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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.