Télécharger le rapport (152 p.) - KCE

90 Urgences KCE reports vol. 19B
FIRST AUTHOR-
YR-CTRY.
GIESEN P.-
2002-NL.
GILL J.M.-
2000-USA.
HALLAM L.-
1994-UK.
HALLAM L.-
1994-UK.
HORROCKS S.-
2002-UK.
TYPE STUDY OBJECTIVE(S) METHOD(S) RESULTS DISCUSSION
Case control
study with semiquantitative
questionnaire.
Cross-sectional
study in a 100%
sample of
Medicaid
patients.
Telephone
survey to health
authorities in
UK.
Systematic
review of
published data.
Systematic
review of RCT
and prosp.
observational
studies.
Studying the impact of a central GPcoop.
for the GPÊs.
Examining whether continuity of care
with 1 healthcare provider is
associated with the number of EDvisits.
Determining the use and organisation
of out of hours services in primary
care.
Study of the PC outside working
hours
DETERMINING WHETHER NURSE PRACT.
CAN PROVIDE EQUIVALENT CARE AS
DOCTORS IN A PC SETTING.
Questionnaire analysis, comparing GPÊs
yes or no participating in a GPCO.For
the participants a comparaison was also
made before and after the start of the
GPCO.
Multivariate analysis of the usual
provider continuity index
Related to the no,1 ,multiple ED visits in
Medicaid pats from 0 to 64 yrs.
Tel. recording of the rate of use of out
of hours care, provision methods, role of
authorities.
Research and review of published data
according to GP-arrangements, need and
demand for out-of hrs care,
inappropriate ED-use.
Cochrane controlled trials register.
Inclusion of RCT Âand obs.studies
related to pat. satisfaction, health status,
costs, process of care.
Workload decreases for participants(to 80%).-
Less deputising to other services-Quality of
family life improves.-Harassment by agressive
pats. decreases.
Continuity is significantly associated with a lower
likelihood of making a single ED visit and even
more strongly with a lower likelihood of making
multiple ED visits.
12-25 % of authorities were unable to answer
key questions because of lacking info.Mean of
night visits/pats/yr was 35 %..
Few suggestions of innovative schemes of PC
dealing with ED calls.-Models proposed: nursing
triage, GP-coop., commercial deputising services,
walk-in centres are not yet experienced, altough
an increasing demand by GPs.
Included st.: 11 trials and 23 obs. studies.More
pat satisf. With nurses, no differences in health
status, more investigations don eby nursepract.,
no differences in prescriptions, return consults,
referrals.
A GPCO has a real benefit for
PC,and this cooperative spurs
the further integration of GPÊs
with the ED. This is a second
desirable step,but first the
GPCO has to be well
organised.
High provider continuity is
associated with lower ED use
fot the Medicaid people.·
Financial incentives like lower
co-payments fotr pats with 1
regular provider would
encourage this instead of not
warranted ED visits.
Without good info systems
family health authorities will
not be able to monitor the
effect on quality and
cost/effectiveness of care.
Further research is
worthwhile and needs to be
evaluated before being
adopted in public health.
Increasing availability of nurse
pract. in PC settings can lead
to high levels of pat.
satisfaction and high quality of
care.