Quelles solutions pour la garde en médecine générale? - KCE
Quelles solutions pour la garde en médecine générale? - KCE
Quelles solutions pour la garde en médecine générale? - KCE
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<strong>KCE</strong> Reports 1771<br />
the ambu<strong>la</strong>nce service within 3 minutes. Nationa al minimum standdards<br />
for<br />
time from definnitive<br />
clinical asssessm<strong>en</strong>t<br />
to face e-to-face consultaation<br />
are<br />
brok<strong>en</strong> down into<br />
three levels of priority: emerg g<strong>en</strong>cy (within one<br />
hour),<br />
urg<strong>en</strong>t (within twwo<br />
hours) and lesss<br />
urg<strong>en</strong>t (within six s hours) calls.<br />
In the Nether<strong>la</strong>ands<br />
times beforre<br />
giving an ans swer are 30 secoonds<br />
for<br />
urg<strong>en</strong>t calls andd<br />
2 minutes for reggu<strong>la</strong>r<br />
calls respec ctively.<br />
In D<strong>en</strong>mark 90%<br />
of all pati<strong>en</strong>ts should be se<strong>en</strong> by b a doctor withinn<br />
1 hour<br />
after referral too<br />
the consultation room and 90% of o the home visitss<br />
should<br />
be provided within<br />
3 hours afteer<br />
referral. In eme erg<strong>en</strong>cy cases thhey<br />
refer<br />
pati<strong>en</strong>ts directlyy<br />
to a hospital.<br />
For France reguu<strong>la</strong>r<br />
calls are answwered<br />
betwe<strong>en</strong> 1 and 15 minutes.<br />
5.4.5.4. Triaage<br />
and servicess<br />
Cooperatives inn<br />
The Nether<strong>la</strong>nds,<br />
UK and D<strong>en</strong> nmark couple thee<br />
use of<br />
triage with three<br />
types of seervices<br />
after this<br />
procedure: teelephone<br />
consultation, coonsultations<br />
and hhome<br />
visits.<br />
Triage in the NNether<strong>la</strong>nds<br />
and the UK is performed<br />
by speciallyy<br />
trained<br />
assistants, mosst<br />
oft<strong>en</strong> nurses. TThey<br />
assess the urg<strong>en</strong>cy of the pati<strong>en</strong>t’s<br />
comp<strong>la</strong>int, givee<br />
telephone advice<br />
or arrange a co onsultation or homme<br />
visit.<br />
Their decision is supported by (national) triage guidelines (on ppaper<br />
or<br />
computer-basedd).<br />
In D<strong>en</strong>mark triiage<br />
and telephoone<br />
consultations s are solely provvided<br />
by<br />
trained GPs. Consultations annd<br />
home visits are also provideed.<br />
The<br />
differ<strong>en</strong>t regions<br />
have their own guidelines for aft ter-hours care, esspecially<br />
for what conceerns<br />
the organizattion<br />
of after-hours<br />
care. About haalf<br />
of the<br />
contacts <strong>en</strong>d up<br />
with advice only<br />
(including presc criptions or referraal<br />
to the<br />
usual GP the foollowing<br />
day).<br />
In France telephone<br />
service, homme<br />
visits and consultations<br />
in primary<br />
care<br />
c<strong>en</strong>tres are provided<br />
by after-houurs<br />
doctors.<br />
5.4.5.5. Usee<br />
of the servicess<br />
: number and nature n of contactts<br />
per<br />
yeaar<br />
In the Nether<strong>la</strong>nds<br />
about 250 peer<br />
1000 citiz<strong>en</strong>s contact c a GP coooperative<br />
each year. Heealth<br />
problems (top-5) include acute infections (26%),<br />
musculo-skeletaal<br />
problems (12.88%),<br />
digestive pr roblems (10.1%), trauma<br />
(6.8%) and respiratory<br />
problemss<br />
(4.8%). 6% of th he pati<strong>en</strong>ts who ccontact<br />
a<br />
Affter-Hours<br />
Primaary<br />
