Colliers Annelies, Remmen Roy, Streffer Marie-Luise, Michiels Barbara, Bartholomeeusen Stefaan, Monsieurs Koenraad G, Goris Jef, Coenen Samuel, Verhoeven Veronique, Philips Hilde
a Faculty of Medicine and Health Sciences, Department of General Practice - Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium.
b Emergency Department , Antwerp University Hospital , Edegem , Belgium.
Acta Clin Belg. 2017 Feb;72(1):49-54. doi: 10.1080/17843286.2016.1245936. Epub 2016 Oct 17.
The implementation of general practitioner cooperatives (GPC) for out-of-hours (OOH) primary care, raises the question if the location of a GPC adjacent to a hospital reduces the OOH caseload of the emergency department (ED).
Two natural experiments were used in this before-after study, the effect of the implementation of two GPCs in two different regions on the out-of-hours caseload of the local EDs was compared. One GPC was located adjacent to the ED of a general hospital, the other was not. GPCs (or rota systems) and EDs in comparable regions were selected as control groups during the same study period. The study was performed in Flanders (Belgium) with no gatekeeping function for general practitioners (GPs).
After implementation of the GPC there was a significantly increase in caseload at the GPC in the two regions, mainly due to an increase of consultations with small children. There were no significant changes in caseload at the ED services. Self-referrals' to the ED did not change significantly. For the GPs the number of home visits decreased during out-of-hours in one region.
In a country with no gatekeeping role for GPs, implementing a GPC increased the out-of-hours caseload of the GPCs. The caseload of the EDs stabilised during the study period.
实施非工作时间初级医疗服务的全科医生合作社（GPC）引发了一个问题，即紧邻医院设立的GPC是否会减少急诊科（ED）的非工作时间工作量。
在这项前后对照研究中采用了两项自然实验，比较了在两个不同地区设立的两个GPC对当地ED非工作时间工作量的影响。其中一个GPC紧邻一家综合医院的ED，另一个则不然。在同一研究期间，选择可比地区的GPC（或轮值系统）和ED作为对照组。该研究在比利时弗拉芒地区进行，全科医生（GP）没有守门人职能。
在两个地区实施GPC后，GPC的工作量显著增加，主要是由于与幼儿的咨询量增加。ED服务的工作量没有显著变化。到ED的自我转诊没有显著变化。对于GP来说，在一个地区非工作时间的家访次数减少了。
在GP没有守门人职能的国家，实施GPC增加了GPC的非工作时间工作量。在研究期间，ED的工作量稳定。
