Quelles solutions pour la garde en médecine générale? - KCE

68
8.1.1.3. Afteer-hours
Primaryy
Care in Belgium
A total of 11 reesearch
questions
concerning afte
Belgium were ccovered
by H. Philips’
PhD thesis
results were preesented:
• 1611 patieent
contacts du
analysed inn
4 large cities (A
January 22005.
The total
emergencyy
department and
to the ED were prominent
doctor and speaking Dutch
the GP’s ccall.
Being male, h
months, sppeaking
neither D
having no medical assuran
Young men
with minor trau
ED. Income
and family situa
study. Thee
results outline th
the servicee
they are used
patients’ innformation
about
SERVICE options, particula
minor traumma.
• From the same sample in
patients weere
interviewed to
purposeful sample of 21 p
structured interview and a
study showw
that GPs are co
(home visitts
and availability
by patientss
who trust them.
of the stafff
are the major re
co-paymennt
(supplementary
hospitals wwhen
the patient c
by a physiccian)
did not influe
• From Febrruary
to June 200
born and Child health ca
consumerss’
knowledge, ex
performancce
of the different
on the annalysis
of 350 q
8 m: PhD thesis 22010
er-hours primary care in
. The following inteeresting
ring 2 week-end ds were recordeed
and
Antwerp, Ghent, Brussels
and Charrleroi)
in
population was 1611 patients: 971 in
640 in the GPs population. Self-referrals
t (64%). Being female, f having a family
or French were determinants d
in faavour
of
having had an ED D visit during the past 12
Dutch nor French,
African nationality
and
nce were associa ated with the ED option.
uma were more likely
to seek helpp
at the
ation did not play y a significant rolee
in this
he fact that patients
tend to seek help at
to. They also outline o the necesssity
of
t the possibilities s of 2 AFTER-HHOURS
arly for foreigner rs and young meen
with
n the 2 cities An ntwerp and Ghent,
787
o assess their rea asons for seeking help. A
patients was also
recruited for a semi-
qualitative analy ysis. The results of this
onsulted if percei ived as more acccessible
y), able to solve minor medical prroblems
. Accessibility, pro oximity and comppetence
easons for the ED D option. Otherwise,
the
y fixed amount implemented byy
some
came at the ED wi ithout preliminary referral
ence the patient’s choice.
6, a study was ca arried out at 3 Freee
New
are services in Antwerp A to asseess
the
perience and perceptions
related to the
t medical services s. The results aree
based
questionnaires. Experience E
is thee
most
Affter-Hours
Primaary
Care
KCE Reportss
171
important facctor
to choose a service. An exppected
shorter w
time is the mmain
reason for thhe
GP option (ann
ODC in this cas
good explanaation
about the disease
and the trreatment
by the d
is the majorr
reason for the ED option, followed
by easy ac
immediate teechnical
examination
and delay for the payment.
• Within the ssame
sample, a market simulation
was based
computer-aidded
discrete chhoice
experimentt.
The predictio
demand demmonstrated
a higheer
preference for the GPs’ ODC. A
from the otheers
after-hours opptions
towards ODDCs
could be pos
mainly if commmunication
strattegies
are implemmented
to increas
population awwareness.
• The implemeentation
of an ODDC
in the city of Turnhout in 2006
used to perfoorm
a prospectivee
before/after studdy.
The study inc
5149 patientt
encounters (2298
in 2006 before
the setting up
2857 afterwaards).
This studyy
shows an increease
in the numb
patients calling
the GP (as coompared
to the foormer
rotation sys
and a stabilitty
in the number of patient seekingg
help at the ED.
trauma casees
at ED, less EDD
arrival by ambuulance
and less
visits are alsoo
noted after the OODC
setting up.
8.1.2. Evaluattion
tools for actiivities
during afteer-hours
periods
In 2005, a study (UCL-KUL) was carried out to prrovide
supportive
(quality indicatorss)
to the circles for
their after-hourss
organization
sources of informmation
were used: stakeholder’s int
(about 60 persons
in charge of after-hours
services
amount of 71 critiical
quality criteriaa
(CQC), in 7 cate
Among the covered
issues, the autthors
outline:
• After-hours service seems to be “the own
implication oof
non medical staaff
in the organiz
triage is not rrecommended
by the participants.
• Defining concrete
task for thee
after-hours serv
is important ffor
the relation wiith
the patients an
department.
• Recording oof
epidemiologicaal
data is releva
medical dataa
can pass on to oother
physicians b
• Data recordinng
and analysis too
improve after-ho
108 waiting
se). A
doctor
ccess,
on a
on of
A shift
ssible,
se the
6 was
luded
p and
ber of
stem)
Less
home
s
tools
. TThree
erviews; brainstorming
s), literature searcch.
An
egories, are the reesults.
ership of GPs”. The
zation, managemeent
or
vice in general praactice
nd with the emerggency
ant and feasible. The
ut not to authoritiees.
ours service.