PubMed · 16302370
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Larry Boxman. 2005. Invent your future.. https://pubmed.ncbi.nlm.nih.gov/16302370/
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BACKGROUND: Our aim was to better understand why inhabitants in a typical Norwegian town use out-of-hours services in primary care, and whether introduction of a patient list system (Fastlegeordningen) in 2001 had any influence on this choice. We analyzed changed use of out-of-hours service in Stavanger, Norway (approx. 110,000 inhabitants) from 1989 to 2002. METHODS: Changes in the number of consultations and home visits between 4 to 11 pm seven days a week, were assessed in the light of changes in operational presumptions for both the out-of-hours service and the family physicians' day-time service. RESULTS: There was a steady increase in the number of consultations and home visits from 1989 to 1997, except for in 1994. The absolute increase in the proportion of the population who sought this kind of care was 4.6%, i.e. a relative increase of 20%. From 1997 to 2002, there was an absolute decrease in consultations and home visits of 5.3%, or a 19% relative reduction. The percentage of patient encounters in patients' homes, decreased from 25% in 1989 to 11% in 2002. The number of consultations and home visits in the evenings during the first 17 months after the list system was introduced, decreased (absolute value) with 2.2% (1.7-2.6), i.e. a 10% relative decrease, as compared to those during a similar period two years earlier. INTERPRETATION: A 20 % change in the use of out-of-hours service during few years, indicates that patients have used the service for other purposes than the intended emergency care. The demand for out-of-hours service is most influenced by the availability of primary care physicians during daytime. The list system has most likely encouraged both doctors and patients to promote the "personal doctor" to solve everyday health emergencies during the day.
BACKGROUND: Presently and even more in the near future more cancer patients will be treated at home especially in the final stage of their disease. For this reason the prehospital emergency system will be confronted with the specific needs of these patients. Palliative care is not part of the German model of post-graduate training regulations for emergency medicine and palliative care teams (PCT) are only involved in the treatment of cancer patients in emergency situations. METHODS: Over a 12-month period we retrospectively analysed all emergency cases that had been categorised as final cancer stage at 2 emergency sites (one air-based, the other ground-based) involving physicians in an out-of-hospital setting. We analysed all cases for indications of emergency call, prehospital treatment and involvement of a PCT in the treatment of symptoms. RESULTS: For this period we analysed 2,765 emergency documents and identified more than 2.5% as emergency calls by cancer patients or their relatives (the majority of patients had been in the final stage of the disease). Most emergency calls occurred at times when no general practitioner was on duty and acute dyspnoea (42.7%) was the prominent diagnosis. After emergency treatment 61.8% patients had been admitted to hospital. In most settings a PCT was not involved in the treatment of palliative care patients or their relatives (92.7%). CONCLUSIONS: Our data demonstrate that care of cancer patients in the final stage of the disease is relevant in emergency medicine. These patients are in need of help based on principles of palliative care. Under these circumstances cooperation of the medical disciplines (emergency and palliative medicine) concerned seems to be necessary. This may increase the possibility for patients to stay at home for the last days of their life. Because of this we are convinced that basic knowledge of palliative care should be integrated into the German model of post-graduate training regulations for emergency care. Combining parts of the curricula (palliative and emergency medicine) it would be possible for emergency physicians to guide their treatment by the ideas and strategies of palliative care. But we are also convinced that the system of PCT should increase and become more involved in prehospital care in emergency cases of palliative care patients.
The major goal of a trauma system is to enhance the community health. This occurs through a process of assessment, policy development, and ongoing assurance. This can be achieved by (1) identifying risk factors in the community and creating solutions to decrease the incidence of injury, (2) providing optimal care during the acute and the late phase of injury, including rehabilitation, and (3) maintaining the objective to decrease overall injury-related morbidity and mortality and years of life lost. Disaster preparedness also is an important function of trauma systems, and using an established trauma system network facilitates the care of victims of natural disasters or terrorist attacks.