Morreel Stefan, Philips Hilde, Verhoeven Veronique
Department ELIZA, University of Antwerpen, Antwerpen, Belgium. https://orcid.org/0000-0001-6090-2426.
Professor, Department ELIZA, University of Antwerpen, Antwerpen, Belgium. https://orcid.org/0000-0002-9503-470X.
J Emerg Manag. 2019 Nov/Dec;17(6):511-516. doi: 10.5055/jem.2019.0443.
Patients in Belgium needing out-of-hours care have two options: the emergency department (ED) or the general practitioner on call. The latter is often organized in a General Practice Cooperative (GPC). At the ED, there is an overload of patients who could be helped more efficiently by the GPC.
What is the proportion of patients switching from the ED to the GPC (called voluntary switchers) with and without an information campaign? What are the characteristics of these patients?
Single-center prospective intervention trial during the opening hours of the GPC (only weekends: Friday 7.00 pm to Monday 7.00 am). The first 10 weekends there was no intervention. The next 24 weekends, patients in the ED were informed about the out-of-hours care in Belgium. The information contained several topics: characteristics of both services, where to go using examples, practicalities, and costs. This information was distributed through leaflets and broadcasted on a screen in five languages.
During the study period, 7,453 patients entered the ED of which 330 are voluntary switchers. The proportion of voluntary switchers was 1.7 percent before and 5.4 percent after the intervention (p < 0.01). This effect remained stable for 10 more months after the study. The average number of patients presenting at the ED per hour was 3.1, whereas on hours with voluntary switchers was 5.1 (p < 0.01). The age distribution and epidemiological profile of the voluntary switchers resembles the one of primary care patients. The general practicioners (GPs) referred 6 percent of the voluntary switchers back to the ED.
Co-location of the GPC and the ED and informing patients is a meaningful step toward a more profound collaboration.
在比利时，需要非工作时间医疗护理的患者有两种选择：急诊部（ED）或随叫随到的全科医生。后者通常由全科医疗合作社（GPC）组织。在急诊部，有大量患者本可由全科医疗合作社更高效地提供帮助。
在开展和不开展信息宣传活动的情况下，从急诊部转至全科医疗合作社的患者（称为自愿转诊者）比例是多少？这些患者有哪些特征？
在全科医疗合作社开放时间（仅周末：周五晚上7点至周一早上7点）进行单中心前瞻性干预试验。前10个周末不进行干预。接下来的24个周末，向急诊部的患者介绍比利时的非工作时间医疗护理情况。信息包含几个主题：两种服务的特点、使用示例说明去哪里就诊、实际情况及费用。这些信息通过传单分发，并以五种语言在屏幕上播放。
在研究期间，7453名患者进入急诊部，其中330名是自愿转诊者。干预前自愿转诊者的比例为1.7%，干预后为5.4%（p<0.01）。该效应在研究结束后又持续稳定了10个月。急诊部每小时就诊患者的平均数量为3.1名，而有自愿转诊者的时段为5.1名（p<0.01）。自愿转诊者的年龄分布和流行病学特征与初级保健患者相似。全科医生将6%的自愿转诊者转回了急诊部。
全科医疗合作社与急诊部共处一地并告知患者，是迈向更深入合作的有意义一步。
