Télécharger le rapport (152 p.) - KCE
Télécharger le rapport (152 p.) - KCE
Télécharger le rapport (152 p.) - KCE
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>KCE</strong> reports vol. 19B Urgences 95<br />
FIRST AUTHOR-<br />
YR-CTRY.<br />
VAN UDEN C-<br />
2003-NL.<br />
VAN UDEN C.-<br />
2004-NL.<br />
VAN UDEN C.-<br />
2005-NL.<br />
WASHINGTON<br />
D.-2000-USA.<br />
WEBER E.-<br />
2005-USA.<br />
TYPE STUDY OBJECTIVE(S) METHOD(S) RESULTS DISCUSSION<br />
Comparative<br />
case study.<br />
Observational<br />
before and after<br />
in out of hours<br />
service.<br />
Comparative<br />
case study with<br />
peer reiewed<br />
structured<br />
questionnaires.<br />
Prospective<br />
cohort design in<br />
a tertiary care<br />
hospital.<br />
National<br />
population-based<br />
study.<br />
Investigating pats numbers and<br />
characteristics usinf PC and<br />
Ecarebecause of different out of<br />
hours care models.<br />
Investigating whether the<br />
reorganisation of out of hours<br />
(creation of 3 new GPCOÊs) PC<br />
changes utilisation of primary and<br />
hospital emergency care.<br />
Determining pat. satisfaction with<br />
current out-of hours care in<br />
GPcooperatives.<br />
Validating standardized clinical<br />
criteria to identify pats whose care<br />
can be safely deferred to a later date<br />
in a nonemergency setting.<br />
Determining whether having a usual<br />
source of care or health insurance is<br />
associated with the likelihood of an<br />
ED-visit.<br />
2 organistional models of GPCOÊs are<br />
compared in annual contact rate, self<br />
referral.One cooperative is city<br />
centred,far from EDÊs(Heer<strong>le</strong>n),with<br />
schedu<strong>le</strong>d appointments(Maastricht).The<br />
second is inside the local ED,free access.<br />
Analysis of all pt. contacts with GPÊs and<br />
EDÊs during a 4-week period before and<br />
after the reorganisation of out of hours<br />
care.(extraction of computerised data).<br />
Cooperatives located nearby a ED.<br />
Questionnaires base on reviewed and<br />
published data and analyzed on 3<br />
processes of consult in GPCO:tel.<br />
advice,in site consult,home visit. This<br />
questionnaire encompasses contactspecific<br />
and general items. Likert<br />
reponse sca<strong>le</strong>.<br />
Defined criteria developed by a<br />
multidisciplinary physician panel.<br />
Screening of > 1000 ambulatory pats.<br />
responding or not to the criteria they<br />
were referred to same day care or<br />
deferred to an appointment(max. 1<br />
week) in the ambulatory clinic.<br />
Multivariate analysis of a nationally<br />
representative Community tracking<br />
study household survey assessing the<br />
association of health status,insurance,<br />
income with 1 or more ED-visits in the<br />
previous yr<br />
* Annual contact rate/1000 inhabitants at the<br />
GPCO-Heer<strong>le</strong>n is significantly lower than in<br />
Maastricht.<br />
*Contact rate at EDÊs in both is not statist<br />
significant.<br />
* The self referral rate in EDÊs is significantly<br />
higher in Heer<strong>le</strong>n than in Maastricht.<br />
The total number of pats. during out of hours<br />
care increased with 4,6 %,but an increase of 9,8<br />
% in GPCOÊs.Selfreferrals diminished<br />
significantly.(3,3 %).Significant shift of pats from<br />
ED to GPCOÊs.(3,6%).<br />
Pats receiving only tel. advice are <strong>le</strong>ss satisfied<br />
than those who attend the GPCO, and those<br />
who receive a home visit.·Various factors give<br />
insight in the pat. opinion and satisfaction: first<br />
tel. contact, or attitude og the doctor be it in site<br />
or at home.<br />
19 % met criteria to be deferred.0% related<br />
none<strong>le</strong>ctive hospitalisations within 7 days after<br />
deferral. But 7 % of non deferred pats were<br />
hospitalised and 0,5 % died.<br />
Adults without usual source of care were <strong>le</strong>ss<br />
likely to have had an ED visit.·Uninsured pats<br />
were not more likely to have an ED visit than<br />
insured pats.·Poor physical and mental health ><br />
5 outpat. visits/yr ,changes in insurance coverage<br />
were associated with ED visit.<br />
The free access gatekeeper<br />
function and the proxy of the<br />
ED in Maastricht has<br />
decreased significantly the self<br />
referral rate at the<br />
ED,compared with Heer<strong>le</strong>n.<br />
The reorganisation of out of<br />
hours PC into<br />
GPCooperatives has reduced<br />
ED-use and increased PC-use.<br />
The study shows that patients<br />
are generally satisfied with<br />
out-of-hours care, but that<br />
those with a only tel. advice<br />
are <strong>le</strong>ss satisfied than those<br />
attending the cooperatives.<br />
This critria can safely screen<br />
ambulatory care fot pats who<br />
attend ED. They deserve<br />
testing in other EDÊs.<br />
The success of efforts to<br />
decrease ED-use may depend<br />
on improving delivery of<br />
outpatient care.