Quelles solutions pour la garde en médecine générale? - KCE

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7. CONCLUSION
This report scrrutinized
the possible
alternatives s for the organizaation
of
after-hours in pprimary
care. The starting point was s the care provideers’
and
authorities’ poinnt
of view. The ddata
have shown that rural areas face a
specific problem
of workload dduring
after-hours s periods. Moreover
the
current organizaation
is not adapted
to slack period ds.
Some caveats sshould
be mentionned:
• The percepption
of the userss
was out of scope
of this researrch:
this
informationn
has been summmarized
from other r Belgian researchhes
and
from foreiggn
experiences. HHowever
not all points p could be ccovered
e.g. the speecific
problem of aaccess
for the min norities and for the
users
from low soocial
class.
• The report focused on the circles
that experie ence problems. Many
GP
circles still perfectly functionn
to the great satisfaction
of the GGPs
and
their patiennts.
There is perhaps
nothing much h to do now within
these
circles provvided
that:
o Their ssystem
is viable inn
the long term;
o The usser’s
interests remmain
at the heart of o their decisions.
• This reporrt
did not find tthe
magic bullet t to solve the pproblem
according to the type of areea
but the Belgian
data and the litterature
emphasizee
that solutions hhave
to be adap pted in rural and border
areas.
The researcherrs
analyzed the mmain
models imple emented in Belgiuum
and
elsewhere. Soome
of them woould
require leg gal amendments to be
implemented inn
our country. Thhe
literature offer rs further informaation
on
their pros and ccons,
with respecct
to one or severa al specific dimenssions
at
stake. These dimensions
requiring
an optimal sol lution are summarized
in
the table beloow:
it illustratess
the issues to o be analyzed before
implementing aany
of the modeels.
The ultimate e objective is to find a
solution, or, moore
likely, a combination
of solutions
offering a baalanced
response for eaach
of the dimensions
of the left-hand
column of the table.
Affter-Hours
Primaary
Care
Authorities Patients
GPs
GP worload
Quality of life
Security
Continuity of medical information
Adaptation to the locaal
situation
Continuity of care (treeatment
&
feed‐back to the GP)
Answer to medical & ppsychosocial
needs (e.g. home visitts)
Waiting time
Communication with health
professional
Accessibility & Securitty
Quality of medical carre
Costs
Human resources
Legislation to amend
Unique call
number with
triage
Merge areas
Out‐of‐ ‐hours during slack
centre periods
Collaboration
with local
hospital
KCE Reportss
171
Phone Nurse Volunteer
consultation consultation MD
The experience of other countriees
added further issues to consider,
in
particular the required
standardizaation
of the proceddures
and the planning
of an evaluation bbased
on indicators.
In all cases the fuuture
decisions shhould
aim:
• To simplify thhe
access to all paatients
for servicees;
• To offer services
tailored to thee
needs,
• To increase tthe
efficiency of the
after-hours heealth
care resourcces,
in
particular durring
slack periodss.
• Finally, one sshould
bear in miind
a parallel wayy
to tackle the prooblem
is to increasse
the attraction oof
the GP professsion
and of the after-
hours work iin
particular. Reccommendations
have
been propossed
in
the KCE repoort
90 and to prevvent
the burn-out in
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