Quelles solutions pour la garde en médecine générale? - KCE

38
Nine models of aftter-hours
services (aaccording
to Huibers
Individual generall
The GP ttakes
care of his/he
practice
days/week
Rota groups
The GPs from
a geographical a
patient poppulation
of the area
GP Cooperative
These non-profit
making organiz
(organized duty ceentre)
owned by, and medically staffe
area in which
it operates (mo
descriptions
further).
Primary care centres
These centtres
(located far from
(PCC)
a multidisciiplinary
team under su
Deputizing servicees
These commmercial
agencies emp
other GPs.
Minor injury (Walkk-in)
The patients
can visit these
centres
appointmennt
for minor injuries o
advice andd
treatment). They are
nearby emmergency
departments
They are opened
all day, 7d/7
Telephone triage aand
A medicall
advice services
them to the
Emergency deparrtments
Care for al
Primary after-hourrs
care Primary aft
in the hospital
emergency
33
s et al)
er patients 24 hourrs/day,
7
area are in turn on caall
for the
zations are entirely annd
equally
d by the GP principaals
of the
odels are heterogenous,
see
hospitals ED) are staaffed
with
upervision of a GP.
ploy GPs to take overr
duties of
e nurse-led centress
without
or illnesses (health infoormation,
e located in shoppingg
centres,
s or in primary care centres.
y trained staff advise es patients by phonee
or refer
e most suitable profess sional
ll patients during after-hours
periods
ter-hours care integra ated in a hospital (e.gg.
GPs in
y departments).
5.3.1.2. Hetterogeneous
moodels
and difficul lt transferability of
resuults
The evaluationn
of the after-houurs
(AH) services s is a delicate isssue
for
several reasonss:
• Firstly, the different models of after-hour serv vice described abbove
are
not mutuaally
exclusive. Byy
instance a GP P cooperative thaat
offers
consultatioons
can work with
a triage call centre. It is sommetimes
difficult to ddefine
the scope oof
the assessment
in the literature.
• Secondly, the structure and
the procedures s of the models broadly
vary, evenn
in the same coountry.
For triage e as an examplee,
some
models proovide
GPs triage, others use nurse es triage. For homme
visits,
some perfoorm
the visits, others
refer to a deputising
agency or r another
service. Eaach
characteristicc
deserves a sep parate analysis too
assess
the real iimpact
of specific
components of the studied model.
Unfortunateely,
details are seeldom
provided by y the authors.
Affter-Hours
Primaary
Care
KCE Reportss
171
• Thirdly, the im
pre-existing s
differs accord
(“improvemen
• Finally, the o
study. Therefo
models based
categories as
55.3.2.
Impact o
In
the light of thes
mmodels
under stu
aauthors
34 mpact of a new aftter-hours
service model depends oon
the
ituation before thee
setting-up of this
model. This situuation
ing to the countryy,
area or target population.
The poositive
nt”) or negative ressults
are rarely “generalisable”.
outcomes vary annd/or
are measurred
differently in each
ore it is difficult too
carry out a comparison
of the diffferent
d on these outcommes
even if they encompass four bbroad
detailed below.
of the models onn
four main outcoomes
se limitations, thee
analysis focusess
on the impact oof
the
dy on 4 categories
of outcomes as described by other
:
• GPs satisfactiion;
• Patient satisfaaction;
• Use of health services;
• Clinical outcomes.
55.3.2.1.
GPs’ ssatisfaction
with
TThe
pressure for cchange
in the afte
GGPs
themselves. TTheir
satisfaction
the
new services. This assessment
foormer
situation ass
rota-groups or a
GGP
cooperatives:
pros and cons
TThe
after-hours coooperative
is the m
GGPs
describe diffferent
benefits lin
oorganization:
• improved quaality
of life and/or o
• decrease of sstress
• better health s
• perception of
• increased mo
HHowever
some stu
36, 41, 42 ;
status 39 ;
a decreased work
otivation 35, 41 new models
er-hours services
is therefore a cru
t always refers to
availability for their
most studied mod
nked to the imple
overall satisfaction
kload
.
udies also point o
35 mainly came from
ucial criterion to as
a comparison wit
r own patients.
el in the literature
ementation of this
n
;
ut dissatisfaction
35-41 m the
ssess
th the
e. The
s new
;
with: