Quelles solutions pour la garde en médecine générale? - KCE

48
prescribing. In DDenmark
those guidelines
differ be etween regions. Inn
the UK
the National QQuality
Requiremments
for after-hours
services seerve
as
guidelines to higgh
quality after-hoours
care.
For France andd
Italy no validatedd
information coul ld be obtained whhether
or
not guidelines aare
used in the coontext
of after-hours
care.
5.4.8. Qualitty
assessment aand
follow-up
5.4.8.1. Quaality
measuremeent
The UK has Naational
Quality Reequirements
for after-hours
servicees
and a
system for acccreditation.
Thrree
organizations s are involved in the
measurement oof
after-hours quaality
indicators: th he Department oof
Health
(responsible for
accreditation), tthe
Care Quality Commission C
(responsible
for the monitoring
of compliancee
against essential
standards of quaality
and
safety) and tthe
Local healthh
Authorities (r responsible for regional
monitoring of quality of after-hhours
services). There has also been a
Department of Health’s 2009 project to asses ss after-hours caare.
The
system that is rrunning
since 2005
is detailed in the e next paragraph.
In the Netheerlands
there iss
no official outcomes o measuurement:
measurements are so far cconducted
in the
context of rresearch
programmes. TThe
measuremennt
of the quality y of clinical caree
in GP
cooperatives is based on evidence-based
clinical guidelines. Theree
is a set
of 24 indicatorss
developed by IQQHealthcare
(Nijm megen) for prescribbing
and
referring in after-hours
primary caare.
In Denmark the
National Boardd
of Health is re esponsible for thee
quality
monitoring bassed
on existing indicators. From m 2013 onwards
these
indicators will bbecome
mandatory
as part of an accreditation a
proccess
but
the final selectioon
of indicators iss
not yet ready.
These three coountries
publishedd
studies on positive
outcomes reelated
to
the implementtation
of after-hhours
care (se ee chapter 5.3.22:
GPs
satisfaction, paatient
satisfaction,
use of healt th services and clinical
outcomes).
In France, the national regulattory
body for soc cial services (“Insspection
Générale des Affaires Sociales”)
is involved d in quality moonitoring.
Information on specific indicatorss
or results of me easurements couldd
not be
obtained within the scope of this research.
There is no afteer-hours
outcomess
measurement in n Italy.
Affter-Hours
Primaary
Care
KCE Reportss
171
55.4.8.2.
Nationnal
Quality Requuirements
for aftter-hours
servicees
in
the UKK:
illustration of an ongoing QI mmeasurement
A detailed overview
of the National Quality Requiremments
is provided in the
teemplate
on after-hhours
in the UK. TThis
system includdes:
• regular and mandatory reporrting
of the GP cooperatives on their
compliance wwith
the quality reqquirements
to the Primary Care Trust,
• reports of GPPs
on duty for all aafter-hours
consuultations
to the praactice
where the pattient
is registered (by 8 a.m the nexxt
working day),
• the set up of systems to suppoort
and encouragee
the regular exchhange
of up-to-date and comprehensive
information between GPs annd
all
health professsionals
who may provide care to patients
with predeefined
needs,
• regular auditss
by GPs of a raandom
sample off
patient contactss
and
appropriate acction
based on thee
results. Reportss
of the results of these
audits will be made available too
the contracting PPCT,
• regular auditss
by GPs of a raandom
sample off
patients’ experieences
with the servicce
with appropriatte
action based onn
the results,
• existence of a complaints pprocedure
that iss
consistent withh
the
principles of tthe
NHS complaints
procedure. AAll
complaints muust
be
audited in reelation
to individdual
staff so thaat,
where necesssary,
appropriate acction
can be takenn,
• ability to maatch
the capacityy
with the predictable
fluctuationns
in
demands for sservices,
especially
at peak hours (Saturday and Suunday
mornings, thee
third day of a BBank
Holiday weeekend).
GPs mustt
also
have robust contingency policcies
for those circumstances
in wwhich
they may be uunable
to meet unnexpected
demandd,
• GPs must ensure
that patients
are treated by the clinician best
equipped to mmeet
their needs,
(especially durinng
peak hours), iin
the
most appropriate
facility.
55.4.9.
Suggesttions
for improveement
of after-hoours
care
SSuggestions
for immprovement
of after-hours
care couuld
be obtained foor
The
NNetherlands,
UK, Denmark and Fraance
(experts and grey literature).