Quelles solutions pour la garde en médecine générale? - KCE

70
death (1%) ). Most encounterrs
were managed d by the GP only without
any additioonal
action.
• During thee
“deep night” (111
pm to 7 am), the
estimated ammount
of
encounterss
was less than 2 for the 3 GPs on o duty (72% aree
visits).
These encoounters
representted
3.8% of all calls.
The night encounters
lead more frequently to a refferral
to a hospita al emergency depaartment
(11.4%), too
a call to the SMUUR
(7.8%) and de eath (5%).
The SMWE ouutlines
the need oof
an after-hours service reform wwith
the
following proposals:
• To cancel tthe
deep night aftter-hours
service for GPs. Among 229
GPs
from the asssociation,
18 are against duty during
deep night.
• To merge sseveral
areas.
• To create a media campaignn
about the appro opriate use of afte
service.
• To ask the GPs to sensitize their patients abo out this appropriat
• To set up oorganized-duty
ceentres
(ODC).
• To professionalize
the after-hours
service.
8.1.5.2. Figuures
from the arrrondissement
of
Dinant 112
er-hours
te use.
Similar figures have been foundd
for night visits (9 pm-8 am) in the GP
circle of the “aarrondissement”
oof
Dinant. A total of 549 GPs provvided
a
report on the number
of patientss
they saw during the night. Each GGP
had
a mean numbeer
of patient contaacts
equal to 0.81 1. 290 GPs did noot
have
had any contacct
during the nightt,
a finding in line with the data anaalysis
in
4.1.4.
8.1.6. Perceeptions
of GPs oof
after-hours wo ork
In 2009, a survvey
was carried oout
by the GP’s association a forumm
(FAG)
113
among the 655
French speakking
GP circles . Thirty-two circles
answered, reprresenting
154 afteer-hours
geograph hical sectors (22119
GPs,
3 059 727 inhaabitants).
The obbjective
of this su urvey was to asseess
the
perception of the after-hours services in GPs s and to examiine
the
possibilities for improving after-hours
care.
• The after-hhours
services peerfectly
run for ne early half (47.4%) ) of the
154 GP cirrcles.
Affter-Hours
Primaary
Care
KCE Reportss
171
• There were pproblems
with the GPs’ participationn:
o Age pyraamid
(80.3%)
o Shortagee
of GPs (35.0%)
o Medical certificate to avoid
being on call (32.9%)
o GPs noot
assuming their
responsibility regarding after- hours
service ( (15%)
• The recurrennce
of periods on call was too highh
for one third (333.8%)
of the circless.
It diverted younng
GPs from setting
up in difficult aareas
(63.9%). Meerging
sectors couuld
be a possibillity
for decreasing
the
burden of aftter-hours
duties (775%
from 28 GP ccircles).
• The number
of patient-docctor
encounters during AFS seeemed
•
satisfactory for the majorityy
of the GP cirrcles
(73.1%). It was
considered tooo
small for 16.8% % and too high foor
10.1% of them (total
n=119).
The proportion
of visits versuus
consultations was 50.5% vs 449.5%
during the daay
and 84.9% verssus
15.1% during the night.
• A single phonne
number seemeed
to decrease thee
number of calls.
• The GP’s ttravel
was consiidered
justified ffor
half of the visits
according to the participants.
• A quarter off
the GP circles experienced secuurity
problems (mmainly
verbal aggreession).
The GPs felt insecure in 77.7%
of the situaations,
sometimes iinsecure
(65.4%) ) and safe 26.9% % (n=26). Otherrwise,
most of themm
felt respected byy
patients (82.7%) ).
• The proportioon
of outstanding payments was 8.2%
(but 20.3% dduring
the night visitts).
• The fees were
considered apppropriate
for half of the GP circless
with
regards to WWE
consultations aand
WE visits. Perrcentages
were sllightly
lower for eveening
visits (42.33%)
and higher foor
night visits (577.7%).
Less than a quarter of the circles who answwered
to the queestion
(23.1%, n=266)
deemed “availaability”
fees to be aappropriate.
• The third-parrty
payment is ussed
in 11.6% of ccases
and it shouuld
be
not encouragged
according to tthree
quarters of tthe
circles.