Quelles solutions pour la garde en médecine générale? - KCE

52
and/or patientss.
In Denmark a quality monitorin
2013.
Still little evidennce
exists in termms
of clinical outc
prevents from drawing firm connclusions
on the
models (e.g. qquality
of care off
consultations pe
patient outcomees
after a telephone
consultation).
Positive effectts
of some modeels
with regard to
One objective oof
the developmennt
of new models
level was a more
efficient use off
health care serv
to emergency department services
for little ailm
visits when posssible.
New models
seem to produc
services. Somee
examples are:
• The triage system by a GP
(Denmark) wh
solved by pphone
only.
• The consuultations
by other
health profess
decrease the
GP workload in
terms of consult
• The integraation
of a GP consultation
in an em
decreases the number of EDD
consultations.
The effect of ccooperatives
seemms
more inconsi
number of GPP
home visits but
have little impa
emergency services.
A possibble
hypothesis is
between the exxisting
structures aat
GP and hospita
recurrent abseence
of liaison structures betw
ambulance serrvices
(at managgement
or operat
hypothesis is tthe
lack of patieent’s
information
he/she attends the service of his/her
choice
5.5.3. Suggeestions
to impro
The authors and experts fr
suggestions to improve the curre
5.5.3.1. Traaining
and scient
58 ng system is fore
comes. This lack
effectiveness of
erformed by nurs
o service use
at the health care
vices e.g. less self
ments and less G
ce an effect on th
ere half of the c
ionals than doct
tations, advice an
mergency departm
stent: they decre
act on the use
s the poor colla
al levels: authors
ween cooperativ
tional levels)
.
ve organization
rom the differen
ent national after-h
tific support of he
100 eseen in
k of data
the new
ses and
e system
f-referral
P home
e use of
calls are
tors that
nd visits.
ment that
ease the
of other
aboration
notice a
ves and
. Another
and incentives, so that
of after-hours caare
nt countries forrmulated
hours systems.
ealth professionnals
• Guidelines for health professsionals
(e.g. to indicate i when to perform
home visitss,
taking into accoount
non-medical conditions);
c
• Supervision
of the triage proocess
by a doctor; ;
Affter-Hours
Primaary
Care
KCE Reportss
171
• Communicatioon
training (e.g. training of triagissts
for patient-ceentred
communicatioon:
active listeningg,
active advising and structured caalls);
• Tools for quuality
improvement:
implementatioon
and evaluatioon
of
computerised decision support systems for triage.
55.5.3.2.
Possibble
avenues to immprove
the patieent’s
satisfactionn
• To provide infformation
on the most accurate seervice
according tto
the
needs, use off
after-hours servicces
and waiting times;
• To reduce thhe
waiting times (definition of maximal
values aree
now
criteria for thee
evaluation of thee
services in Denmmark
and in the UK);
• To enable an access of the medical
record for the doctor on dutty
(cf.
paragraph 5.55.1.3);
• To pay attenttion
to the accesssibility
of the AH services (cf. a Beelgian
study that aanalyzed
the beest
possible impplementations
off
GP
cooperatives in two provinces,
see 8.1.7): mmost
models offeer
the
possibility of hhome
visits for paatients
who are unable
to travel buut
this
review did nnot
identify any system of patieent
transport in other
countries (impplemented
at a naational/regional
levvel).
55.5.3.3.
Improvements
at heallth
system care level:
commmunication,
qualitty
assurance, huuman
resourcess,
financcing
• To join primary
and hospital
after-hours carre
services (including
ambulances) in one after-hourss
care facility with a triage system;
• To develop ICCT
equipment (effiicient
sharing of innformation);
• An acceptablee
number of shiftss
during midnight;
• New roles andd
competences off
health nurses to offset the lack of GPs;
• To think abouut
incentives within
the system to aavoid
the inappropriate
use of servicces,
source of coosts
and of posssible
delay in case
of
emergency;
• To set up quaality
systems that register the qualitty
of after-hours caare
in
the different settings: accesssibility,
reactivityy
and safety off
the
services, efficciency
and impact on other servicess;