Quelles solutions pour la garde en médecine générale? - KCE

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98 Items Critical success factors Guidelines Indicators/quality requirements Affter-Hours Primaary Care Results the ambulancce in case of an emerg gency. Around 60% off emergency ward patients arrive without refferral. Access: With single reegional telephone num mber. Most GP coooperatives require patie ents to contact the coooperative by telephonee before attending (appproximately 95% of all cooperatives). Some cooperratives allow patients to t attend the facility wwithout prior contact. Workload GPPs: 4 hours on caall per week. GP shifts of 6 to 8 hours. KCE Reportss 171 Services: Triage and teelephone consultation: : Specially trained asssistants, supported byy national triage guidelines (paper guideliness or computer-based ttriage system that supports decision) assess the urge ency of the patient’s coomplaint, and give teleephone advice or arrange a consultation or home visit. Consultationss Home visits Staff involvedd: Triage assistaants: GP cooperatives s are most of the time staffed by triage nurses (80% GP nurses and 20% hospital nursees). The triage nurse is supervised by a GP, who can be cconsulted in case of do oubt and who checks and authorizes all callls handled by the triagge nurses. Triage assisstants have a nursing background most of tthe time. GPs: Per shifft GPs have different roles: r home visit, centrre consultations, and ttelephone triage consultation (larger cooperratives have a specificc telephone GP who only provides telephone consultations, supervises s the nursess and authorise the triaage nurse contacts). Logistic suppport: Medically traiined chauffeurs provid de transport for GPs mmaking home visits (veehicles equipped with ooxygen, infusion drips and automatic heart ddefibrillation equipmennt) Information aand communication tec chnology: Information aand communication tec chnology (ICT) supporrt including electronic patient files and onlinee connection to the GP care. Some GP coooperatives use compu uter-based decision sooftware for triage. Motivation of the GPs to develop successful after-hours care and to initiate thee reform. Presence of a strong primary care system and gatekeepper role of GP. Training of triiage nurses (there is a national training proggram for professionalss involved in triage at tthe GP cooperative). Guidelines foor triage. The developmment of a national triag ge system for the whoole acute care chain (thhe Netherlands Triagee Standard) increasedd uniformity and the chhance of having the rigght care providerr at the right time in the e whole country (for GGP cooperatives, EDs and ambulance care) . Adequate rennumeration and prevention of work overloadd. Information aand communication tec chnology. Medical cultuure open to collaboratio on. Insurance reggulations. To assess thee quality of medication n prescribing and referring patients by PCPss at cooperatives, an iinstrument is availablee containing quality inddicators based guidelines of the Dutch PCP association (Ned derlands Huisartsen GGenootschap, Utrecht, the Netherlands). Performance measurement of gene eral practice cooperattive clinical care is bassed on well-developedd, evidence-based clinical guidelines. Set of 24 indiicators developed by IQHealthcare I (Nymegen) for prescribing andd referring in after-houurs primary care. Acute coronaary syndrome 240 mg acetyylsalicylic acid (including the patients) who uuse coumarine derivattives Atrial fibrillatioon
KCE Reports 1771 Items Who does the Affter-Hours Primaary Care Results First choice bbeta-blocker (excluding g patients with heart 47 failure) Referraal: atrial fibrillation andd signs of haemodynamical instability (such as, chest pain, acute heart failure) Heart failure Give a quick--acting nitrate sublingu ual Give intravennous administration of a loop diuretic Referral: insuufficient result of acute e treatment, inadequatte possibilities for homme care taking and susspected myocardial inffarct as the cause for tthe acute heart failuree Transient ischaemic attack Patients with a TIA without cardiac c arrhythmias or valve disorders: give acetylsalicylic acid. Asthma in addults Severe dyspnnoea: give a beta-2-sy ympathicomimeticum When not impproving sufficiently add ipratropiumbromide COPD treatmment Severe exaceerbation: give beta-2-s sympathicomimeticumm When improvved: give tablets with 25 2 mg prednisolon daily Pneumonia Children: amooxicillin; second choic ce: azitromycine Adults: doxyccyclin; second choice: amoxicillin; third choicce: erytromycin Bacterial skinn infections When presennting with multiple lesio ons: local fuscidin crèmme When reduceed resistance, fever an nd other general signss or worsening of the ssymptoms despite locaal treatment: oral fluclooxacillin Otitis externaa Otitis externaa with fever and other general signs: oral flucloxacillin Otitis media aacuta Antibiotics Increase in general signs as decreased alertness or deccrease in fluid consumption Risk factors ffor complications No improvemment after 3 days Child 2 yearss with otitis media at tw wo sites Sinusitis Increase of general symptoms, risk k factors for complications, no decrease of ssymptoms after 2 weeks: amoxicillin or doxyycycline Red eye Cornea-erosion: small erosion: chlo ooramphenicol drops second choicce: tetracyclin eye ointment. Suspected baacterial conjunctivitis: chloramphenicol dropps; second choice: tetrracyclin eye ointment. Urinary tract infections Complicated UTI with signs of tissu ue invasion, all boys, yyears, girls, 5 years annd all patients with knoown abnormalities to tthe kidneys or the urinnary tract or having a permanent caatheter: augmentin; second choicce: cotrimoxazol or fluo orchinolon. Complicateed UTI without signs oof tissue invasion, all mman, all pregnant womman, all girls between 5 and 12 and diabeticcs: nitrofurantoinn; when allergic: trimet thoprim Migrain (pain management) Step 1: metocclopramide or domper ridon orally or rectal combined with paaracetamol or carbasalate calcium Step 2 (whenn step 1 is not giving enough e relief): metocloopramide or domperidoon and a NSAID Step 3 (whenn step 1 and 2 do not give g enough relief): tripptane Vertigo Any use of mmedication, specifically given for vertigo, is not recommendeed There is no reegular measurement. 99
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KCE REPORTS 2011 171B QUELLLES SOOL
