Quelles solutions pour la garde en médecine générale? - KCE

118
Items
Affter-Hours
Primaary
Care
Informaation
and communicat tion technology:
Modernn
information technolo ogy is used in a largee
extent, including a patient record, and eelectronic
contact to aall
pharmacies in the region. There is no electronic
connecction
to the hospitals re ecords nor to daytime records at the GP’s cclinics.
The dooctors
doing home visit ts are connected by coomputer
in the car andd
use cell phones
Informaation
concerning the encounters e is sent elecctronically
to each patiient's
own doctor (98% % of all citizens have their
own family doctorr).
Critical success faactors
High leevel
of medical service e/outcome.
High saatisfaction
among patients.
Low usse
of GPs time (so they
can work in daytimee).
Reasonnable
costs.
Guidelines
The diff fferent regions have th heir own guidelines forr
after-hours care, mosstly
including guidelinees
on the organizationnal
aspects of after-hours
care.
Indicators/ qualityy
Report from the National Boa ard of Health (2009) concluded
that the primmary
service after-hours
care functions well.
requirements
Patientt
satisfaction is high although a improvementss
can be made, for exxample
concerning thee
communication betwween
the service and hospitals. Moreover, when run
by general
practitioners it fu unctions more or less in isolation, and therre
may be a need to integrate the service better with the broadder
acute service, inclluding
the
municippal
home nursing serv vice.
Who does the meaasurement
Nationaal
Board of Health.
Outcomes (evidennce):
Individuual
scientific studies
Increasse
in the proportion of phone consultations
Reducttion
in proportion of ce entre consultations
Reducttion
in the proportion of o home visits
Reducttion
in doctors’ after-ho ours workload
Reducttion
in number of home
visits
Satisfaction
in doctors, patien nts and administratorss
Suggestions for
Since 22010:
improvement of affter
-hours Danish Regions plan to hav ve general practitionerrs
working in the new acute hospital servicce
as hired staff and uunder
the hospital maanagement
structure. That plan
care
needs ffurther
discussion bec cause the GP’s and the
politicians do not aggree
at all about the orrganizational
details yeet.
The ideea
is to merge the aft ter-hours function intoo
the hospitals' new acute
function. A single
telephone number aapplying
to the wholee
country is to give acccess
to a
servicee
where health care pe ersonnel can refer a paatient
to a relevant serrvice
like acute hospital
service, an acute loocal
clinic or home nurrsing.
Merging
of after-hours service
with the hospitals'
new acute service mmay
be an issue in thhe
coming negotiationns
between Danish RRegions
and the Assoociation
of
Generaal
Practitioners on the terms of service.
As a reesult
of a recent agree ement between GP’s oorganizations
and the Danish Regions Quality
monitoring will be pperformed
for certain iindicators.
These indiccators
will
be manndatory
as from 2013 as a a part of an accredditation
process.
Data sources withh
regard to after-hoours
care in Denmar rk
Results
KCE Reportss
171