Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
1.1.3. Initial
The current org
circles” 2 research propossal
ganization of rotaa
systems mainly y relies on the loocal
“GP
. Their national represenntative
organizatio on, the Federal Coouncil
of
GP Circles (FCCGPC),
submittedd
to the KCE a re esearch proposal with the
following questiions:
• What is the
workload of general practitio oners during afteer-hours
periods in tthe
different regioons
of Belgium?
• What are the existing moddels
in Belgium and in the literature
to
answer to patients’ demands
in general pr ractice during afteer-hours
periods?
• Which soluutions
could be prooposed
in Belgium m to ensure the coontinuity
of the GPP
care during after-hours
period ds: what are theeir
legal
(practitioneers’responsibility)
and budget conse equences?
However, the oorganization
of aftter-hours
rapidly moved m during 20110-2011:
the stakeholderrs
(GPs, Ministry of public health, NIHDI) proposedd,
tested
and implementeed
new initiatives.
The second and d third research questions
consequently mmerged
as these initiatives are a potential solutionn
for the
future.
1.2. Objectiive
: alternativee
models for af fter-hours care
The objective of this researrch
is to analy yze the conditions
for
implementation and the possible
consequences of alternative models
to
answer efficienntly
to the patientt’s
demands durin ng after-hours peeriods
in
primary care.
“After-hours peeriods”
(see glosssary)
refers to eve enings, nights, weeek-ends
and public holiddays.
In Belgium official definitions
of the start andd
end of
the periods currrently
depend on the billing codes (see ( 2.3).
This report deffines
the “patient’ s demand” by the
calls to the firsst
line of
care during afteer-hours.
Consultaations
in hospitals s and emergency ccalls
are
out of scope.
The report focuses
on the situation
from the providers’
and autthorities’
points of view; The perception oof
the patient is not
analysed in this
report
but data are avvailable
in the indexed
literature (see
satisfaction in 5.3.2.2)
and in a Belgiaan
PhD thesis (ssee
summary in the t next paragrapph).
The
final synthesis aand
conclusion inttegrates
those da ata.
Affter-Hours
Primaary
Care
11.3.
Perceptioon
of patients inn
Belgium
A PhD thesis brings
forward information
on the ppatients’
perception
of
aafter-hours
servicees
in Belgium (seee
details in 8.1.1.33):
TThe
results showw
that patients choose a service
that they already
cconsulted
previously
(emergency ddepartment
or GPP).
The thesis ouutlines
the
need to providde
information to tthe
patients aboutt
the optimal servvice
to
cconsult
during afteer-hours
periods. In particular, minorities
and youngg
men
wwith
minor trauma consult easier emmergency
departmments
than the GPP.
AAnother
finding iss
that the GP iss
consulted whenn
the patient has
the
pperception
that hee
is more accessible
(home visits aand
short waiting time)
aand
able to solve tthe
problem. The patients who connsult
the ED appreeciate
the
accessibility, immediate techhnical
tests, explanations
aboutt
the
ddisease,
compettence
of the staff and delaayed
payment. The
ssupplementary
feees
asked by somme
hospitals are nnot
a barrier for those
oones
who opt for this
option.
11.4.
Structure of the report
TThe
report begins with an analysis oof
the Belgian situuation:
• The initiativess
to answer to the
patient’s demands
during after- hours
(chapter 0),
• The legislatioon
and deontologiical
aspects relatted
to after-hourss
care
(chapter 3),
• An analysis off
the GPs’ activityy
during after-hourrs
periods (chapteer
4),
TThe
following chaapters
analyze thhe
situation and solutions propossed
in
oother
European ccountries
(chapter
5) and the ecoonomic
aspects oof
the
oorganization
of after-hours
care in BBelgium
and abroaad
(chapter 6).
A synthesis (see KCE website) summarizes
the maain
scenarios andd
their
ppotential
consequeences.
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