Quelles solutions pour la garde en médecine générale? - KCE

100
Items
measurement
Outcomes (evidennce):
Individual scientific
studies
Reduction in doctors’ after-hours workload w
Increased (joob)satisfaction
in GPs and patients
Increase in thhe
proportion of phone e consultations
Reduction in the proportion of cent tre consultations
Reduction in the proportion of hom me visits
Large scale eevaluations
Affter-Hours
Primaary
Care
Study Willekeens
et al. (2011)
Adherence too
national guidelines: average a adherence too
national guidelines off
77%. Guidelines on rreferral
to medical speecialists
and prescriptiion
of pain medicationn
have the highhest
adherence scores s (92% and 71% respeectively).
Prescribing aantibiotics
and treatmeent
in emergency casees
had the lowest scores
(69% and 71%,
respectively). . Antibiotics are overprescribed
in 42% of thhe
cases and underpreescribed
in 41%.
Study Smits eet
al (2010) and Giese en et al (2007)
Patient safetyy:
incident rate of 2.4% % (inadequate or subooptimal
treatment, incluuding
no treatment, wrong
treatment, or delayed
treatment).
All incidents ccaused
by failures in clinical c reasoning
Triage nursess
estimated the level of o urgency correcty in 69% of contacts
Study Giesenn
et al (2007)
Waiting timess:
average waiting time e is 30 minutes. 90% of all patients were vissited
within 1 hour.
Suggestions for Improving GPPs’
grip on patients skipping
primary care annd
attending emergency
departments without
a GP referral (i.e. self-referrals)
dealing wwith
non-urgent mediccal
improvement of affter-
complaints.
hours care
Joining primaary
and hospital emerg gency care (and ambuulances)
in one after-hhours
care facility with one front office for paatients.
After triage, paatients
are sent to a GPP
or to a speciaalist
at the accident an nd emergency departmment.
Improving thee
effectiveness and sa afety of telephone triagge
services (e.g. furtheer
implementation andd
evaluation of computterised
decision suppoort
systems as the NTTS
and telephone
GPs).
Educating paatients
by their own GP P and through the meddia
on how to use afteer-hours
care.
Preventing unnnecessary
use of dia agnostic tests and presscribing
medication to minimise medicalization
of patients.
Introducing financial
incentives in patients p when using thhe
GP cooperative
Existing cliniccal
guidelines need to be expanded with subbsections
addressing conditions in after-houurs
care and acute carre
setting.
Support of the
nurse telephone tria age by a telephone GPP
to improve patient saafety.
Improving access
and extension of f surgery hours of GPss
(in the evening)
Improvementt
areas are:
Getting to thee
patient’s home within n 15 minutes in case oof
urgency
Quality and ssafety
of telephone tria age
Discovering ppatients’
care needs and a expectations and ggiving
patient-tailored telephone advice
Data sources : affter-hours
care in Thhe
Netherlands.
Results
KCE Reportss
171