Télécharger le rapport (152 p.) - KCE
Télécharger le rapport (152 p.) - KCE
Télécharger le rapport (152 p.) - KCE
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<strong>KCE</strong> reports vol. 19B Urgences 87<br />
FIRST AUTHOR-<br />
YR-CTRY.<br />
AFILALO J.-<br />
2004-<br />
CANADA.<br />
AVERY J.A.-<br />
1999-UK.<br />
BEALES J.-<br />
1997-UK.<br />
BENGER JR-<br />
2004-UK.<br />
BROGAN C.-<br />
1998-UK.<br />
BUNN F.-<br />
2004-UK.<br />
TYPE STUDY OBJECTIVE(S) METHOD(S) RESULTS DISCUSSION<br />
Analysis of crosssectional<br />
st.<br />
Observational<br />
Prospective<br />
study.<br />
Observational<br />
before and after<br />
study.<br />
Randomised<br />
control<strong>le</strong>d trial<br />
(RCT).<br />
Prospective<br />
cross sectional<br />
survey.<br />
Cochrane based<br />
systematic<br />
review.<br />
Non urgent and semi urgent features<br />
and barriers to primary care, instead<br />
of EDÊs.<br />
Address patterns of use of GP and<br />
ED outside normal hours.<br />
Experience with a nurse practitionerrun<br />
minor injuries care unit.<br />
Determine the safety and clinical<br />
effectiveness of MI-te<strong>le</strong>medicine<br />
compared with on site (district<br />
hospital) specialist care.<br />
Determine the use and costs of out<br />
of hours services.<br />
Assess the effects of tel-consult by<br />
different health care profs. on safety,<br />
service usage, pat. satisfaction.<br />
Triage based sampling of cross-sectional<br />
data in 5 tertiary hosp. Structured in a<br />
behavioural model for care.<br />
Datacol<strong>le</strong>ction prepared sheets in 6<br />
GP and ED areas..<br />
Tabel of provisions and protocols of tel.<br />
advice and care and cure in a MIU,<br />
runned by nurses.<br />
Doub<strong>le</strong> blind random design of pats to 3<br />
treatment plans(12 months):emergency<br />
doctor(ED) on site, an ED using<br />
te<strong>le</strong>medicine, a on site GP.<br />
Study the out of hours activities of 6 GP<br />
and local EDÊs. (6 months).<br />
9 studies included,5 RCTÊs, 1 CCT, 3<br />
ITSs (interrupted time series).<br />
25 % of NU and USU pats were seeking care<br />
from a GP!! Reasons : accessibility, self<br />
perception of need, trust in ED.<br />
63 % of first contacts GP.<br />
30 % dealt by tel. Minor Avery symptoms.<br />
Marked decrease in waiting times for MI care<br />
attenders and reduction in complaints.<br />
40 % of pats allocated to te<strong>le</strong>medicine,35 % to on<br />
site ED, 25 % to GP. Te<strong>le</strong>medicine took the<br />
longest consult(6 min).No significant differences<br />
in clinical outcome.<br />
Wide variations in e<strong>le</strong>ctoral wards in GP and<br />
EdÊs.·Out of hours activity hughest,both in GP<br />
and EDÊs, in deprived inner city areas.<br />
50 % of calls hand<strong>le</strong>d by tel. advice only.·<br />
Unc<strong>le</strong>ar if triage is delaying or reducing EDvisits,2<br />
studies showing an increase in return<br />
consultations.<br />
Reasons of self referral are<br />
diverse in NU and USU pats.<br />
Diversion strategies to<br />
consult fist a GP have to be<br />
multifaceted.<br />
Referrals to ED mainly for<br />
dyspnoea and chest pain.<br />
Minor symptoms to GP.<br />
Scope for more tel. dealt<br />
advices by GP.<br />
The MIU decreases the need<br />
for ED-attendance fot MI and<br />
are well cared in the scope of<br />
trained nurses.<br />
Safety of minor injuries<br />
te<strong>le</strong>medicine= conventional<br />
practice. No differences in<br />
type of errors. Presently no<br />
evidence of effectiveness of<br />
TELEM. In urgent cases.<br />
New multidisciplinary primary<br />
care centers with tel.-advice<br />
and triage are required to<br />
assure high quality and cost<br />
effective care.<br />
Tel-consultation can rerduce<br />
the surgery contacts and the<br />
out-of-hours visits by GPÊs<br />
and appears to be safe.There<br />
may be an increase in repeat<br />
visits. Further research<br />
needed.