Quelles solutions pour la garde en médecine générale? - KCE

30
4.1.5. Summmary:
workload dduring
24 hours periods
The available ffew
but consistennt
data show a pattern p in the number
of
contacts during a 24 hours duty pperiod:
• The peak oof
contacts occurss
between 8 AM and a 11 AM;
• The numbeer
of contacts durring
the evening and night (or deeep
night)
rapidly deccreases
from 7 PMM
onwards;
• Considering
different “deepp
night” periods shows s that the limmits
are
region speccific.
However:
o the nuumber
of contactss
per 100,000 hab bitants is quite coonsistent
from oone
circle to anothher
i.e. a mean of 1 to 2 contacts peer
“deep
night” for any definition of the “deep night t”;
o a slack
period can be iddentified
from mid dnight to 7AM: the
period
betweeen
11 PM and midnight
seems to be still “active peeriod”.
In
the moorning,
there is deefinitively
an incre ease in activity froom
7AM
onwards.
4.2. Worklooad
and nights on call by mon nth and by yearr
4.2.1. Objecctive
The objective oof
this part is to prresent
the workloa ad of the GPs durring
their
official after-hours
periods as reegistered
by the Ministry of Public
health
(MEDEGA). Thhe
number of coonsultations
and visits during afteer-hours
periods (NIHDI source) includes days (week-ends s and public holidaays)
and
nights.
4.2.2. Methoodology
The analysis is based on the datta
sets available in n 2 databases fromm
2009:
• NIHDI database
(2009): per GP and month, the nummber
of
•
interventionns
considered ass
after-hours work k per specific billing
code
(see the lisst
in appendix 8.6. .2). The attribution n of the period waas
based
on the billing
code (see apppendix)
mainly da ay, evening (6-9 ppm)
and
night (9pm-8
am).
MEDEGA database (2009): GP circles recor rd the date and tiimetable
of after-houurs
work per GP aand
transfer the information
to the Ministry
of Public HHealth.
The exact time of the beginning
and end of thhe
after-
Affter-Hours
Primaary
Care
KCE Reportss
171
hours period is reported. Based
on this inform
hourly fees too
the GP for the affter-hours
period
• The coupling of those 2 data
identifier.
TThere
are differences
between the 2
aand
usefulness of f the data for this
bbilling
codes invoicced
by the GPs. T
innformation
reporteed
by the GP circ
pperiods.
44.2.2.1.
Outcoomes
under stud
2
mation the NIHDI pays
23
.
abases was baseed
on the GPs ccoded
2 sources of data as regards the vaalidity
study. The NIHDII
database is baseed
on
The MEDEGA dattabase
is based oon
the
le for all GPs worrking
during after- hours
dy
PPeriods
on call bby
GP
TThe
number of hours
on call per GP are calculate
aavailable
in the MMEDEGA
databaase
(2009): it is
pperformed
over thee
month or year (ddepending
on the
NNumber
of periodds
on call covering
a night by GP
TThe
number of pperiods
on call inncluding
night ho
66:00AM)
is the sum
of all distinct pperiods
covering a
oor
year (dependingg
on the analysis) ).
NNumber
of contacts
by GP
TThe
actual numbeer
of “contact” – home visit or con
dduring
after-hourss
duty time is baased
on a list of
rregistered
in the NNIHDI
database (ssee
appendix 1.1.
44.2.2.2.
Attribuution
of a type off
area (urban, se
In
order to analyzze
the data by typpe
of area (urban
wwe
used the conncept
described bby
Eurostat base
mmunicipalities
at 01.01.2008.
(see AAppendix
8.6.1).
NNevertheless
the circle usually cov
pperform
after-hours
in several circ
hhours
on call wwith
a specific
sstraightforward.
Thherefore
it was de
ccode
of the GP’s contact address
rreported
in NIHDI database to dete
pperiod
(urban, semmi-rural,
rural).
22
ed based on the data
the sum of all hours
e analysis).
P
ours (from midnigght
to
a night over the mmonth
nsultation – perfoormed
f specific billing ccodes
1).
emirural or rural) )
, semi-rural and rrural),
ed on the typology
of
vers several municipalities;
a GP might
cles: the association
of the numbber
of
area (from thee
GP circle) iss
not
ecided to take intoo
account only thee
INS
(not necessarily the home addresss)
as
ermine the type oof
area during thee
duty