Quelles solutions pour la garde en médecine générale? - KCE

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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;
KCE Reports 1771 • To assesss the cost-effectivveness of after-ho ours services (esspecially the co-exisstence of parallel systems betwee en midnight and 8 a.m.) and foresee innovative soluttions. 6. ECONNOMIC ANNALYSIS: DATA D FROOM BELGGIUM ANDD OTHER COUNTRIES C S This chapter haas two aims: • to provide financial informaation on after-ho ours services in the five countries ddescribed in 5.4; • to analyze the two main Beelgian initiatives fin nanced by the auuthorities in collaboraation with GP associations: o the orgganized duty centtres (ODC) (see 2.4); o the pilot project 1733 seet up by the Minis stry of Public Heaalth (see 2.6). 6.1. Financ Five countries a The choice of t 8.4.3) and the national uniform different model quite similar to from Zurich 101 ing of after-houurs care in othe er countries are described in detail in chapter 5.4. and in appenndix 8.4. these countries hhas been explaine ed above: Denmaark (see Netherlands (seee 8.4.1) have resp pectively a regionaal and a m after-hours systtem. The UK (see e 0) has a systemm where s coexist. Francee (see 0) (and Ita aly) have a healthh system the Belgian one. This chapter adds a descriptive coost study . The literature seaarch in economic databases show s a lack of cost-effectiveeness studies in thhis field. Affter-Hours Primaary Care 53
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KCE REPORTS 2011 171B QUELLLES SOOL
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Contrôle Direction Contact Comm mi
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COLOPHOON Titre : Auteurs : Experts
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KCE Reports 1771B PRÉFFACE Il y a
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KCE Reports 1771B Obstacles liéés
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KCE Reports 1771B Autres alternnati
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KCE Reports 1771B Garddes en médec
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KCE Reports 1771B SYNTTHÈSE Garde
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KCE Reports 1771B 1.3.2. Chargees d
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KCE Reports 1771B La plupart des é
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KCE Reports 1771B n'est pas le cass
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KCE Reports 1771B PROCESSUS PROCÉD
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KCE Reports 1771 study of twwo inte
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KCE Reports 1771 10. Dale J, Croouc
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KCE Reports 1771 INAMI/RIZIV/NIHDI
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