Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
8. APPEENDICES
8.1. Researrch
on after-hoours
in Belgium
8.1.1. Who cconsult
the GP oor
emergency de
after-hhours
periods?
8.1.1.1. Commparison
between
GP and eme
setttings:
transversaal
study from UC
In January 20003,
a team from tthe
KULeuven an
survey about affter-hours
in Belggium
was to compaare
the patients
general practice
during week-en
and rural, Frennch
and Flemish
Auvelais, St-Luuc
Brussels, AZ
Heilig Hart Leuvven.
The main res
• A total of 2651 emergency
practice annd
1309 in hospita
daily encouunters
(and rarely
general praactice
and 1082 a
• 74.5% of patients coming
referred byy
a GP.
• In comparisson
with the hosp
o more wwomen,
more chi
75 yeaars.
o a lower
proportion of
support,
a slightly low
patientts
with preferentia
o more patients who ha
previous
12 months
emerggency
consultation
previous
12 months.
o 79.5% % of emergencies
psychoologically
justified
postpooned
to the next
that 776.5%
of emerge
9 epartments durinng
ergency departmment
CL-KUL
nd the UCL perfoormed
a
. The princip pal objective of thiis
study
in the emergency
departments and in
nds. Several area as were included:
urban
h. The 6 hospita als were Mont-Godinne,
Klina Brasschaat t, UZ Gasthuisbeerg
and
sults are:
y cases were rec corded: 1342 in general
al. The compariso on concerned maainly
the
y the night encoun nters): 977 encounters
in
at the hospital.
to an emergenc cy department weere
not
pital, there were in n general practice :
ildren below 5 ye ears, more elderlyy
above
patients disposing
of family orr
social
wer level of educ cation and slightlyy
more
al reimbursement. .
ave had an enco ounter with GPs in the
and less patien nts who have hhad
an
n or an admission n to a hospital durring
the
were medically ju ustified, 6.5% soccially
or
d. 12.8% were no ot justified and coould
be
Monday. In hosp pitals, the doctorss
stated
ency cases were medically justified
and
Affter-Hours
Primaary
Care
2.1% soocially
or psycholoogically
justified. 99.2%
were not jus
and could
be managed byy
a GP during thee
same day and 1
were noot
justified and coould
be postponedd
until after the w
end. 68. 2% of patients were
able to go to the surgery but a
a visit with
a the GP.
o 91.7% oof
patients were treated at home whereas in hosp
75.9% oof
patients were seent
back home.
• The cost of a patient was 101
euros higher in hospital (n=614)
when treatedd
by a GP (n=8559).
The use of mmedical
imaging
explains thiss
difference. For the not justified eemergency
cases
mean cost wwas
105 € in hosppital
versus 40€ wwhen
treated by a
There are immportant
variationss
between each sttructures
studied.
• The authorss
outlined the limits
of this annalysis:
evaluatio
encounters aand
no evaluation of the total sick eepisode;
no evalu
of care’s result;
any consideraation
of the differeence
between ho
function (to recognize and nname
pathology) and GPs functio
dismiss a serrious
disease).
• The authorss
suggest possibbilities
to integratte
the 3 paths
simplify the eemergency
care ooffer
towards 2 or only 1 structure.
8.1.1.2. Profille
of the patientss
who consulted d an emergency
deparrtment
during affter-hours
periodds
A similar study has
been conducteed
in 2008 to anaalyse
the profile o
patients who coonsult
an emerggency
department
adolescents and elderly were the main groups of a
persons with loww
economic statuss
have had at le
one-year period vversus
15% of thee
general populati
to the emergencyy
departments haas
been defined u
(i.e. based on meedical
decisions affter
tests). Less th
(44%) had an “appropriate“ reeason
for consu
department: 70% % hospitalisationss,
64% with an
and/or referral byy
a GP, 14% plastter
casts. The pro
consultations” haad
a close relattionship
with age
among elderly weere
“appropriate”) ). The appropriate
when the patiennts
were referredd
by a GP (57%
patients (22%).
10 stified
1.8%
weekasked
pitals,
) than
partly
s, the
a GP.
on of
uation
ospital
on (to
or to
of the
. Young children,
attenders. A quarrter
of
east one visit durring
a
on. “Appropriate” visits
using sensitive criteria
han half of the paatients
ulting an emerggency
emergency trannsport
oportion of “appropriate
e (most consultaations
eness was also hhigher
%) versus self-refferred
67