Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
the patient’s neeeds
and to use more efficiently th he health care reesources
(in particular health care proofessionals
acco ording to their specific
competencies). The evaluations show indeed an impact i on GP homme
visits
but no clear effeect
on the other aaspects
of health care c system use.
The triage by a non-physician is an important issue. The few aavailable
evaluations sugggest
that this trriage
has no effe ect on mortality, hospital
admissions andd
GP workload. HHowever
the Danish
GPs opted to perform
this task themsselves,
arguing thhat
this is the most
sensitive step in after-
hours process oof
care.
The safety and quality of the triagge
depend on the e quality procedurees:
tools
(e.g. guideliness)
have been deeveloped
in all countries c under sstudy
to
standardize the
decision proccess
and to facilitate
quality asssurance
initiatives (e.g. incident analysis, supervision sche emes).
5.5.1.5. Heaalth
professionalls
with different profiles p
The analysis off
the Belgian situaation
highlighted the local problemms
of GP
shortage: one ccurrent
solution iss
the call for “duty y GPs” to give a hhand
for
duty periods (see
2.5.2). In somme
countries (as in n Italy) a fully reccognized
status exists forr
those doctors sppecializing
in after r-hours services.
Duty periods aare
usually covereed
by experience ed licensed GPs: it might
even be a conddition
to keep theiir
official recogniti ion (cf. The Netheerlands).
However the profile of after-hours
service doctors d varies bbetween
countries. In Frrance
for examplee
GPs and specia alists may stand ffor
each
other. In Italy yyoung
doctors soometimes
begin their t GP experiennce
with
after-hours caree.
In these cases, , doctors might eit ther be too speciaalised
or
insufficiently eexperienced,
withh
possible cons sequences in teerms
of
excessive hosppital
referrals or quuality
of care.
Not only doctorrs
but also specialised
nurses/assis stants sometimes care for
minor health prroblems.
They acct
as “gatekeeper r’s gatekeeper” and
work
either as stand alone or supervised
by doctors. They T perform facee-to-face
consultations and
telephone connsultations.
These e models show a positive
impact on the workload of GPss
and emergency y departments. TThey
are
however one ssource
of dissatisfaction
among the patients and little is
known about the
quality of care.
Affter-Hours
Primaary
Care
55.5.1.6.
Payment
of doctors annd
incentives for
after-hours
servicces
In
Belgium the finnancing
of after-hhours
services combines
a payment
for
sspecific
duty perioods
with a fee-for-service
system. AAll
countries havee
also
sset
up a system too
reward the GPs who take part in tthe
after-hours system:
eeither
a fixed summ
for duty periodss
on call (NL, UKK)
or a fee-for seervice
ssystem
(Denmark, , France).
55.5.2.
Impact oof
the new modeels
on GPs, patieents
and HC sysstem
use
55.5.2.1.
Answeer
to the GPs’ exxpectations
AAs
stated above, , new models haave
usually a poositive
impact onn
the
pperceived
workloaad
of GPs. The literature also cconcludes
on a gglobal
ppositive
perceptionn
of GPs with regard
to quality of life
and job satisfaaction.
TThis
perception depends
on the pprevious
situation (rotation or indivvidual
oorganization)
and on their personal desire to adopt a new system.
55.5.2.2.
Patiennt
satisfied but ssome
concerns
PPatients
are usuaally
satisfied withh
current system but one fifth of them
eexpress
their disssatisfaction.
Theeir
frustration maainly
arises fromm
the
ddiscrepancy
betweeen
their expectaations
and the reaality,
in particular when
there
is a contactt
with another heealth
professionall
than a doctor. OOther
ppoints
that warrannts
attention are thhe
waiting times, the accessibility oof
the
ccooperative
and thhe
continuity of caare
as explained aabove.
55.5.2.3.
Impacct
at health care system level: feew
data on qualitty,
some effects on the uuse
of services
FFew
available datta
about the effeect
on the qualityy
of care
FFew
data are avaailable
on the quuality
of the afterr-hours
services. In all
ccountries
different
systems coexisst
(at hospital annd
primary care level)
mmaking
a global aassessment
of alll
structures difficuult.
Moreover, thee
new
mmodels
have beeen
set up providding
more attention
to organizaational
aaspects
than to quualitative
aspects of care.
TThe
UK is the onnly
country applyinng
official quality y standards. Theyy
take
innto
account a nummber
of quantitative
dimensions (ee.g.
waiting time, ccosts,
pproductivity,
numbber
of referrals) aand
qualitative suurveys
among dooctors
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