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Contrôle Direction Contact Comm mi
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COLOPHOON Titre : Auteurs : Experts
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KCE Reports 1771B PRÉFFACE Il y a
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KCE Reports 1771B Obstacles liéés
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KCE Reports 1771B Autres alternnati
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KCE Reports 1771B Garddes en médec
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KCE Reports 1771B SYNTTHÈSE Garde
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KCE Reports 1771B 1.3.2. Chargees d
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KCE Reports 1771B La plupart des é
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KCE Reports 1771B n'est pas le cass
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KCE Reports 1771B PROCESSUS PROCÉD
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KCE Reports 1771 SCIENTIFIC RREPOR
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KCE Reports 171 Affter-Hours Primaa
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KCE Reports 171 Affter-Hours Primaa
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KCE Reports 1771 LIST OF FFIGURES L
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KCE Reports 1771 LIST OF AABBREVIAT
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KCE Reports 1771 Affter-Hours Prima
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KCE Reports 1771 1.1.3. Initial The
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KCE Reports 1771 below. 15 The eeva
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KCE Reports 1771 2.6. Uniquee call
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KCE Reports 1771 • Advising thhe
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KCE Reports 1771 regarding tthe org
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KCE Reports 1771 • The GP By join
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KCE Reports 1771 sanctioning coompe
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KCE Reports 1771 contacts and too s
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KCE Reports 1771 Table 3: Numbber o
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KCE Reports 1771 4.2.2.3. Limmitati
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KCE Reports 1771 When looking at ag
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KCE Reports 1771 4.3.2. Type of are
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KCE Reports 1771 1.a.Use oof search
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KCE Reports 1771 • perceived work
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KCE Reports 1771 Continuity of c as
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KCE Reports 1771 • The safetyy of
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KCE Reports 1771 5.4.4. Financial i
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Page 89 and 90: KCE Reports 1771 Some demograaphic
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Page 95 and 96: KCE Reports 1771 • A logistic o c
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Page 99 and 100: KCE Reports 1771 o Decreaase of GP
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Page 105 and 106: KCE Reports 1771 • Eviter les pat
Page 107 and 108: KCE Reports 1771 Nombre de vissites
Page 109 and 110: KCE Reports 1771 • Prévoir dees
Page 111 and 112: KCE Reports 1771 appelss, délais e
Page 113 and 114: KCE Reports 1771 8.3.4.4. Othhers T
Page 115 and 116: KCE Reports 1771 • One difficuult
Page 117 and 118: KCE Reports 1771 personnes (réggio
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Page 121 and 122: KCE Reports 1771 overchargee of som
Page 123: KCE Reports 1771 Items System refor
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Page 129 and 130: KCE Reports 1771 study of twwo inte
Page 131 and 132: KCE Reports 1771 Items Main drivers
Page 133 and 134: KCE Reports 1771 Items Affter-Hours
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Page 137 and 138: KCE Reports 1771 Items Suggestions
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Page 155 and 156: KCE Reports 1771 INAMI/RIZIV/NIHDI
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Page 167 and 168: KCE Reports 1771 • Les norme Deux
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Page 173 and 174: KCE Reports 1771 L’article 9, §
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KCE Reports 1771 o En ou grave. A c
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KCE Reports 1771 L’on envisage s
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KCE Reports 1771 Si le conseil nnat
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KCE Reports 1771 patiënten. Zoa hi
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KCE Reports 1771 o De aaangestelde
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KCE Reports 1771 De standaardlijs b
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KCE Reports 1771 de 1733-centrrales
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KCE Reports 1771 worden in een ziek
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KCE Reports 1771 waarvan de veerant
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KCE Reports 1771 De arts die dooor
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KCE Reports 1771 rétablissemment d
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KCE Reports 1771 peuplée et une zo
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KCE Reports 1771 Code de nomenclatu
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KCE Reports 1771 8.6.3.2. Nummber o
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KCE Reports 1771 Number of outt-of-
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KCE Reports 1771 8.7. Appenddices:
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KCE Reports 1771 8.7.2.2. Thirrd ye
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KCE Reports 1771 9. REFEERENCES 1.
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KCE Reports 1771 38. Pickin DMM, O'
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KCE Reports 1771 79. Thompsoon F, G
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KCE Reports 1771 121. Arrêté roya
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