Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
2.6. Uniquee
call number wwith
triage syste em
2.6.1. Organnization
The triage is ddefined
as “sorting
out and clas ssification of patieents…to
determine priorrity
of need and proper place of treatment” [MESSH].
The
objective is to pprovide
the most aappropriate
answe er tailored to the patient’s
need (and not request): emergeency
team, GP ho ome visit, referral to a GP
surgery, other information
relatedd
to the care orga anization.
In 2009, a pilott-project,
named “ “1733”, has been set up by the Miinistry
of
Public Health. The 1733 is a unique call number
(24H/24) with a
professional diispatching
to soort
out any medical
call, either medical
emergencies or
other medical rrequests.
In 2010 0 the regions of Hainaut,
Luxembourg, BBrugge
and Chimay
joined the experiment e (see 6.3 and
8.3.7).
The telephonistts
follow standarddised
protocols se et up in collaborattion
with
GPs. Two scennarios
have been foreseen to ensu ure the follow-up of a call
for a GP consultation
or visit.
• The dispatcching
passes on tthe
call to the GP circle;
• The dispattching
itself referss
the patient to a consultation (or OODC)
or
sends a GPP
at home (or advvice
the patient to report the consultation).
2.6.2. First rresults
The first evaluaations
by the perssons
in charge of the pilot-projects in Mons
and Brugge (unnpublished
data, ssee
see 8.3.7) sho ow e.g. that:
• During afteer-hours
periods 440%
of 1733 calls s are referred to the
ODC
and 2% reqquired
emergencyy
services.
• 94% of thee
calls occur betweeen
7 am and 9 pm
(Brugge).
• Decreasedd
number of home
visits and in particular p of “not jjustified”
home visitss
(according to the
perception of th he GP): from 36% % to 26%
after the introduction
of the ttriage
system.
2.6.3. Strenggths
and weaknesses
The descriptionn
and interviews highlighted
some strengths s (see 8.33.7):
• Complemeentarity
with the emergency call number 100: ccommon
dispatchingg,
appropriate pattient
referral;
Affter-Hours
Primaary
Care
• Direct transmmission
of medicaal
information to tthe
GP who holdds
the
electronic medical
record of thee
patient;
• Registration oof
all cases for quaality
assurance prrocedures;
• Safety e.g.:
o GP anonyymity
when the paatient
calls;
o Potential warning of the GP if safety prooblems
with a patient
(Brugge) .
SSome
weaknessess
are:
• Some GP circcles
did not agreee
to join in the innitiative:
in these aareas
the patients might call the 1733,
whilst he/she
is in a zonee
with
another GP on
duty;
• Telephonists experienced withh
emergency callss
are less familiar
with
common complaints
in general practice;
• The fact that the patient is still
free to follow thhe
advice (he migght
go
the the ED insstead
of waiting till
the next day),
• No information
for the patient aabout
the waiting ttime
for a visit.
KKey
Points – Belggian
situation
• In Belgium, tthe
organizationaal
model for after-hours
care rapidly
evolved fromm
a rota model too
more innovativee
solutions that
coexist now: : unique GP call numbers, mergee
of areas duringg
the
night, organiized
duty centress
and more recenntly
a unique calll
number with triage system.
• These modells
were first set uup
by the GPs thhemselves
(GP
circles) to faccilitate
the organnization
of after-hhours
services.
• The respectivve
advantages oof
the models beccome
apparent (ee.g.
workload, saafety)
as well as tthe
potential treaats
i.e. viability aat
long term, coorrect
financing, necessary legislation
changes.
• GPs, GP circcles
and the authhorities
play a maajor
role to solvee
the
problem of aafter-hours
organnization
by creatiing,
promoting aand
financing innnovative
solutionns.
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