Télécharger le rapport (152 p.) - KCE

92 Urgences KCE reports vol. 19B
FIRST AUTHOR-
YR-CTRY.
RAYPAR S.-
1999-UK.
RICHARDSON
S.-1999-NEW-
ZEALAND.
C. RIEFFFE-
1999-NL..
ROBERTS E.-
1998-UK.
TYPE STUDY OBJECTIVE(S) METHOD(S) RESULTS DISCUSSION
Case control
study with a semi
structured
questionnaire.
Systematic
review of
national health
system(NZEAL)
and the
litterature.
Case control
study.
Systematic
studies review in
UK,according to
the Cochrane
centre for
reviews.
Determining the reasons for choosing
between PC out of hours centers and
EDÊs for patients with PC problems.
Examining the key role of PC in the
ED.Asking whether this is an
appropriate use of ED ressources and
which are the implications for the
role of the ED?
Interviews with 2 grps of pats: one grp
attending the ED with(triaged) PC
problems and another grp.PC pats
attending the GPCO.,both located in a
socially deprived area.
Litterature and data review about the
inappropriate ED attendance,crowding of
ED., profile of PC pat. in ED., refusal and
redirection of NU pats, Pcin the ED.,
minor injury units.
Reasons for bypassing GPED. Multiple choice questionnaire based on a
multidimensional measurement
instrument.(21 motives for bypassing
GP.)
Quantifying the impact of PC based
services on the patterns of ED
demand across the primarysecondary
interface.
34 studies included,grouped in 3 cat.
based on intervention type:
*Primary care role,access and
facilities.(out of hours).
*Integration PC and SC.
*E-care(GPs in EDs)
interventions.(MIUtel-triage,user
charges)
Considerable misunderstanding concerning the
role of the GP When used high satisfaction.
Perception that waiting time would be longer at
GPCO than in ED??Selfperception of severity of
illness is a stressing factor for ED visit.
Most encouraging novative models are nurse
practitioners,use of GP run clinics, classical
reasons for self referrals ( ED access,perception
of urgency,more ED technical facilities etc...).
2 groups of pats.identified:
1) Pats with high socioeconomic status living in
residential suburbs.
2) Pats living in inner cities.
*With exception of GP in ED,no evidence of the
relative cost-effectiveness of alternative models
of care.
*despite the variable methodological quality (only
4 RCT) there is evidence that primary and
community forms of Edcare can substitute ED
care.
Still lack of knowledge among
PC attenders to EDÊs
regarding the role of the GP
in out of hours care.Hence a
better education and info
about GPCOÊs has to be
implemented and a larger
scaled research has to be
planned from the different
socioeconomic backgrounds.
Research highly
recommended to define safe
ways of triaging and diverting
pats with minor
complaints,and to formalise a
well organised,quality based
PC in ED.(minor injury unit).
*Suburbs residential rich pats
choosed the ED for financial
reasons.
*Citizens poorer people
choosed the expertise and
facilities of ED.
Shifting the balance from Sec.
to Pcare is possible,but this
review highlights the still false
perceptions of the
appropriate sources fotr
minor illness and injury.