Télécharger le rapport (152 p.) - KCE
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Télécharger le rapport (152 p.) - KCE
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22 Urgences <strong>KCE</strong> reports vol. 19B<br />
- accessibilité financière directe : lÊaccès ÂgratuitÊ<br />
- accessibilité géographique<br />
Confiance / compétences<br />
Autres<br />
- plus grande confiance en un service hospitalier quÊen service de 1 ère<br />
ligne<br />
- accès à un plateau technique<br />
- accès à plus de spécialités<br />
-Méconnaissance des solutions alternatives<br />
Les patients bénéficiant de revenus faib<strong>le</strong>s sont plus nombreux à recourir aux urgences<br />
Une grande partie des recours considérés par <strong>le</strong>s auteurs comme ÿ inappropriés est<br />
due à une perception favorab<strong>le</strong> des services dÊurgence et particulièrement cel<strong>le</strong> de son<br />
accessibilité (en termes de proximité, de plateau technique, de disponibilité) et à<br />
lÊincapacité des services de garde de médecine généra<strong>le</strong> de répondre à la demande.<br />
Les recours inappropriés seraient plus fréquents pour <strong>le</strong>s jeunes et pour <strong>le</strong>s enfants<br />
surtout lorsque la mère est jeune et appartenant à un milieu social plus précaire.<br />
3.4.4. Interventions to change the inappropriate use of ED.<br />
Most strategies addressing non-urgent or inappropriate ED-use target a change in<br />
patient behaviour by imp<strong>le</strong>menting access, gate-keeping, education and cost-sharing<br />
strategies.<br />
Improving the interface of emergency care (urgent and non-urgent) between primary<br />
care services and emergency departments is an important policy issue whi<strong>le</strong> dealing with<br />
non-urgent ED-use. Other strategies are staff-centered (e.g. triage training) or systemcentred<br />
(e.g. medical advice te<strong>le</strong>phone lines) The impact of triage, out of hours care and<br />
te<strong>le</strong>medicine on ED-use will be discussed here.<br />
Triage<br />
Triage is the process used to assess individuals and identify their clinical need for care 89 .<br />
Each triage system aims to define the emergency status of the patient in order to<br />
reduce the cumbersome amount of patients to categories depending on the <strong>le</strong>vel of<br />
urgency. Most of these triage systems only apply to patients presenting to the ED<br />
focussing on the urgency of treatment in the ED, evaluated by a doctor. Triage systems<br />
performed by different health care workers like physicians, nurses and non-medical<br />
assistants have been described 90 .<br />
Triage by nurses<br />
Recent changes in policy, mainly in USA, UK, Scandinavian countries, Australia and<br />
South-Africa, enhance the ro<strong>le</strong> of well trained nurse practitioners in triage and providing<br />
patient information in both primary and secondary emergency care 91 .<br />
In secondary emergency care two randomized control<strong>le</strong>d trials dealing with treatment<br />
of patients with minor injuries presenting to the emergency department 92, 93 suggest<br />
that emergency nurse practitioners perform equally accurate and reliab<strong>le</strong> as doctors,<br />
and are more informative to patients in advising self care. Further research investigating<br />
the performance of nurse practitioner for other types of diseases is needed.