Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
• The safetyy
of triage by no
limited avvailable
data sh
admissionss
and daytime GP
o A multicentre
study su
complaaints
by non-ph
contaccts,
69% had an u
with thhe
gold standard,
for 19% % of the calls and
correlaation
was found
urgenccy
and specific tra
Unfortunately,
there is n
performming
triage.
o A piloot
study conclude
changed
by the GP.
Safety rules ha
arranging face
programs for t
analysis of m
supervision of t
78
on-physicians is
how no change
P contacts
ave been sugges
e-to-face contacts
triage nurses, the
medical (near)ca
he triage process
77-79
broadly discuss
e in mortality,
uggested a trend to underestimate
ysician triagists. Among 352 te
urgency estimatio on in perfect conc
, the urgency deg gree was underes
d overestimated for f 12.5%.
between the ac
aining on the use
no research comp
ed that the triag
sted for triage: no
s, the provision
e use of comput
lamities in pee
s by a trained phys
68 ed. The
hospital
e urgent
elephone
cordance
stimated
. A siggnificant
ccurate estimationn
of the
e of telephone guidelines.
paring doctors andd
nurses
ge decision is not
often
ot being too restrrictive
in
of educational certified
terised decision support,
r group meetings
and
35, 66, 68, 69
sician.
Affter-Hours
Primaary
Care
KKeypoints
– Systtematic
review
• New models of after-hours seervices
have usuually
:
o a positivve
impact on GPs
satisfaction, evven
if limited in
some stuudies;
o a limitedd
impact on the ssatisfaction
of thee
patients, in
particulaar
for triage and ttelephone
consuultations.
Waitingg
times annd
accessibility aare
topics of possible
dissatisfacction.
A correcct
information of the patient woulld
decrease
unrealisttic
expectations. .
o a limitedd
impact on the hhealth
system use/efficiency.
Thee
exceptioon
is a positive immpact
on the GP workload for
cooperattives
with triage and telephone aadvice.
• There is a lacck
of studies on the impact on cllinical
outcomess:
in
particular noo
study has been found that compared
the qualityy
of
care betweenn
models..
• The authors suggest to pay aattention
to :
o the discrrepancy
betweenn
expectations off
the users and tthe
functioning
of the service,
source of disssatisfaction;
o the impoortance
of waitingg
times;
o the accessibility
: keep thhe
possibility of home visits, maainly
in socially
deprived or reemote
areas; takee
into account thhe
geographical
barriers annd
the difficultiess
for patient to traavel
to the coonsultation
centrre;
o the commmunication
skillss
of after-hours pprofessionals:
neeed
of traininng,
protocol use and supervisionn
of after-hours
professioonals;
o the contiinuity
of care: immprovement
by innformation
managemment
and technoology:
a corner stone
is the
informattion
of the patiennt’s
usual GP;
o the data collection for evvaluation
and quality
improvement.
43