Models of the out-of-hours care

  - European experiences
Paul Giesen (Netherlands)
Morten Bondo Christensen (Denmark)
Jan...
1. Introduction, aims and program

aim:
  Providing information on the different
  organisation models of out-of-hours car...
2. Out-of-hours primary care
               services throughout Europe
Paul Giesen
  overview what are different organisat...
3. Three different organisation
              models of out of hours care
    Danish solution by Morten Bondo Christensen
...
Danish solution

Morten Bondo Christensen, Denmark
Slovenian system

Janko Kersnik, Slovenia
The ice berg of health care

                                          HOSPITATLISED

                                    ...
The concept of FM/GP

                                             First contact
                                         ...
The practice of the first contact
    Regular hours
    – Emergency care
    – Outside the GP/FP area
    – Holidays
    O...
Principles
    24-hours responsibility
    catchment area (15 – 30.000 population)
    network of appointed institutions (...
Strength

                                            Primary care concept
                                            in ...
Weaknesses

                                             Lack of human
                                             resour...
Dutch solution

Paul Giesen, Netherlands
4. Reflection to your own out-of- hours
  care system: What is the strong and
  weak side and what would be ideal?
     Di...
Country experiences

    Work in groups of 3 – 5.
    Answer the questions regarding your country:
      – How is out-of-h...
Lessons to learn

    Reports from the groups:




Wonca Europe 2004, June 4      Out-of-hours care   16
4b. What would be ideal - with
             reflection to your own system
1. organisation of out of hours care:
    hospit...
4b. What would be ideal - with
             reflection to your own system
2. What kind of doctors                         ...
4b. What would be ideal - with
             reflection to your own system
4. In case of                         5. demands...
Conclusions

    We poses the skills to deliver primary care in a
    patient oriented way.
    There should be systems in...
Thank you for your attention!
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Out Of Hours Services in Slovenia

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Out Of Hours Services in Slovenia

  1. 1. Models of the out-of-hours care - European experiences Paul Giesen (Netherlands) Morten Bondo Christensen (Denmark) Janko Kersnik (Slovenia)
  2. 2. 1. Introduction, aims and program aim: Providing information on the different organisation models of out-of-hours care in some European countries. Reflection on the benefits and the disadvantages of the different models and the position of de GP’s in future. To chose the organisation model preferred. Wonca Europe 2004, June 4 Out-of-hours care 2
  3. 3. 2. Out-of-hours primary care services throughout Europe Paul Giesen overview what are different organisation forms in Europe what are the general problems Wonca Europe 2004, June 4 Out-of-hours care 3
  4. 4. 3. Three different organisation models of out of hours care Danish solution by Morten Bondo Christensen (Denmark) Slovenian system by Janko Kersnik (Slovenia) Dutch solution by Paul Giesen (The Netherlands) Wonca Europe 2004, June 4 Out-of-hours care 4
  5. 5. Danish solution Morten Bondo Christensen, Denmark
  6. 6. Slovenian system Janko Kersnik, Slovenia
  7. 7. The ice berg of health care HOSPITATLISED SPECIALIST TREATMENT PRIMARY CARE SELF-TREATMENT ILL Wonca Europe 2004, June 4 Out-of-hours care 7
  8. 8. The concept of FM/GP First contact … Wonca Europe 2004, June 4 Out-of-hours care 8
  9. 9. The practice of the first contact Regular hours – Emergency care – Outside the GP/FP area – Holidays Out of hours – Emergency care – Usual primary care – Outside the GP/FP area Wonca Europe 2004, June 4 Out-of-hours care 9
  10. 10. Principles 24-hours responsibility catchment area (15 – 30.000 population) network of appointed institutions (community based) rota system/deputising services (each doctor with patients on the list has to paritcipate) first contact (each patient needs a referral) primary care emergency services doctors Wonca Europe 2004, June 4 Out-of-hours care 10
  11. 11. Strength Primary care concept in place Better accessibility Better availability Personalised Wonca Europe 2004, June 4 Out-of-hours care 11
  12. 12. Weaknesses Lack of human resources Cost effectiveness? Involvement in serious emergencies Check point? (PHC, hospital, patients’ homes…) Wonca Europe 2004, June 4 Out-of-hours care 12
  13. 13. Dutch solution Paul Giesen, Netherlands
  14. 14. 4. Reflection to your own out-of- hours care system: What is the strong and weak side and what would be ideal? Discuss with your neighbour {from other country, if possible} (5 min) on the following questions: structure of the organisation (scale, management), distances to the doctor, doctor: workload, satisfaction with work personal and material support who does the triage position and cooperation in emergency care (GP/hospital/ambulance) benefits and disadvantages of the model Wonca Europe 2004, June 4 Out-of-hours care 14
  15. 15. Country experiences Work in groups of 3 – 5. Answer the questions regarding your country: – How is out-of-hours care organised from the doctors perspective. – How is out-of-hours care organised from the patient perspective. – How is out-of-hours care organised from the health policy/payers perspective. Wonca Europe 2004, June 4 Out-of-hours care 15
  16. 16. Lessons to learn Reports from the groups: Wonca Europe 2004, June 4 Out-of-hours care 16
  17. 17. 4b. What would be ideal - with reflection to your own system 1. organisation of out of hours care: hospital/ambulance care, no duty for a GP I am always on duty my own small rota’s (groups <10 PG and <20.000 patients) large scales co-operatives (groups > 50 GP and > 100.000 patients Wonca Europe 2004, June 4 Out-of-hours care 17
  18. 18. 4b. What would be ideal - with reflection to your own system 2. What kind of doctors 3. Triage should do the out of myself hours work? my wife/relatives B. GP’s nurses/ call C. specialised GPs centre D. all doctors can do it Wonca Europe 2004, June 4 Out-of-hours care 18
  19. 19. 4b. What would be ideal - with reflection to your own system 4. In case of 5. demands of patients emergency B. I am the first B. I accept all demands responder C. I accept just urgent C. Patient ring demands ambulance or go to hospital D. I accept all demands D. I cooperate with but discourage non- hospital/ambulance urgent demand and divide tasks Wonca Europe 2004, June 4 Out-of-hours care 19
  20. 20. Conclusions We poses the skills to deliver primary care in a patient oriented way. There should be systems in place to help reduce the burden of workload. There should be a sound division of work between emergency care services and GP/FM services in line with the needs of the local/regional populations. Wonca Europe 2004, June 4 Out-of-hours care 20
  21. 21. Thank you for your attention!

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