Quelles solutions pour la garde en médecine générale? - KCE

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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:
KCE Reports 1771 • perceived workload some GP responsibil • continuity o lack of ac service (e.g Some GPs’ sug numbers of shif role of nurses, medical educat premises and emergency serv GP users of co A comparison b GPs users hav satisfaction with the reports of th GP cooperativ A comparison department (ED higher GPs’ sa if GPs apprecia Summary: per The new mode in comparison w Nevertheless th of improvement 5.3.2.2. Pat When they are producing differ Satisfaction in Several authors 47-50 even if this service, as coo 37 and Ps still feel ove ities. 36 of care: GPs com ccess to the patie g. mental health, d ggestions for imp fts after midnight decision-making tion, preference fo need for public vice, not an AH cl ooperatives and between cooperat ve a high satisfac h cooperative, par he duty doctors. 41 organization of t erburdened by mplain about poor ent’s record, ina dental, social serv provements in the or equitable alloc processes of the or a flat rate of pa c awareness that linic. deputising servi tive and deputisin tion level with bo rticularly with the ve: within or sepaarate from emerg between GP ccooperative integ D) and GP coopperative separate tisfaction with thee organization sep ate the cooperation with specialists rception of coopeeratives by the G ls of cooperativess are often positiv with former systeems as rota-group he increase of GPPs satisfaction can t remains moderaate in certain studi tient satisfaction e compared, nonee of the type of rent levels of patieent satisfaction. n many studies, s s observe a high s level decreases perative by instan 43- the after-hours s taking on coo knowledge of the dequacy of ancil vices or pharmacy eir cooperative co cation of shifts, in e organization, co y, improved purpo t the cooperative ices: are they sa ng service shows oth services but a quality of prescrib gency departmen rated to an em e from the ED s parate from the E within ED. still a minority of level of patient sa after the setting- 35, 50, 51 nce. 37 GPs: usually pos vely assessed by p or own patients n be light and the es 39, 40 services: operative e patient, llary AH y). . AH model appea -46 f dissatisfaction atisfaction with AH up of a new mod 36 oncern 36 : ncreased ontinuing ose-built e is an tisfied? that the a greater bing and nt ? mergency shows a ED, even itive the GPs service. e degree ar to be H care 33, el of AH Affter-Hours Primaary Care HHowever, about oone fifth of the p TThe determinantss of (dis)satisfa pparagraphs. TThemes in relatioon with (dis)satis • Meeting or faiiling to meet ideal MMeeting the patient’s expectations 35, 48, 52, 53 46, ppatient satisfactioon. 55 45, 5 eexpectations for a home visit. TThe unmet expecttations are a parti eexperience of partticular illnesses, fo oold and for individuals who live alon iff the users know tthe type of care th TThe authors sugggest to provide cl ccontact, on the orrganization of AH oof expecting a hoome visit and to f GGuidelines for GPs on when to und faactors other than purely the medica • Telephone coonsultation TTelephone consulltations may be s pprefer face-to-facee contact and a lo rreceiving telephonne advice only. HHowever, some a trrigger dissatisfact the average rate ppatients welcomed rresponse, the adv ssatisfied when the • Waiting time: WWaiting time is an 45-48 authors underline tion. 43, 49, 55 patients express s action are detai sfaction: ised expectation of care is an im 54 This concern 56 cular issue for pa or mothers with yo ne. In a s of GP telephone d the ease of usi vice and reassura ey felt that they did length and uncert other determinan 52 some dissatisfact led in the follo portant determina ns notably the u atients with no pre oung children
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KCE REPORTS 2011 171B QUELLLES SOOL
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Contrôle Direction Contact Comm mi
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COLOPHOON Titre : Auteurs : Experts
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KCE Reports 1771B PRÉFFACE Il y a
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KCE Reports 1771B Obstacles liéés
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Page 15 and 16: KCE Reports 1771B Garddes en médec
Page 17 and 18: KCE Reports 1771B SYNTTHÈSE Garde
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Page 21 and 22: KCE Reports 1771B La plupart des é
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Page 25 and 26: KCE Reports 1771B PROCESSUS PROCÉD
Page 27 and 28: KCE Reports 1771 SCIENTIFIC RREPOR
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Page 33 and 34: KCE Reports 1771 LIST OF FFIGURES L
Page 35 and 36: KCE Reports 1771 LIST OF AABBREVIAT
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Page 79 and 80: KCE Reports 1771 • To assesss the
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Page 87 and 88: KCE Reports 1771 The NIHDI tablees
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Page 93 and 94: KCE Reports 1771 8. APPEENDICES 8.1
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KCE Reports 1771 • One difficuult
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KCE Reports 1771 personnes (réggio
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KCE Reports 1771 • Réponse à un
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KCE Reports 1771 overchargee of som
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KCE Reports 1771 Items System refor
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KCE Reports 1771 Items Who does the
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KCE Reports 1771 8.4.1.1. Weebsites
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KCE Reports 1771 study of twwo inte
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KCE Reports 1771 Items Main drivers
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KCE Reports 1771 Items Affter-Hours
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KCE Reports 1771 Items Critical suc
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KCE Reports 1771 Items Suggestions
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KCE Reports 1771 10. Dale J, Croouc
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KCE Reports 1771 8.4.3. After-hhour
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KCE Reports 1771 Items Number of ac
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KCE Reports 1771 8.4.5. After-hhour
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KCE Reports 1771 INAMI/RIZIV/NIHDI
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KCE Reports 1771 o Avec l Il y a de
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KCE Reports 1771 compléter les sse
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KCE Reports 1771 des accords de soi
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KCE Reports 1771 qui seerait de gar
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KCE Reports 1771 8.5.2.2. Norrmes e
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KCE Reports 1771 • Les norme Deux
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KCE Reports 1771 S’il ne particip
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KCE Reports 1771 Des deux dispoosit
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KCE Reports 1771 L’article 9, §
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KCE Reports 1771 o En ou grave. A c
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KCE Reports 1771 L’on envisage s
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KCE Reports 1771 Si le conseil nnat
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KCE Reports 1771 Affter-Hours Prima
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KCE Reports 1771 patiënten. Zoa hi
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KCE Reports 1771 o De aaangestelde
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KCE Reports 1771 De standaardlijs b
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KCE Reports 1771 de 1733-centrrales
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KCE Reports 1771 worden in een ziek
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KCE Reports 1771 waarvan de veerant
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KCE Reports 1771 Affter-Hours Prima
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KCE Reports 1771 De arts die dooor
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KCE Reports 1771 rétablissemment d
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KCE Reports 1771 peuplée et une zo
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KCE Reports 1771 Code de nomenclatu
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KCE Reports 1771 8.6.3.2. Nummber o
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KCE Reports 1771 Number of outt-of-
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KCE Reports 1771 8.7. Appenddices:
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KCE Reports 1771 8.7.2.2. Thirrd ye
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KCE Reports 1771 9. REFEERENCES 1.
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KCE Reports 1771 38. Pickin DMM, O'
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KCE Reports 1771 79. Thompsoon F, G
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KCE Reports 1771 121. Arrêté roya
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KCE Reports 1771 Tijdschrifft van d
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