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Part of the variable funding allocated to primary health care centres depends on the status of each centre according to specific quality criteria and special projects. The Ministry of Welfare initially selected these quality criteria in collaboration with the Primary Health Care of the Capital Area.
The criteria were chosen according to the quality criteria used in Sweden, where this system has been used for several years and adjusted to Icelandic reality.
The quality criteria can change as time passes and depending on the priorities at any given time.
Quality criteria
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General description: A person cannot use Heilsuvera's services without being registered at a specific primary health care centre. When calculating the quality criteria for using Heilsuvera, statistical data generated from the user's log history is entered into the Heilsuvera database. A user's actions in Heilsuveru are categorised according to the person's primary health care centre. The number of appointments through Heilsuvera, the number of requests for medication renewal through Heilsuvera, and the number of communications with a healthcare professional each month through Heilsuvera are counted, and the funding is distributed proportionally based on that.
Further definition: One-third of the monthly funds is based on the number of appointments, one-third is based on the number of medication renewals, and one-third is based on the number of communications.
Control group: Not applicable
Measurement period: 1 month
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General description: The number of persons whose medication list has been evaluated (code LYYF1) or the number of central medication cards created (code LYST1) in the last 12 months.
Payments based on the criterion are divided into 12 monthly payments. If a person's medication list is re-evaluated within 12 months of the last evaluation or a new central medication card is created for the individual, the period is renewed, and payment will be made for the evaluation for the next 12 months.
The evaluation of the medication list is aimed at persons over 60 years of age. The age of individuals is based on the last day of the period being evaluated. A person who has reached the age of 60 at the end of each month is therefore included in the calculation for that month, despite not having reached the age of 60 when the medication list was evaluated. An evaluation of the medication list must be done in an interview with a doctor at the patient's registered primary health care centre.
Age does not matter regarding the payment for creating a new central medication card.
Further definition: Code for evaluation of medication list: LYYF1
Code for the creation of a new central medication card: LYST1
Reference group: Evaluation of the medication list: All persons aged 60 and over.
Creation of a new central medication card: All persons with one or more medicines.
Measurement period: 12 months
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General description: The goal of the quality criteria is that the percentage of quinolones among antibiotics generally prescribed for urinary tract infections will be below 10% of all prescriptions. The use of Ciprofloxacin will be reduced.
The number of women aged 18 and over with quinolone prescriptions is calculated as a percentage of all prescriptions for antibiotics commonly prescribed for urinary tract infections among women.Further definition:
Quinolone antibiotics: ATC codes: J01MA02 and J01MA06
Other antibiotics for urinary tract infections: ATC codes: J01CA08, J01EA01 or J01XE0
Reference group: All women aged 18 and over
Measurement period: 1 month (last month before calculations).
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General description: Counts the number of persons aged 60 and over and persons with registered diagnoses of specific diseases who have received influenza vaccination as a percentage of persons belonging to these groups.
The age of individuals is based on the last day of the period being evaluated. A person who has reached the age of 60 at the end of the month is therefore included in the calculation for that month, despite not having reached the age of 60 when the influenza vaccination was given.
Further definition: Vaccinations registered with ATC codes: J07BB01, J07BB02, and J07BB03
Reference group: 60 years and older or persons with active diagnoses in the following disease categories (see list of ICD-10 diagnoses):
Diabetes
Ischemic heart disease
Chronic obstructive pulmonary disease
Asthma
Measurement period: 15 months
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General description: Counts the number of persons with recorded blood pressure measurements and registered diagnoses of certain diseases as a percentage of the total number of persons in these groups.
Further definition: Measurement: Blood pressure recorded.
Reference group: Individuals with active ICD-10 diagnoses in the following disease categories (see list of ICD-10 diagnoses):
Diabetes
Hypertension
Ischemic heart disease
Chronic obstructive pulmonary disease
Measurement period: 15 months
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General description: Counts the number of persons recorded as having been asked about smoking and registered diagnoses of certain diseases as a percentage of the total number of persons in these groups. The registration of smoking is reviewed based on the appropriate measurement, resolution code, and diagnosis code. The criterion is considered fulfilled if one or more of these items are listed.
Further definition: Measurement: Smoking recorded.
Resolution code: WSPR1.
Disease diagnosis (ICD-10): F17 with all subcategories.
Reference group: Individuals with active ICD-10 diagnoses in the following disease categories (see list of ICD-10 diagnoses):
Diabetes
Hypertensive disorders
Ischemic heart disease
Chronic obstructive pulmonary disease
Measurement period: 15 months
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General description: Counts the number of persons with a registered BMI measurement and registered diagnoses of certain diseases as a percentage of the total number of persons in these groups.