Care<br />
GGP<br />
cooperative aare<br />
referred to accid<strong>en</strong>t<br />
and emergg<strong>en</strong>cy<br />
departm<strong>en</strong>nts.<br />
In<br />
the<br />
other countriess<br />
no (validated) data<br />
could be id<strong>en</strong>tified<br />
on the numbber<br />
of<br />
ppeople<br />
who use affter-hours<br />
care.<br />
55.4.5.6.<br />
Informmation<br />
and commmunication<br />
technnology<br />
In<br />
the Nether<strong>la</strong>ndss<br />
and the UK, infoormation<br />
and commmunication<br />
technology<br />
( ICT) support include<br />
electronic paati<strong>en</strong>t<br />
files and onnline<br />
connection tto<br />
the<br />
GGPs<br />
office.<br />
In<br />
D<strong>en</strong>mark ICT inncludes<br />
a pati<strong>en</strong>tt<br />
record and electtronic<br />
connection to all<br />
ppharmacies<br />
of thee<br />
region. There is no electronic connnection<br />
neither tto<br />
the<br />
hhospitals<br />
records nor to records froom<br />
GPs clinics. DDuring<br />
home visitts<br />
the<br />
ddoctors<br />
have a coomputer<br />
in the car:<br />
they s<strong>en</strong>d the iinformation<br />
conceerning<br />
the<br />
<strong>en</strong>counters to the pati<strong>en</strong>t's GP eelectronically<br />
.<br />
FFor<br />
France and Itaaly,<br />
no (validated) information is avaai<strong>la</strong>ble<br />
on ICT.<br />
55.4.6.<br />
Critical ssuccess<br />
factors<br />
CCritical<br />
success ffactors<br />
for the DDutch<br />
and Danishh<br />
systems have be<strong>en</strong><br />
idd<strong>en</strong>tified<br />
in the liteerature<br />
and by experts<br />
from these ccountries.<br />
FFor<br />
The Nether<strong>la</strong>nnds<br />
a first group of success factoors<br />
re<strong>la</strong>tes to the GPs:<br />
their<br />
motivation too<br />
develop successsful<br />
after-hours ccare<br />
and to initiatte<br />
the<br />
rreform,<br />
a strong primary<br />
care system,<br />
their role of gaatekeeping.<br />
A second group off<br />
success factors has a connectionn<br />
with triage: a naational<br />
trraining<br />
program foor<br />
professionals innvolved<br />
in triage, guidelines for triaage,<br />
a<br />
nnational<br />
triage sysstem<br />
for the whoole<br />
acute care chaain<br />
(standardizatiion<br />
of<br />
the<br />
answers to thee<br />
calls and best cchance<br />
of having the right care proovider<br />
aat<br />
the right time).<br />
FFinally,<br />
adequate remuneration, preev<strong>en</strong>tion<br />
of work ooverload,<br />
a performing<br />
ICCT<br />
system and a medical culturee<br />
op<strong>en</strong> to col<strong>la</strong>boration<br />
and insurance<br />
rregu<strong>la</strong>tions<br />
are me<strong>en</strong>tioned.<br />
TThe<br />
Danish systemm<br />
would pres<strong>en</strong>t tthe<br />
following criticcal<br />
success factors:<br />
the<br />
pprovision<br />
of a higgh<br />
level of mediccal<br />
service, an aatt<strong>en</strong>tion<br />
to the pati<strong>en</strong>t<br />
ssatisfaction,<br />
a resttricted<br />
number of duty periods and reasonable costss<br />
from<br />
the<br />
governm<strong>en</strong>t peerspective.<br />
55.4.7.<br />
Guidelinnes<br />
in the UK, Thhe<br />
Nether<strong>la</strong>nds aand<br />
D<strong>en</strong>mark<br />
FFirst<br />
organizationaal<br />
guidelines guidde<br />
the triage and the referral of paati<strong>en</strong>ts<br />
too<br />
GP cooperativves.<br />
Second, clinical<br />
guidelines exist on mediccation<br />
47
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