Quelles solutions pour la garde en médecine générale? - KCE

94
First contact wwith
the after-houurs
service is pro ovided by a disppatcher.
Based on guidaance
protocols, the
dispatcher will notify n the GP on dduty
(for
a consult in thee
duty centre or foor
a home visit) or o will redirect the patient
to the emergenncy
services. Duriing
day-time the dispatcher is memmber
of
the staff of the duty centre and is a qualified nurse.
During the nigght,
the
dispatcher is mmember
of the fire
brigade and has followed a specific
course for urgent
medical care.
Evaluation of thhis
system of dispatching
indicated the lack of knowledge
of
the night dispattcher
about the kinnd
of complaints seen s by a GP. There
is a
need for a paraamedical
trained dispatcher, for a better redirectionn
of the
calls.
3. Administration
The GPs are responsible for tthe
administration n linked to the mmedical
aspects, mainlly
encoding and reporting in a central databasse.
The
advantage of thhis
central databaase
is that the GP P with the global mmedical
record of the paatient
is kept informed.
Moreover all caalls
are registered in the central dat tabase, which enssure
the
quality control and the legal frammework
of the GP.
In case of commplaint,
the trajectory oof
the call can be retrieved. This re egistration systemm
exists
already for thee
duty centres, but is now exte ended to all afteer-hours
services (duty ccentres
and individdual
GPs on duty).
4. Other healtth
professionals
In the near futuure
(end of 2011)
a multidisciplina ary team will be set up,
consisting of specialists in ddiabetics,
physiotherapists
and speech
therapists, in the
framework of thhe
care pathways. .
5. Others
The cleaning is done by the stafff
of the social serv vice department.
Infrastructure
1. Building
The building iss
rented from thhe
social service department of Brugge
(OCMW).
2. Medical insstallation
The medical innstallation
is similar
to the clinical office of a Gp, wwith
the
addition of an EECG
and a defibrilllator.
Affter-Hours
Primaary
Care
KCE Reportss
171
Functioning: schhedule
The ODC duty ceentre
is only openn
during day-time (between 8h andd
21h)
during the weekeend
and on feast-ddays.
Two GPs arre
available in thee
duty
centre to take caare
of the patientss
and two GPs aare
on the road foor
the
home visits. Durring
the night, thhe
GP on duty will be called byy
the
dispatcher and wwill
visit the patieent
at home. The
night shifts are
not
limited to the weeekends,
but everyy
night of the weeek
is covered by a GP
on duty.
Evaluation of thee
performance oof
the duty centrre
and its registration
system, indicatess
that 94% of thee
calls occur betwween
7h and 21hh
and
only 6 % during tthe
night. This miight
questioning the
value of the GGP
on
duty during the niight.
In the future, a syystem
of mobile duty
centres will bee
set up. These mmobile
centres are meddical
offices dispposed
by colleaggue
GPs in order
to
decrease the number
of home viisits
and to be mmore
reachable foor
the
more remote areaas.
Network with othher
services
No official agreemments
have been made with the neighbouring
hospitals.
Evaluation
The performancee
of the duty centtre
is evaluated ttwice
a year baseed
on
the registered datta
in the central database
(working group of 7 GPs).
Strengths of thee
system
• Data centralisation:
the GP wwho
holds the gloobal
medical recoord
of
the patient can
consult the infformation
registerred
by the GP on duty.
The registration
of the conssults
and home vvisits
further alloows
a
control on thee
quality of care.
• Warning of the GP in case of potential risk of a home visit to a
specific patieent.
This warning system does nott
specify the detaails
of
the potential risk (violent behaaviour,
financial prroblems,
etc).
Weaknesses of tthe
system (e.g. legal)
• Area: the unique
call number (project 1733) syystem
is set up foor
the
area of Brugge
but certain secctions
refused to be included. Howwever,
the patient is
not aware of this heterogeneitty
in coverage by
the
1733-project and calls the unique number.
This leads too
an