Further definition: Measurement: BMI recorded.
Reference group: Individuals with active ICD-10 diagnoses in the following disease categories (see list of ICD-10 diagnoses):
Diabetes
Hypertension
Ischemic heart disease
Chronic obstructive pulmonary disease
Measurement period: 15 months.
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General description: The percentage of children who have received 12-month, 18-month, and 4-year vaccinations.
Further definition:
12 months: Three doses of vaccination against pertussis, diphtheria, tetanus, Haemophilus influenzae type b (Hib), and poliomyelitis in one injection (Pentavac). Pneumococci in another injection (Synflorix).
18 months: One dose of vaccination against measles, mumps, and rubella in one injection (M-M-RVAXPRO).
4 years: One dose of vaccination against diphtheria, tetanus, and pertussis in one injection (Boostrix) after the third birthday.
Reference group:
12 months: Birth cohort that turns two years old this year.
18 months: Birth cohort that turns three this year.
4-year-old: Birth cohort that turns five years old this year.
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General description: Counts the number of persons with a recorded spirometry code.
Further definition:
Code: WQFJ3 (STARRI)
Code: VGX30 (NCSP)
Code: GXF434 (NCSP-IS)
Reference group: Individuals registered at the clinic
Measurement period: 36 months
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General description: The percentage of teenagers who, upon graduation from the 10th grade, have received vaccinations against diphtheria, tetanus, pertussis, polio, measles, mumps, and rubella (usually given to 12- and 14-year-old teenagers) and the percentage of girls who have received two vaccinations against cervical cancer.
Further definition:
DTP-IPV vaccine against diphtheria, tetanus, pertussis, and polio (Boostrix Polio). One injection in the last five years.
MMR vaccine against measles, mumps, and rubella (MM-RVAXPRO). One injection in the last four years.
HPV vaccine against the human papillomavirus, which can increase the risk of cervical cancer (Cervarix and Gardasil). Two injections in the last five years in girls. Boys are added starting with the birth cohort of 2011.
Reference group:
Teenagers who turn 16 this year.
DTP-IPV and MMR for both sexes.
HPV girls only (until cohort 2011 turns 16).
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General description: Counts the number of hypertensive individuals with a blood pressure of 140/90 or lower at least once in 15 months. Percentage of the total number of individuals with hypertension diagnoses.
Further definition: Blood pressure measurement is recorded.
Reference group: Individuals with active ICD-10 diagnosis for hypertension (see list of ICD-10 diagnoses).
Measurement period: 15 months.
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General description: Percentage of persons who visit a doctor, nurse, midwife, or psychologist at their primary health care centre at least once every 15 months.
Further definition: Number of persons who visit primary health care with ICD-10 diagnoses for diabetes, COPD, hypertension, ischemic heart disease, mood disorder and chronic kidney disease. Percentage calculated from all individuals in a reference group.
Reference group: Individuals with active ICD-10 diagnoses in the following disease categories (see list of ICD-10 diagnoses):
Diabetes
Ischemic heart disease
Chronic obstructive pulmonary disease
Hypertension
Mood disorder
Chronic kidney disease
Measurement period: 15 months.
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General description: Percentage of persons who have received more than 300 daily doses (DDD) of strong analgesic (opioids), (i.e. drugs in category N02A) in 12 months.
Further definition: Dispensed prescriptions for strong analgesics (opioids, i.e. N02A excluding N02AC52 and N02AE01) exceeding 300 daily doses (DDD) in 12 months. The percentage calculated of all with repeated prescriptions of N02A (excluding N02AC52 and N02AE01).
Reference group: Individuals on strong analgesic in category N02A (without N02AC52 and N02AE01)
Measurement period: 12 months.
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General description: Proportion of individuals who have received over 600 daily doses (DDD) of sedatives and hypnotics in 12 months.
Further definition: Dispensed prescriptions for sedatives and hypnotics from category N05C (without melatonin N05CH) exceeding 600 daily doses (DDD) in 12 months. The proportion calculated for all with repeated prescriptions of N05C (without melatonin N05CH).
Control group: Individuals on sedatives and hypnotics (without melatonin)
Measurement period: 12 months.
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General description: Counts the number of communications where the use of an interpreter is recorded. The number of communications in the last month with recorded codes (ZZXA00 and ZZXA01) is counted. Also counted is the number of persons in the previous 15 months who have received interpreting services with the same codes.
Further definition: Codes (Classification system NCSP-IS):
ZZXA00 = Interpreter called (Legal interpretation service)
ZZXA01 = Interpreting with the assistance of staff
Measurement period: 1 month and 15 months.
Service provider
Directorate of Health