Quelles solutions pour la garde en médecine générale? - KCE

42
• Less demaand
for emergencyy
hospital admissi ions.
However, a nurrse
telephone connsultation
service a
not be cost-effeective
at night because
of the low
less than at the
evening and WWE).
In that case,
offered by larger
groups of practices,
or by NH
80 ;
at cooperative levvel
might
number of calls (4 times
, the economies of scale
S Direct, are connsidered
beneficial. 79
Effect of triagee
on calls, GP wo
The central triaage
in NHS Direct
in the first year :
• No real inccrease
in after-ho
some);
• Decrease oof
after-hours cal
on in-hourss
calls)
• Fewer call
locally orga
• Increase in
• Decrease
care centre
• Negligible
83
: only Lat
The large geog
GP workload. R
frequent attend
increases have
82, 83 orkload and eme
t appears to have
ours call volumes
ls to GP coopera
;
ls managed by ttelephone
advice
anized nurse telepphone
consultatio
n the proportion off
after-hours calls
in the proportionn
of after-hours c
e visits, referral to GP, home visits
change in overall
ttimer et al. descri
graphical triage by
Researchers note
ders (4 or more G
e been recorded
8
ergency services
a limited impact,
s
l demand for amb
bed an increased
y GPs as in Denm
ed a decrease of h
GP contacts/year d
d for telephone
81 (although expe
atives (but may be
e in NHS Direct
n 84 ;
resulting in GP ad
calls resulting in
81
;
bulance services
d ambulance use. 8
mark led to a redu
home visits partic
during after-hours
consultations 85 use
at least
ected by
e impact
than by
dvice
a
81 ;
primary
or ED 81-
84
uction of
cularly in
s). Slight
and ED
contacts. 86
Conflicting ressults
for primary y care centres
The evidence aabout
the impact oof
primary care ce
ED services usse
is inconclusivee.
Some authors
attendance, nootably
for non traumatic
presentat
not detect any cchange
in the nummbers
of patients
Few studies onn
deputizing servvices
Few studies foccus
on deputisingg
services. This s
less GP telephhone
advice thann
practice doctor
more home visits
than cooperativves.
90
entres on ambula
show an increas
tions 87 . Other stu
consulting the ED
service appear to
s 89 ance and
se in ED
dies did
D.
or cooperativ
88
provide
ve 90 and
Affter-Hours
Primaary
Care
KCE Reportss
171
LLittle
or no impac
TThe
impact of Wa
iss
high).
c
a
n
r
in
I
A
d
A
m
w
I
w
c
S
e
I
h
o
a
w
5
T
o
•
33 One U
consultations and
an ED) but the im
no change in the
routine appointme
n NHS Direct calls
ntegrated after-h
An after-hours ser
decrease the ED a
A reluctance of G
models) has been
worry about loosin
n addition, an afte
would have little
costs). 94
Summary: limite
efficiency/use
n conclusion, the
health system u
observed in the G
are provided. A p
when the GP serv
5.3.2.4. Clinica
There are few dat
on clinical outcom
• One study d
subsequent u
usual GP. 34 ct of walking cenntres
alk-in Centres is small
if any (despi
K time series annalysis
reports a
in ED demands (mainly in the ce
pact is not statistically
significant.
e workload of loc
ent and daily atten
s but less non-am
hours services in
rvice integrated in
attendance and to
GPs towards inte
n mentioned in th
ng their identity an
er-hours service i
effect on ED co
ed evidence f
ere is limited evid
se/efficiency. A
P cooperatives, m
positive effect on
ice is integrated in
al outcome
a and little eviden
es.
did not observe
use of the health
AAnother
study sho
doctors, otherr
GPs give more
visit in a shortter
delay (35 vers
discriminationn
(e.g. antibiotics,
9
cal GP (emergen
ndances at AH se
mbulance attendan
n emergency dep
n an emergency d
o increase the num
egrated ED mod
he chapter on GP
nd autonomy. 94
integrated in an e
osts (fewer patien
for an effect
dence on the effe
positive effect
mainly when triage
n emergency dep
n this department
nce about the imp
any difference
h service for dep
ows that in comp
telephone advice
sus 52 minutes) an
generic drugs). 89
te patients satisfa
slight reduction i
entres located clo
1
Another study s
ncy GP consulta
ervices) and no ch
nces at ED. 92
action
n GP
ose to
shows
ations,
hange
partments
department appeaars
to
mber of GP contaacts.
els (versus sepa
P satisfaction: the
emergency depart
nts seen at the
on health serv
ect of new mode
on GPs workloa
e and telephone a
partment use is
t.
pact of the new m
in health statu
putising service v
parison with depu
(20.2% versus 0
nd prescribe with
93
arated
e GPs
tment
same
vices
els on
ad is
advice
noted
odels
us or
ersus
utizing
0.7%),
more