Télécharger le rapport (152 p.) - KCE

88 Urgences KCE reports vol. 19B
FIRST AUTHOR-
YR-CTRY.
BYRNE M.-
2003-IRL.
CABRERA MF-
2002-SPAIN.
CHALDER M.-
2005-UK.
COLEMAN P.
CROUCH R.-
1998-UK.
TYPE STUDY OBJECTIVE(S) METHOD(S) RESULTS DISCUSSION
Case cohort
study.
Case control
study.
Control case
study with time
series analysis.
Questionnaire
survey and notes
review.(7
weeks).
Systematic
litterature
review.
Compare with a control grp.,
frequent ED-attenders in terms of
health service use and their
clinical,psychological and social
profiles.
Compare experimental systems of
telemedicine in prehospital care of 2
grps of pats: conventional EMS and
telemed.EMS.
Impact of walk-in centres on the
workload of local ED, GP, out of
hours services.
Potential of GP,MIU, NHS direct,
walk-in c., to reduce non-urgent
demands on EDÊs, matched with
socio-economic reasons for
attendance.
Exploring the role of telephone triage
and the level of demands for tel.advice
in EDÊs
100 frequent users (> 4 visits/yr) and
100 nonfrequent users interviewed in
ED about health service use,mental
health(questionnaire),social
support,alcohol and drug use.
Tool model based on management of
emergency ressources, records,
multimedia medical data(ECG and images
from ambulance to ED), route guidance
and telepresence.
Comparaison with different models of
variables between walk-in centre sites
and matched control towns.
Triage of pats using defined criteria
studying the suitability of their health
problem to be treated bi primary care
services all included.
Review of UK studies summarising the
key characteristics of the studies, with
the total amount of calls/time period,
dealt by doctor/nurse and the findings
and notes.
More visits to GPÊs, social and nursing
services,addiction centers,psychiatric clinics by
frequent users.(men age 55 yrs;more man than
female).
The cost with 100 pats using telemed. Was much
lower than conventional E-care.Assessment of
telemed. was recorded from the healthcare staff
and evaluated.
Non statistically reduction in consultations in ED
and GP close to walk-in cnters. No impact on
out-of hours consults in this services.
55 % of health problems are suitable for Pri-
Care.24% of this pats, the ED was not the first
contact. But only 12 % donÊt include a strong
reason for presenting to ED! Hence only 7 % of
non-urgent pats are expected to attend PC in th
future for their serious perceived problem..
3 to 5 % of pat.-contacts with EDÊs occur over
phone. The GP availability and the long expected
delay for assessment by GP are important factors
in pat. choice for tel. or direct contact with ED.
Frequent ED-users are also
frequent PC-users.Frequent
users are a socially and
mentally more vulnerable grp.
Telemedicine can safe lives
and reduce morbidity through
high-speed links in urgent
cases. Avoiding unnecessary
hospitalisation and
overmedicalisation are
benefits.
A larger scales impact
assessment among walk-in
centers compared with other
NHS providers will be
necessary.
The increasing availability of
alternative services is likely to
have little impact on the
demand on pats with nonurgent
problems.(no propsals
of alternatives were added in
this study.)
Tel.-triage and contact is not
replacing the face to face
consult. But the potential of
tel. advice and triage is
seriously argued and need to
be deepened.