Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
• The after-hhours
service has
nights) for 46.7%. A referra
a.m. is a ppossibility
for 64.3
another poossibility
(74%) (n=
• The ACIODD
se Déplace
social taxi f
• The TASR
known by 8
(n=29).
• The call of
areas (n=2
urban area
• The setting
n=26): 90.
(n=28).
• Two thirds
I is a pos
improveme
the after-ho
8.1.7. Searc
Mobili
In 2009 and 2
studies on after
and Luxembou
common statem
In particular in
fall from 355 in
from 49 to 52.7
by 26% (from 1
c (“Abolition du C
er”) should beco
for 75% (n=28).
E d s to be compulsory
(WE 24/24 an
l to hospital emer rgency between 0
3%. Merging areas
during nights co
=28).
Caractère Incondit tionnel de l’Obliga
me legal for 85.7 7% and supporte
(“Triage des AAppels
Sous la Responsabilité
de l’E
82.8% of the circcles
and considere ed as important f
volunteer GP is aappropriate
for 55.6%
of the circles
27) (and realistic for 35.7%). It is appropriate a for 73
as (n=23) (realisticc
for 60.9%).
g up of ODC is a solution for 65 5.4% of the circle
.9% for urban areas
(n=22) and d 64.3% for rura
of the circles sugggested
that the im mprovement of Im
sibility for increaasing
the setting up of young GP
ent of the GP trainning
is another po ossibility to help t
ours service probllem
(85.7% of 28 answers).
ch for optimal soolutions
in two pr rovinces (Instituu
iteit)
2010, the “Instituuut
voor Mobiliteit”
of Hasselt prov
r-hours care in geeneral
practice in the t provinces of L
rg in collaborationn
with the GPs fro om the provinces
ment was the decrreasing
number o
some areas of Luuxembourg,
the n
2010 to 227 in 22020.
The mean a
7 years. The nummber
of patients fo
028 to 1608).
1
d week
0 and 7
ould be
ation de
ed by a
Etat") is
for 69%
in rural
3.9% in
es (total
l areas
mpulseo
Ps. The
to solve
ut voor
vided 2
Limburg
114
. The
of GPs in both proovinces.
umber of active GGPs
will
age of GPs will inncrease
or each GP will inncrease
c
ACIOD = Obligation to perforrm
home visits when n requested.
d
TASRE = Triage of calls in Sttate’s
charge.
Affter-Hours
Primaary
Care
In the province off
Limburg also, thhe
number of GPss
will fall from 7166
now
to 446 in 10 yearrs
(with an increaasing
median agee
from 47 to 50 yeears).
The average nummber
of GPs per inhabitants (for a constant populaation)
will decrease fromm
1.01 to 0.63.
Two options are proposed for the future in order too
ensure the conttinuity
of GP after-hourrs
service. The ffirst
one is mergging
the sectors. This
solution is more difficult to impleement
in the proovince
of Luxembbourg
where the sectorrs
are more extensive
than in thee
province of Limmburg,
with a lower denssity
of populationn.
There is also a disparity betweeen
the
sectors in relationn
to the burden off
after-hours workk
per year (and a lower
attraction of thesse
areas for younng
GPs). This prooposal
is thereforre
not
sustainable as a llong-term
solutionn.
The second posssibility
to solve thhe
problem is thee
creation of ODCCs
at
strategic places. TThe
study carefully
analysed the best
place to impleement
those centres takking
account of tthe
density of thee
local populationn,
the
available GP huuman
resources and the distancces
(and duratioon
of
jjourneys).
Many scenarios have been consideredd
for the provincce
of
Luxembourg withh
different numbeers
of centres (froom
1 to 7) at variable
places. Each opption
has been proposed with cconsequences
foor
the
patients (travelling
time) and for thhe
GPs (number of duty days or wweek
ends per year).
However, many ssolutions
are hammpered
due to thee
borders betweeen
the
GP circles. The mmost
relevant soluutions
are those thhat
do not take account
the current borders
between GP circles.
8.1.8. Summaary
of the researrch
findings
Researches provvide
statistics andd
data about the problem of after- hours
e.g.:
• The profile aand
perception off
the patients whoo
consult during after-
hours periodss
GPs or emergenncy
departments;
• The perceptioon
of GPs;
• After-hours sservice
is perceiveed
as a burden byy
many GPs and might
give them ann
unsecure feelingg;
• Some figuress
highlight the nuumber
of patient ccontacts
by GP dduring
the nights, wwith
a mean of lesss
than one per nigght;
71