Quelles solutions pour la garde en médecine générale? - KCE

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122 Items Financer and financing system Characteristics off model most frequently used Critical success factors Guidelines according to three criteria of seve erity (urgent medical aassistance, medical coonsultation within the half-day, counselling). After-hours care annd urgent medical assisstance may be manag ged separately but the two management cenntres are interconnecteed. Legal framewwork: the public health code applied nationwwide. Between 20004 and 2007, the SHI budget dedicated to PPDS (‘permanence dees soins’) increased frrom €270 million to €3350 million (that is, 4.44% of the total SHI feess of self-employed phy ysicians), showing a reelative success in devveloping the system. After-hours care is generally subjec ct to flat-rate remunerration. Hourly paymment for regulating se elf-employed doctors – payment of time oon call for after-hourss doctors (per duty ssession) specific additions per procedure. Hourly rates ffor the regulating doct tors with higher fees foor care provided and a time-slot-based on-ccall care payment formmula. Initiator: After-hours service provis sion is organized and regulated by regional authorities comprisinng independent bodiess of general practitioners. Both hospitals andd GPs initiate the servi ice based on agreemeents determined by thee ARS for a period of ffive years. Number of GGPs taking part in afte er-hours care: Accordding to a 2009 cross-national survey, 78% % primary care practicces in France offer affter-hours arrangementss whereby patients co ould see a physician oor nurse without visitinng the ED. An estimatted number of 300 GPPs are taking part in thhe on-call medical centrres (primary care cent tres). Number of Ammbulatory care centre es: Not known Population: NNot known Distance: Not known Indication: Inttended for urgent help p requests that cannott wait until the next dayy Availability off after-hours care: Usual openinng times: from 8 p.m. to 8 a.m. (nights fromm Monday to Friday) aand from 10 p.m. to 8 a.m. on the followingg working day on WE or public holidays. Time frame foor answering to calls: Between 1 and 15 minutes. Time frame foor urgent and non-urgent visits: see above Location: Situuated near or within a hospital, but there is ooften no regulated floww between them. Access: Therre are three ways of ac ccessing by phone. Thhrough the ‘centres 155’, or a phone numberr linked to the centres or through a direct phone call. Workload GPPs: Not known Services: Telephone seervice Home visits Consultation in ambulatory care ce entre Staff involvedd: GPs, specialists, nu urses and administrativve personnel Logistic suppport: Not specified Information aand communication tec chnology: Not specifieed Not specified Not specified Affter-Hours Primaary Care Resullts KCE Reportss 171
KCE Reports 1771 Items Affter-Hours Primaary Care Resullts Indicators Not specified Who does the Reports fromm the national regulato ory body for social servvices (the IGAS, Inspeection Générale des AAffaires Sociales) reguularly takes stock of hhow after- measurement hours servicees are operating nation nwide. Outcomes (evidennce) Not specified Suggestions for The difficultiees faced by the emergency care system are linked to the difficuulties of the primary ccare sector, which aree currently exacerbateed by the improvement of affter- increasing geeographical disparities s of the health care woorkforce. hours care The hiatus between the self- emp ployed practices and tthe hospital sector dooes nothing to facilitatte the coordination, nonetheless essential, between outpatient and inpatient care. The separation s between thhe two sectors still impplicitly relies on the assumption that these services are substitutabble. After-hours sservices turn out to be e expensive, especially between midnight and 8 a.m., which pooses the question of their appropriatenesss, since a hospital treatment paid for on a cha arge-per-service basiss could prove much less expensive for the ppayer. Patient educaation on when to use after-hours a care Preventing mmisuse of the hospital emergency e departmennt. 123
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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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KCE Reports 1771 the ambulance serv
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KCE Reports 1771 5.4.9.1. Thee Neth
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KCE Reports 1771 the patient’s ne
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KCE Reports 1771 • To assesss the
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KCE Reports 1771 6.1.1.1. Thee Neth
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KCE Reports 1771 between € 14 inn
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KCE Reports 1771 Table 16 : Disstri
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KCE Reports 1771 The NIHDI tablees
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KCE Reports 1771 Some demograaphic
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KCE Reports 1771 In the same wway,
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KCE Reports 1771 8. APPEENDICES 8.1
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KCE Reports 1771 • A logistic o c
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Page 99 and 100: KCE Reports 1771 o Decreaase of GP
Page 101 and 102: KCE Reports 1771 o en terrme de san
Page 103 and 104: KCE Reports 1771 Place, Populattion
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
Page 119 and 120: KCE Reports 1771 • Réponse à un
Page 121 and 122: KCE Reports 1771 overchargee of som
Page 123 and 124: KCE Reports 1771 Items System refor
Page 125 and 126: KCE Reports 1771 Items Who does the
Page 127 and 128: KCE Reports 1771 8.4.1.1. Weebsites
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
Page 135 and 136: KCE Reports 1771 Items Critical suc
Page 137 and 138: KCE Reports 1771 Items Suggestions
Page 139 and 140: KCE Reports 1771 10. Dale J, Croouc
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Page 151 and 152: KCE Reports 1771 8.4.5. After-hhour
Page 155 and 156: KCE Reports 1771 INAMI/RIZIV/NIHDI
Page 157 and 158: KCE Reports 1771 o Avec l Il y a de
Page 159 and 160: KCE Reports 1771 compléter les sse
Page 161 and 162: KCE Reports 1771 des accords de soi
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Page 165 and 166: KCE Reports 1771 8.5.2.2. Norrmes e
Page 167 and 168: KCE Reports 1771 • Les norme Deux
Page 169 and 170: KCE Reports 1771 S’il ne particip
Page 171 and 172: KCE Reports 1771 Des deux dispoosit
Page 173 and 174: KCE Reports 1771 L’article 9, §
Page 175 and 176: KCE Reports 1771 o En ou grave. A c
Page 177 and 178: KCE Reports 1771 L’on envisage s
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Page 181 and 182: KCE Reports 1771 Affter-Hours Prima
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Page 185 and 186: KCE Reports 1771 o De aaangestelde
Page 187 and 188: KCE Reports 1771 De standaardlijs b
Page 189 and 190: KCE Reports 1771 de 1733-centrrales
Page 191 and 192: KCE Reports 1771 worden in een ziek
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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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KCE Reports 1771 Tijdschrifft van d
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