Télécharger le rapport (152 p.) - KCE

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86 Urgences KCE reports vol. 19B COUNTRY STUDY DESIGN LEVEL OF EVIDENCE SARVER ET AL., 2002 USA Enquête nationale représentative (1996 Medical Expenditure Panel Survey) Etude transversale SEMPERE-SELVA ET AL., 2001 THOMSON ET AL., 1995 Espagne, Hôpital universitaire dÊElche Etude transversale dans un service dÊurgence. Echantillon aléatoire de patients adulte. Adéquation du recours mesurée à lÊaide du Hospital Urgences appropriatness Protocol Ecosse Patients consultant dans un service dÊurgence pendant une période de cinq jours consécutifs Questionnaires auto-administrés SAMPLE RESULTS REMARKS III 9146 adultes Les patients non satisfaits par les soins de première ligne ont plus de risques de consulter un service dÊurgence (p
KCE reports vol. 19B Urgences 87 FIRST AUTHOR- YR-CTRY. AFILALO J.- 2004- CANADA. AVERY J.A.- 1999-UK. BEALES J.- 1997-UK. BENGER JR- 2004-UK. BROGAN C.- 1998-UK. BUNN F.- 2004-UK. TYPE STUDY OBJECTIVE(S) METHOD(S) RESULTS DISCUSSION Analysis of crosssectional st. Observational Prospective study. Observational before and after study. Randomised controlled trial (RCT). Prospective cross sectional survey. Cochrane based systematic review. Non urgent and semi urgent features and barriers to primary care, instead of EDÊs. Address patterns of use of GP and ED outside normal hours. Experience with a nurse practitionerrun minor injuries care unit. Determine the safety and clinical effectiveness of MI-telemedicine compared with on site (district hospital) specialist care. Determine the use and costs of out of hours services. Assess the effects of tel-consult by different health care profs. on safety, service usage, pat. satisfaction. Triage based sampling of cross-sectional data in 5 tertiary hosp. Structured in a behavioural model for care. Datacollection prepared sheets in 6 GP and ED areas.. Tabel of provisions and protocols of tel. advice and care and cure in a MIU, runned by nurses. Double blind random design of pats to 3 treatment plans(12 months):emergency doctor(ED) on site, an ED using telemedicine, a on site GP. Study the out of hours activities of 6 GP and local EDÊs. (6 months). 9 studies included,5 RCTÊs, 1 CCT, 3 ITSs (interrupted time series). 25 % of NU and USU pats were seeking care from a GP!! Reasons : accessibility, self perception of need, trust in ED. 63 % of first contacts GP. 30 % dealt by tel. Minor Avery symptoms. Marked decrease in waiting times for MI care attenders and reduction in complaints. 40 % of pats allocated to telemedicine,35 % to on site ED, 25 % to GP. Telemedicine took the longest consult(6 min).No significant differences in clinical outcome. Wide variations in electoral wards in GP and EdÊs.·Out of hours activity hughest,both in GP and EDÊs, in deprived inner city areas. 50 % of calls handled by tel. advice only.· Unclear if triage is delaying or reducing EDvisits,2 studies showing an increase in return consultations. Reasons of self referral are diverse in NU and USU pats. Diversion strategies to consult fist a GP have to be multifaceted. Referrals to ED mainly for dyspnoea and chest pain. Minor symptoms to GP. Scope for more tel. dealt advices by GP. The MIU decreases the need for ED-attendance fot MI and are well cared in the scope of trained nurses. Safety of minor injuries telemedicine= conventional practice. No differences in type of errors. Presently no evidence of effectiveness of TELEM. In urgent cases. New multidisciplinary primary care centers with tel.-advice and triage are required to assure high quality and cost effective care. Tel-consultation can rerduce the surgery contacts and the out-of-hours visits by GPÊs and appears to be safe.There may be an increase in repeat visits. Further research needed.
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KCE reports 1. Efficacité et renta
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