Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
4.3.2. Type of area: the majjor
determinant for f periods and nnights
on calll
These data illusstrate
clearly the higher workload in rural areas in tterms
of
number of houurs
on call. A fuurther
comparison n between Flanders
and
Wallonia is therefore
not valid: tthere
are differen nces in topology bbetween
the 2 regions aand
the type of areea
is a major con nfounding factor. WWallonia
have a higher nnumber
of GPs woorking
in rural area as compared to FFlanders.
The number off
periods and nigghts
on call are mainly m determinedd
by the
type of area annd
therefore soluttions
should be specifically s tailoredd
to this
variable.
4.3.3. What is a “deep nightt”
?
Solutions outlinned
in the descripption
of Belgian initiatives
include specific
arrangements ffor
deep nights pperiods
(see 8.3. .6 and the chaptter
3 on
legislation). Thee
NIHDI billing codes
consider a night
period from 9 pm to 8
am but the activvity
varies greatlyy
within this period d. Pilot studies (seee
8.1.5)
already pointedd
out a specific slaack
period where GPs have a meann
of less
than one visit. TThis
study confirmms
these findings. GPs have calls ttill
11PM
- midnight: a slack
period followws
till 7 AM wher re the number off
calls is
around 1 to 2 pper
100 000 inhabbitants.
Alternative e solutions for deeep
night
periods should target this time slot
specifically.
Key Points – DData
analysis
• Possible pprediction
of the workload period ds of GPs duringg
after-
hours in teerms
of number of contacts:
o Peak hhours
from 8AM to 11AM,
o decreaase
between 6PMM
and 7PM,
o slack period: from 11PPM
until 7AM
• Possible ddetermination
of the “dark” night t period whereass
the
activity is really low: from 11PM-midnight to 7:00 AM.
• Non homoogeneity
of the use
of billing codes
for the after-hhours
duty betweeen
6PM and 9PM,
• Big differeences
in the nummber
of hours and d number of nighhts
under afteer-hours
on call bbetween
GPs of different d types oof
area,
median for
the year 2009 oof:
Affter-Hours
Primaary
Care
o 630h/GP and 38 nights/GGP
in rural area,
o 326h/GP and 20 nights/GGP
in semi-rural aarea,
o 224h/GP and 14 nights/GGP
in urban area. .
55.
IDEAS FROM ABBROAD:
LITTERATURE
ANALYYSIS
55.1.
Scope
HHealth
policy makkers
are concerneed
about the acce
aand
efficiency of aafter-hours
care aas
a measure of th
ccare
system. In paarticular,
the overuse
of emergency
mminor
ailments leaads
to an ‘inapprropriate
use’ inclu
8, 25-2
ppersonnel,
infrastrructure
and financcial
resources
In
many countriess
the organization of after-hours ca
SSince
the 1990s, , policy makers and physicians
ppatient
with minoor
ailments to pprimary
care
sshifting
more andd
more towards
ssuch
as those in thhe
United Kingdo
In
most countriess
different organ
ccoexist,
varying froom
three to nine m
TThis
chapter summarises
the litera
ccare
in Western European coun
oorganization
of caare
during after-ho
MMESH
thesaurus as “Care which
ccare
services by clinicians … pr
ccommunity”.
The specific organiz
eemergencies
is thee
topic of a specif
TThe
SPICE acronyym
has been used
• Setting : Westtern
European co
• Perspective : general populatio
• Intervention: AAfter-hours
care m
– evaluation);
• Comparison : existing models;
30 . W
large-scale prima
m (UK), Denmark
nizational models
models 29 essibility, quality, ssafety
he quality of the hhealth
y departments (EDD)
for
uding inefficient uuse
of
28
(see also 8.1.1) ).
are changed recenntly
have tried to re
Western countries
ary-care organiza
k, and the Netherl
s for after-hours
.
ature on the orgaanization
of after-
ntries. The anallysis
focuses on
ours in primary care
i.e. defined b
provides integrated,
accessible h
racticing in the ccontext
of family
zation set up too
answer to me
fic work by the Minnistry
of Public He
d to delineate the scope of the sear
ountries;
on in ambulatory ccare
- family prac
models - triage proocedures
(organiz
29 .
direct
s are
ations
ands.
care
hours
n the
by the
health
y and
edical
ealth.
rch:
ctice;
zation
35