Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
5.4.9.1. Thee
Netherlands: ccentral
role of GP P, efficient and ssafe
usee
of after-hours sservices
In the Netherlands
the followiing
suggestions were formulatedd
in the
literature to impprove
after-hours ccare:
• To improvve
the GPs’ ggrip
on patients s attending emmergency
departments
without a GP referral (i.e. self f-referrals) for non-urgent
medical coomplaints.
• To join primmary
and hospital emergency care (and ambulancess)
in one
after-hourss
care facility with a triage system.
• To improvee
the effectivenesss
and safety of telephone t triage services
(e.g. implementation
and evvaluation
of computerised
decision support
systems ass
the NTS and teleephone
GPs).
• To educatee
patients about thhe
use of after-hours
care.
• To minimisse
the use of unneecessary
tests and d prescriptions.
• To introducce
financial incenttives
for patients who w consult the GGP.
• To complete
the existingg
clinical guide elines with subsections
addressingg
the care in after-hours
settings.
• To improvee
patient safety byy
the supervision of o the triage by a GP.
• To improvee
access and exteension
of surgery opening o times (evvening).
5.4.9.2. UK: : focus on cost-eeffectiveness,
be enchmarking, ICCT
equuipment
and infoormation
sharing g
In the UK The NNational
Audit Offfice
Report sugge ested that the Deppartment
of Health shouldd
encourage PCTTs:
• To improvve
cost-effectiveness:
through benchmarking b
off
costs,
improvemeents
to local commissioning,
and making m training aand
best
practice avvailable.
• To performm
benchmarking for Primary Care e Trusts (PCTs) (of their
costs againnst
those of other geographically co omparable PCTs) .
• To invest iin
software systems:
ICT applications
should to bee
able to
meet basicc
requirements wwith
regard to input,
transfer andd
secure
storage off
confidential pattient
information, , prioritization annd
‘time
stamping’, search, retrieval aand
reporting of in nformation held wwithin
the
Affter-Hours
Primaary
Care
database whiilst
being compattible
with other teelephone
systemss
and
mobile devicees.
55.4.9.3.
Denmmark:
on the way y to centralisationn
TThe
Regions plann
to merge the aafter-hours
care ffunction
into hosppitals'
aacute
function i.e. . to have GPs woorking
as hired staff
within the hoospital
mmanagement
structure.
That plan needs further discussion
because
the
GGPs
and the politiccians
did not yet aagree
on the orgaanizational
details.
A single national telephone numbber
should give aaccess
to health care
ppersonnel
to referr
a patient to the relevant service like a GP cooperrative,
aan
acute hospital sservice,
an acute local clinic or homme
nursing.
55.4.9.4.
France
TTwo
key recommeendations
for Frannce
deal with pattient
education: coorrect
uuse
of after-houurs
care and prrevention
of missuse
of the hoospital
eemergency
departtment
by self-referral.
KKeypoints
– After-hours
care in five
countries
• Main drivers for system reforrm
mainly came from GPs (worklload,
patients’ demmands)
but authoorities
had also rreasons
to suppoort
changes in thhe
care during affter-hours
periodds
(e.g. lack of
human resouurces,
accessibillity
and costs).
• The cooperattive
is the most prevalent model in the selected
countries: ussually
run by GPs,
supported by nurses/ancillaryy
staff.
• The participaation
of GPs in affter-hours
care is
high (from 78% % to
more than 900%)
and sometimmes
an obligatoryy.
• Triage is a crritical
point: somme
countries empploy
nurses or
assistants, oother
countries oonly
GPs.
• Three types oof
after-hours seervices
may be pprovided
after triaage:
telephone coonsultation,
conssultations
and hoome
visits.
• Different GP payment systemms
are applied (bby
duty period/ caall).
• Guidelines are
used for triage/referral
and for
prescribing.
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