Additional requirements : Primary Care
Version 0.3, Etiene Saliez
- Make use of most generic
functionalities described above, adding the following aspects.
- Coordination role:
- The GP
has a coordination and continuity role. At the
primary care level, he his expected to look at every kind of health
- Of course it is impossible to go deep in
every kind of problem and the GP may often need to ask the support of
- Organizational model:
- Most patients have a "referent GP", i.e. a
with one GP of their choice. In some countries this relation
formalized. In Belgium the Social Security recognize a
contract and pay one extra fee per year per patient, for the
maintenance of the patient record.
- Most GP work
as independent or as members of small group practices.
basic unit of thinking is the contact:
contact is a particular type of the concept of Activity. It
may be a
consultation at the office of the doctor or a visit at the home of the
- During a contact one or more problems
are discussed, not necessarily all the problem every time.
most western countries and for most independent
doctors, the incomes are based on the number of contacts, as
defined in Activities. The work unit is the direct contact,
regardless of the duration from 3 minutes to one hour. There
no incentives at all for collaborations by means of telecommunications.
- Gate keeping:
GP has often a role as gate keeper, issuing a request for specialist
advice or admission in hospital.
- Depending on the
country this gate keeper role is mandatory or not, but only encouraged
with some incentives for the patient.
- Access to information:
must be possible to retrieve as well all what has been said
during a previous contact, as well all what is known about a problem
across several contacts.
- Virtual group practice:
- A kind of intensive collaborative work between a
of associated GPs, typically 3 to 8 GPs. They keep their own
office in their own houses, but they have easy access to the records of
a common population of patients.
- The patient is
still in contact with a preferred GP, but if
he is not available, the patient may go to one of the others who have
access to the complete record.
- From a
medical point of view
- A group practice is based on a common secured small
trough internet, available 24 hours a day. This make use of
module about synchronizations.
local group level, normally 100 % of information is shared, although
exceptions remain possible.
seen from larger regional servers, it look like
any other practice or like a small institution, like a mini hospital,
sharing most relevant
information, but not necessarily all information.
- Evolution of group practices can provide continuous
even during week-ends. This evolution is important for 2
- Young GPs are no more
available during a very high number
of hours per week, particularly because today more than 50 % of medical
student are womens.
- As a way to limit the load of emergency entries in
hospitals, taking care of many simple situations which are not really
great emergencies, and avoiding the higher costs of hospitals.