicians and nurses, respectively. Similarly, 88% were pleased with the care they recieved but 25% felt they received insufficient explanations of their symptoms or that follow-up care was lacking. Patients of the ACU generally appear to be satisfied with their care. However, our results suggest that improvement is needed in several areas, including information provided at discharge and follow-up care.

Frestun læknisþjónustu meðal Íslendinga: Umfang og skýringar

Equal access to health care is a central goal in socialized health systems like the one in Iceland. Previous research in Iceland indicates considerable individual and group differences in access to health care. The study maps the distribution of postponement and cancellation of physician care among Icelandic adults and considers a number of potential explanations. The data come from a national postal health survey of Icelandic adults, age 18-75, who were randomly drawn from the National Register. 1532 individuals responded to the survey yielding a 60% response rate. 22% of the respondents had postponed or cancelled a physician visit they thought they needed in the past 6 months. The study found considerable variations in postponement rates. Postponement was positively related to younger age, full employment, financial difficulties, high out-of-pocket health care costs, inflexible daily schedules (fixed roles), dissatisfaction with last physician visit, and the number of chronic medical conditions experienced. Postponement or cancellation of medical care is fairly common among Icelandic adults, although considerable individual and group differences in postponement are observed. The results raise concerns, as equal access to care is a central goal of the Icelandic health care system. It is incumbent upon health authorities to pursue effective ways to equalize access to medical care and prevent postponement and cancellation of needed services.

Population genomics: laying the groundwork for genetic disease modeling and targeting.

The family has proven the most appropriate unit with which to study Mendelian diseases. There are, however, certain limitations on the use of the family as a fundamental unit in the study of common diseases, most of which are complex genetic diseases. The groups that are most likely to yield the genetics of complex diseases are isolated populations with strong founder effects. Therefore, access to such populations is proving to be a precious resource in the work on the genetics of common diseases. The Icelandic population is an excellent population for the study of the genetics of common diseases; it is genetically homogeneous, with founder effects for many traits, and the genealogy of the entire nation is well documented back to the founding days. Furthermore, the nature of the Icelandic national health care system facilitates the assignment of phenotypes in the search for disease genes. Decode Genetics has begun to study of the genetics of 20 of the most common diseases in the Western parts of the world. The company has placed the groundwork for the construction of an encrypted database with information on the health care of the entire nation, genealogy of the entire nation, genotyping information with high density of markers on a large part of the nation (including typing for known disease genes), and resource use in the Icelandic health care system. The plan is to build the database with approval of participating individuals as well as Icelandic government and health care officials. The database will be used to model health care as viewed in the context of genetic predisposition to the development of disease. The database will also be used in the search for drug targets in complex diseases and in the solution of pharmacogenomic problems. Basing the company in Iceland directly benefits the population in terms of employment and return on investment as well as providing the health care system with an information resource which may be used in preventive medicine and in the optimization of health care in Iceland.

Letter from Reykjavik.

Medical care in Iceland can be viewed as an experiment of nature. This small island society has combined the Nordic social and welfare structures with advanced international medicine. The Vikings settled Iceland in the ninth century, and the population has remained biologically homogeneous because of its remote isolation. This homogeneity may provide a unique opportunity to contribute to the understanding of the genetics of common disorders. Iceland's isolation has also limited the resources that are available for clinical training. Therefore, it has been necessary for most physicians who graduate from the medical school at the University of Iceland to obtain postgraduate training abroad. This has been of enormous benefit to Icelandic medicine. Fewer opportunities for foreign medical graduates to train in the United States would have a substantial effect on the future practice of Icelandic medicine. The Icelandic health care system faces many challenges. Because health care spending has been reined in, priorities must be set more clearly than in the past, and heated discussions have erupted about gatekeeping and merging of hospitals. These have been "interesting times" for Icelandic medicine. Other countries may learn lessons from our medical situation: a microcosm, to be sure, but no longer an isolated one.

The experience of people awaiting coronary artery bypass graft surgery: the Icelandic experience.

Prolonged waiting for major elective surgery has been a problem in several Western countries for many years. In Iceland coronary artery bypass graft (CABG) surgery was installed in 1986 and this descriptive study was conducted to describe systematically the experience of Icelandic people waiting for CABG surgery with the purpose of gaining information about what nursing services these people need during the waiting period. The survey used a mailed questionnaire developed by the authors. The target population consisted of people awaiting coronary artery bypass graft surgery at the National University Hospital in Iceland, at two predetermined days with a 10-month interval. The return rate was 81.8% (n = 72). Mean time on the waiting list was 5 to 6 months. The waiting for surgery had negative effects on the work and daily life of the majority of the subjects and they were dissatisfied with their health status. Prominent symptoms were fatigue, shortness of breath, chest pain, anxiety and depression. Most patients (86.6%) experienced stress with 28.4% of them reporting a serious level of stress. The majority reported considerable negative influences of their illness on their spouse and family, particularly on their emotional condition. The conclusion drawn is that shortening the waiting period for CABG surgery should be a primary objective; however, that may be unlikely with the present Icelandic health care system. Therefore, helping the individuals and their families live with the lengthy wait is a necessity.