Télécharger le rapport (152 p.) - KCE
Télécharger le rapport (152 p.) - KCE
Télécharger le rapport (152 p.) - KCE
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88 Urgences <strong>KCE</strong> reports vol. 19B<br />
FIRST AUTHOR-<br />
YR-CTRY.<br />
BYRNE M.-<br />
2003-IRL.<br />
CABRERA MF-<br />
2002-SPAIN.<br />
CHALDER M.-<br />
2005-UK.<br />
COLEMAN P.<br />
CROUCH R.-<br />
1998-UK.<br />
TYPE STUDY OBJECTIVE(S) METHOD(S) RESULTS DISCUSSION<br />
Case cohort<br />
study.<br />
Case control<br />
study.<br />
Control case<br />
study with time<br />
series analysis.<br />
Questionnaire<br />
survey and notes<br />
review.(7<br />
weeks).<br />
Systematic<br />
litterature<br />
review.<br />
Compare with a control grp.,<br />
frequent ED-attenders in terms of<br />
health service use and their<br />
clinical,psychological and social<br />
profi<strong>le</strong>s.<br />
Compare experimental systems of<br />
te<strong>le</strong>medicine in prehospital care of 2<br />
grps of pats: conventional EMS and<br />
te<strong>le</strong>med.EMS.<br />
Impact of walk-in centres on the<br />
workload of local ED, GP, out of<br />
hours services.<br />
Potential of GP,MIU, NHS direct,<br />
walk-in c., to reduce non-urgent<br />
demands on EDÊs, matched with<br />
socio-economic reasons for<br />
attendance.<br />
Exploring the ro<strong>le</strong> of te<strong>le</strong>phone triage<br />
and the <strong>le</strong>vel of demands for tel.advice<br />
in EDÊs<br />
100 frequent users (> 4 visits/yr) and<br />
100 nonfrequent users interviewed in<br />
ED about health service use,mental<br />
health(questionnaire),social<br />
support,alcohol and drug use.<br />
Tool model based on management of<br />
emergency ressources, records,<br />
multimedia medical data(ECG and images<br />
from ambulance to ED), route guidance<br />
and te<strong>le</strong>presence.<br />
Comparaison with different models of<br />
variab<strong>le</strong>s between walk-in centre sites<br />
and matched control towns.<br />
Triage of pats using defined criteria<br />
studying the suitability of their health<br />
prob<strong>le</strong>m to be treated bi primary care<br />
services all included.<br />
Review of UK studies summarising the<br />
key characteristics of the studies, with<br />
the total amount of calls/time period,<br />
dealt by doctor/nurse and the findings<br />
and notes.<br />
More visits to GPÊs, social and nursing<br />
services,addiction centers,psychiatric clinics by<br />
frequent users.(men age 55 yrs;more man than<br />
fema<strong>le</strong>).<br />
The cost with 100 pats using te<strong>le</strong>med. Was much<br />
lower than conventional E-care.Assessment of<br />
te<strong>le</strong>med. was recorded from the healthcare staff<br />
and evaluated.<br />
Non statistically reduction in consultations in ED<br />
and GP close to walk-in cnters. No impact on<br />
out-of hours consults in this services.<br />
55 % of health prob<strong>le</strong>ms are suitab<strong>le</strong> for Pri-<br />
Care.24% of this pats, the ED was not the first<br />
contact. But only 12 % donÊt include a strong<br />
reason for presenting to ED! Hence only 7 % of<br />
non-urgent pats are expected to attend PC in th<br />
future for their serious perceived prob<strong>le</strong>m..<br />
3 to 5 % of pat.-contacts with EDÊs occur over<br />
phone. The GP availability and the long expected<br />
delay for assessment by GP are important factors<br />
in pat. choice for tel. or direct contact with ED.<br />
Frequent ED-users are also<br />
frequent PC-users.Frequent<br />
users are a socially and<br />
mentally more vulnerab<strong>le</strong> grp.<br />
Te<strong>le</strong>medicine can safe lives<br />
and reduce morbidity through<br />
high-speed links in urgent<br />
cases. Avoiding unnecessary<br />
hospitalisation and<br />
overmedicalisation are<br />
benefits.<br />
A larger sca<strong>le</strong>s impact<br />
assessment among walk-in<br />
centers compared with other<br />
NHS providers will be<br />
necessary.<br />
The increasing availability of<br />
alternative services is likely to<br />
have litt<strong>le</strong> impact on the<br />
demand on pats with nonurgent<br />
prob<strong>le</strong>ms.(no propsals<br />
of alternatives were added in<br />
this study.)<br />
Tel.-triage and contact is not<br />
replacing the face to face<br />
consult. But the potential of<br />
tel. advice and triage is<br />
seriously argued and need to<br />
be deepened.