The (Cost-)Effectiveness of Nurse Practitioners Working at the Primary Out of Hours Emergency Service
NCT ID: NCT01388374
Last Updated: 2015-04-22
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
COMPLETED
Clinical Phase
NA
Total Enrollment
12092 participants
Study Classification
INTERVENTIONAL
Study Start Date
2010-12-31
Study Completion Date
2012-10-31
Brief Summary
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The aim of this study is to explore whether the implementation of Nurse Practitioners can lead to a more accessible and efficient patient care at the primary out of hours service.
The primary objectives of the proposed study are:
1. What are the effects of the implementation of NPs on the primary out of hours service in comparison with the current out of hours service? Effects in terms of accessibility, objective and subjective workload of general practitioners, quality of care and patient satisfaction.
2. How efficient is the implementation of NPs in the primary out of hours services?
3. What is the feasibility of the implementation of NPs in the out of hours services? And under which conditions?
4. What are the barriers and facilitating factors considering the implementation of NPs?
The primary objectives of the proposed study are:
1. What are the effects of the implementation of NPs on the primary out of hours service in comparison with the current out of hours service? Effects in terms of accessibility, objective and subjective workload of general practitioners, quality of care and patient satisfaction.
2. How efficient is the implementation of NPs in the primary out of hours services?
3. What is the feasibility of the implementation of NPs in the out of hours services? And under which conditions?
4. What are the barriers and facilitating factors considering the implementation of NPs?
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Detailed Description
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The emergency care and primary out of hours care in the Netherlands is under pressure. There is a rising demand from patients for acute care at the primary out of hours service (run by General Practitioners) as well as for the emergency departments (EDs) at the hospitals. The workload for healthcare professionals in these acute care setting is high. Without changes in the organization of primary out of hours care and emergency care, the quality, accessibility and efficiency of the acute care can't be guaranteed in the future.
The substitution of care from General Practitioners (GPs) to Nurse Practitioners (NPs) is seen as one possible solution to decrease the GPs' workload and improve accessibility and efficiency of care without reducing the quality of care.
It turned out that about 80% of the acute complaints is U3 and U4 (low complex and not urgent) and does not necessarily to be seen by a physician.
Based on previous research we expect that the NPs are competent to diagnose and treat almost all low complex and not urgent complaints. During surgery hours (day time) the NPs act in about 90% of the consultations independently.
Hypothetical substitution of care should contribute to enhancing quality, improving accessibility and reducing the workload of doctors. It can also benefit the efficiency of the acute (primary out of hours) care.
However, specific scientific evidence for this is lacking.
In this study we examine whether substitution of care from GPs to NPs in a primary out of hours care setting can contribute to a more accessible and efficient patient care. Also the feasibility of implementing NPs in a primary our of hours setting is examined.
Comparison: Care provided by the Nurse Practitioner will be compared to care provided by a General Practitioner.
The substitution of care from General Practitioners (GPs) to Nurse Practitioners (NPs) is seen as one possible solution to decrease the GPs' workload and improve accessibility and efficiency of care without reducing the quality of care.
It turned out that about 80% of the acute complaints is U3 and U4 (low complex and not urgent) and does not necessarily to be seen by a physician.
Based on previous research we expect that the NPs are competent to diagnose and treat almost all low complex and not urgent complaints. During surgery hours (day time) the NPs act in about 90% of the consultations independently.
Hypothetical substitution of care should contribute to enhancing quality, improving accessibility and reducing the workload of doctors. It can also benefit the efficiency of the acute (primary out of hours) care.
However, specific scientific evidence for this is lacking.
In this study we examine whether substitution of care from GPs to NPs in a primary out of hours care setting can contribute to a more accessible and efficient patient care. Also the feasibility of implementing NPs in a primary our of hours setting is examined.
Comparison: Care provided by the Nurse Practitioner will be compared to care provided by a General Practitioner.
Conditions
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Out of Hours Medical Care
Primary Health Care
Study Design
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Allocation Method
NON_RANDOMIZED
Intervention Model
PARALLEL
Primary Study Purpose
HEALTH_SERVICES_RESEARCH
Blinding Strategy
NONE
Study Groups
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General Practitioners Care
Usual medical care provided by a general practitioner at the Primary Out of Hours Emergency Service.
Group Type
NO_INTERVENTION
No interventions assigned to this group
Nurse Practitioners Care
Medical care provided by the Nurse Practitioner at the Primary Out of Hours Emergency Service.
Group Type
EXPERIMENTAL
Other, care provided by Nurse Practitioners
Intervention Type
OTHER
Patients will receive care at the Primary Out of Hours Emergency Service by a Nurse Practitioner instead of a General Practitioner (substitution of care from physicians to nurses).
Interventions
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Other, care provided by Nurse Practitioners
Patients will receive care at the Primary Out of Hours Emergency Service by a Nurse Practitioner instead of a General Practitioner (substitution of care from physicians to nurses).
Intervention Type
OTHER
Eligibility Criteria
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Inclusion Criteria
* Patients (with urgency U2, U3, or U4) requesting an appointment at the primary out of hours emergency service during the weekend between 10.00 and 17.00 hours.
Exclusion Criteria
* Patients under the age of 1 year
* Patients with psychiatric complaints
* Patients with abdominal pain, abdominal infections, chest pain or neck complaints (angina pectoris), headache and dizziness.
* Patients with psychiatric complaints
* Patients with abdominal pain, abdominal infections, chest pain or neck complaints (angina pectoris), headache and dizziness.
Minimum Eligible Age
1 Year
Eligible Sex
ALL
Accepts Healthy Volunteers
Yes
Sponsors
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ZonMw: The Netherlands Organisation for Health Research and Development
OTHER
Sponsor Role
collaborator
Radboud University Medical Center
OTHER
Sponsor Role
lead
Responsible Party
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Responsibility Role
SPONSOR
Principal Investigators
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M.G.H. Laurant, Dr.
Role: PRINCIPAL_INVESTIGATOR
IQ healthcare, UMC St Radboud
Locations
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Centrale Huisartsen Post (CHP)
Eindhoven, North Brabant, Netherlands
Site Status
Countries
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Netherlands
References
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Van Der Biezen M, Adang E, Van Der Burgt R, Wensing M, Laurant M. The impact of substituting general practitioners with nurse practitioners on resource use, production and health-care costs during out-of-hours: a quasi-experimental study. BMC Fam Pract. 2016 Sep 13;17(1):132. doi: 10.1186/s12875-016-0528-6.
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DERIVED
Wijers N, Schoonhoven L, Giesen P, Vrijhoef H, van der Burgt R, Mintjes J, Wensing M, Laurant M. The effectiveness of nurse practitioners working at a GP cooperative: a study protocol. BMC Fam Pract. 2012 Aug 7;13:75. doi: 10.1186/1471-2296-13-75.
Reference Type
DERIVED
Related Links
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http://www.iqhealthcare.nl/ContentFront/ContentProjects/ProjectsMain.aspx?projectId=411
Projectdescription and dutch documentation related to the project
Other Identifiers
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80-82800-98-227
Identifier Type: -
Identifier Source: org_study_id
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