Quelles solutions pour la garde en médecine générale? - KCE

50
• The use off
quality indicatoors
and outcome es measurement is still
in a premaature
stage. Onlyy
the UK applies a system of Natiional
Quality Reequirements.
• Critical suuccess
factors foor
after-hours car re are e.g. the strrong
involvemeent
of the GPs, addequate
remuneration,
team worrk,
patient infformation,
the prresence
of a natio onal triage systeem
for
the whole acute care chainn,
prevention of work w overload,
informatioon
and communiccation
technolog gy.
• Suggestioons
for improvemment
of after-hours
care are e.g. tto
take
actions aggainst
self-referraals
to emergency y departments, to
join
primary annd
hospital emerrgency
care in on ne after-hours caare
facility witth
a triage systemm,
to improve the e effectiveness aand
safety of telephone
triage services, to educate
patients aboout
the
appropriatte
use of after-hoours
care, to enc courage the use oof
clinical guuidelines
in after-hours
care settings.
5.5. Lessonns
learned fromm
other countrie es: new modelss
for
after-hoours
care, theirr
impact and av venues for the future
The countries under study deveeloped
a system mainly based onn
(large)
scale GP cooperatives
to replacce
the former rota ation systems. Thhey
have
either nationall/regional
uniformm
after-hours systems
(Denmark,
The
Netherlands) orr
systems where different models coexist c (UK in paarticular).
The next paraggraphs
summarizee
the main feature es of the new afteer-hours
models in termms
of organizationn,
impact on GPs s, on patients andd
on the
health care system.
5.5.1. Main ffeatures
of the aafter-hours
mode els
5.5.1.1. Assset
: a centrally oorganized
prima ary care system
The reforms of after-hours sservices
are linked
to the insttitutional
architecture of the health systemm.
In countries with w a centrally orrganized
primary care syystem
(The Netherlands,
UK and Denmark), the reeform
of
after-hours serrvices
is implemeented
since more e than one decade.
The
drivers were GPP
professional orgganizations:
their early initiatives mmoved
to
the current situuation,
nowadays organized and supported s by the national
health authorities
in collaboratioon
with them. In countries where primary
Affter-Hours
Primaary
Care
KCE Reportss
171
ccare
is less centr
sservices
depend o
AAll
countries und
aaccess
to emerge
55.5.1.2.
Reaso
TThe
reasons to im
98
. GPs were diss
pparticular
the perc
oof
life and the sa
aafter-hours
care as
FFurthermore,
key
bby
the public, the s
55.5.1.3.
Contin
OOne
complaint fr
ppatient’s
situation
rremark
is howeve
than
the usual G
hhighlights
more ge
ccare
(pharmacists
ccare.
A lack of coordin
mmedical
errors, to
ddoctors
(who do
frragmentation
of c
CConcrete
proposa
sseamless
care
IC
t
5
B
tr
e
d
tr
99 rally organized, aas
in France andd
Italy, the after-
on the local or regional
features.
er study strugglee
to restrict the unwarranted pat
ncy care but no mmiracle
solution haas
been found till n
ons to think abouut
new models
mplement changess
are similar to thee
Belgian situation
satisfied with the system, usually rotation groups a
ceived workload, the patients’ demmands,
the poor q
afety conditions. A previous KCEE
report also iden
s a factor against the attraction of tthe
profession
issues for the auuthorities
were the
shortage of GPs, issues of accessi
nuity of care: a cconcern
that call
rom GPs and paatients
is the po
, in particular in the absence of
r applicable to any
care provided b
P (e.g. hospitalizzation,
rotation sy
enerally the lack of communication
s, GPs, nurses) and between ou
nation between aafter-hours
care
poor communicattion
with the patie
not know what happened durin
care and to unneceessary
service pro
als have been ooutlined
in a pre
. TThis
report proposes
solutions as f
CT systems to allow
the GP on duuty
to consult the
he patient’s GP before
8 a.m., speccial
delivery of me
5.5.1.4. Triagee
systems with qquality
procedure
Belgium now launcched
pilot projectss
to have a unique
riage for all after- hours calls. The NNetherlands,
The
experience of triagge
during after-hoours
services whil
development in oother
countries (ee.g.
“15” in Fran
riage systems aimmed
to offer the most appropriate
3 hours
tients’
now.
41, 95-
n
and in
quality
ntified
.
e demand for serrvices
bility and costs.
ls for solutions
oor knowledge oof
the
f medical record. This
by another professsional
ystems). This critticism
n within the first liine
of
utpatient and inpatient
providers can leaad
to
ent, to frustration oof
the
g after-hours), too
the
ovision.
evious KCE repoort
on
for example integgrated
medical record, ffax
to
edication at home.
es
e regional numbeer
with
UK, Denmark havve
an
st this system is uunder
ce). The launching
of
e solution accordiing
to