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KCE reports vol. 19B Urgences 93
FIRST AUTHOR-
YR-CTRY.
RUGER J.-
2004-USA.
RUTSHMANN
O.-2003-
SUISSE.
SALISBURY C.-
2002-UK.
SANDERS J.-
2000-UK.
TYPE STUDY OBJECTIVE(S) METHOD(S) RESULTS DISCUSSION
Retrospective
cross-sectional
study.
Descriptive study
of 2 strategies
focused on
(emergency and
chronic) disease
management.
Descriptive study
based on
monitoring
returns and
anonymised
patient level data
for further
analysis.
Systematic
review.
Determining the rates of ED-use by 5
grps with number of annual visits;
examine the visit characteristics by
frequency of ED-use;comparing levels
of resource utilization among
frequent users.
Arguing 2 novative models of home
care services, based on a integrated
GP and home care agencies service.
Analysing the impact and role of
recent opened walk-in centres by the
NHS in UK.
Reviewing and analysing in depth the
health professional attitudes and
patient perceptions on ÂinappropriateÊ
ED attendances. The subsequent
implications for minor injury
provisions.
Study of the clinical and financial
records,regarding triage acuity, health
status and complaints,diagnosis related
grp., hospital stay,payment method,
demographics,costs.
*On litterature and field based
exploration of hospital at home care.
*Systematic review of 11 studies about
2000 CHeartF pats, taking benefit of a
skilled home re-education and tel. or
home visit follow-up.
Monitoring returns including the number
of visits/ month, waiting times, referrals.
Interviews with walk-in centre managers
about facilities, staffing, service provision,
use of E-technology.
Review of all British studies concerning
Âinappropriate ÂED-use.
Pats with 3-20 visits,mostly Medicaid insured,
were more admitted to hospital than pats visiting
ED once or twice.-- Pats > 20 ED visits more
likely to present non urgent conditions and
virtually no Medicare or Medicaid managed care
or a health maintenance organisation.
Rehospitalisation risk is significantly reduced and
these home programs are cost-efficient. Even in 2
studies a reduced mortality could be
demonstrated.
The walk-in centre is at a first impression
attracting a different population(young
adults>>ageing people) from these attending GP.
Less waiting times and longer consults in walk-in
centres.
Use of nurses supported by clinical assessment
soft ware. Level of nurse and doctorÊs training
remain unclear and the comparison with face to
face visits not yet established.
Lack of definition of ÂinappropriateÊ.
Little difference between all ED-attenders and
ÂinappropriateÊ at
tenders.
Main reasons are to obtain quicker and better
medical care and rarely for reasons of
convenience.
Frequent ED users are
heterogenous. Pats thought to
overutilize ED for
socioeconomic or minor
medical problems are as sick
as less frequent users!! Only
the more than 20 visits grp.
are less ill or injured but also
incurred lower average costs
per ED-visit.
Hospital at home care could
fullfill complex patterns of
care, supply the
hospitalisation length of stay,
and reduce the hospitalization
rate.
Future components of a
national evaluation has to
provide evidence about the
impact of different types of
walk-in centres on pats,their
cost-efficiency,quality of care
provided.
The need for a clear definition
of the role of GPÊs and ED
staff to minor illness and
injury care,against all
subjective blaming attitudes
towards the pat.This
resaearch should be
conducted among MIU(nurse
practitioners) and ED staff.