Primary Care Provider Supply and Patient Outcomes

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

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

10852 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-03-20

Study Completion Date

2022-06-30

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The evidence on how primary care provider supply and skill relates to patient outcomes is limited and inconclusive. The issue of skill is a particularly important one in low-income countries where the shortage of skilled medical professionals has led to greater use of the task-shifting model in which medical tasks are redistributed from highly skilled health workers to mid-level providers who receive less training. In this large-scale cluster-randomized trial, the investigators randomly select primary health care facilities to receive a highly skilled provider (a doctor), a mid-level health provider, or no additional providers (the control group). The investigators study the effect of this intervention on patient outcomes. Embedded within this trial is another experimental intervention in which pregnant women residing in communities served by the primary health care facilities are assigned to receive a cash transfer conditional on using antenatal, delivery and postnatal care. The investigators study the effect of the cash transfer on health care utilization and on maternal and infant outcomes.

Related Clinical Trials

Explore similar clinical trials based on study characteristics and research focus.

A Mixed-Method Evaluation of the Impact of Social Risk Screening on Uptake of Social Assistance

NCT05251311

Low-income Populations Social Determinants of Health

COMPLETED NA

Improving Blood Pressure Control Among Food Insecure Hypertensive Adults

NCT05877898

Hypertension

COMPLETED NA

Primary Care Evidence-based Approach for Improving Lifelong Health

NCT06526312

Clinical Trial

RECRUITING NA

The Impact of Provider Demographics on Patients' Continuity of Care

NCT04315402

Race Concordant Patient-provider Relationship Race Discordant Patient-provider Relationship Rate of No-show at Follow-up Visits

UNKNOWN

Health in the Right Measure: Promoting Healthy Food and Regular Physical Activity Practice for UFRJ Servers

NCT03060161

Human

COMPLETED NA

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

180 primary health care facilities in Nigeria are participating in this study. In one arm of this trial, 60 of the participating facilities are randomly assigned a physician (in addition to existing clinic staff); in a second arm, 60 facilities are randomly assigned an additional mid-level provider (of similar training to existing providers); and the third arm consists of facilities that receive no additional providers (the control group). Assigned providers will practice in those facilities for approximately one year. Stratifying by treatment arm, the investigators further randomize 10-15 enumeration areas within each facility catchment (service) area to either a Conditional Cash Transfer (CCT) arm or to a control arm. The cash transfer is intended for currently pregnant women in those enumeration areas and is conditioned upon attending four antenatal care visits, giving birth in the facility, and attending at least one postnatal visit.

To measure the effects of the interventions the investigators randomly sample 15 households in each facility catchment area and enroll all currently pregnant women within the study enumeration areas. Women at an advanced stage of pregnancy - third trimester - are excluded because such women will not be exposed to the intervention for the majority of their pregnancy. All household members are interviewed at baseline, midline (6 months later) and endline (12 months later) to collect information about health-seeking behavior and health status. Pregnant women are also interviewed at baseline and approximately 1-3 months after birth to collect information about health care utilization and birth outcomes. Additionally the investigators collect data from the participating health facilities and providers. Using a combination of provider surveys, clinical vignettes, direct clinical observation, and patient exit interviews the investigators examine the effects of the intervention on service delivery and quality.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Health Services Accessibility Health Behavior Health Care Quality, Access, and Evaluation

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

No provider - No cash transfer

Study primary health centers (PHC) will carry out business-as-usual, with no additional staffing or changes to usual clinic operations. Study participants who live in the community served by the PHC will not receive any incentives (conditional cash transfer) to encourage them to seek care at the study clinic.

Group Type NO_INTERVENTION

No interventions assigned to this group

No Provider - Cash Transfer

Study primary health centers (PHC) will carry out business-as-usual, with no additional staffing or changes to usual clinic operations. Study participants who live in the community served by the study PHC will receive a conditional cash transfer if they use services provided by the study PHC.

Group Type EXPERIMENTAL

Conditional Cash Transfer

Intervention Type BEHAVIORAL

Study participants (who are pregnant women) will receive a cash transfer conditional upon: registering for and attending antenatal care in the study clinic, giving birth in the study clinic and completing a postnatal visit with the new infant

Physician - No Cash Transfer

Study PHCs will receive an additional health provider - a physician. Study participants who live in the community served by the PHC will not receive any incentives (conditional cash transfer) to encourage them to seek care at the study clinic.

Group Type EXPERIMENTAL

Physician

Intervention Type OTHER

Study primary health centers will be staffed with an additional physician

Physician - Cash Transfer

Study PHCs will receive an additional health provider - a physician. Study participants who live in the community served by the study PHC will receive a conditional cash transfer if they use services provided by the study PHC.

Group Type EXPERIMENTAL

Physician

Intervention Type OTHER

Study primary health centers will be staffed with an additional physician

Conditional Cash Transfer

Intervention Type BEHAVIORAL

Study participants (who are pregnant women) will receive a cash transfer conditional upon: registering for and attending antenatal care in the study clinic, giving birth in the study clinic and completing a postnatal visit with the new infant

Mid-level Provider - No Cash Transfer

Study PHCs will receive an additional health provider - a mid-level provider. Study participants who live in the community served by the PHC will not receive any incentives (conditional cash transfer) to encourage them to seek care at the study clinic.

Group Type EXPERIMENTAL

Mid-level provider

Intervention Type OTHER

Study primary health centers will be staffed with an additional mid-level provider

Mid-level Provider - Cash Transfer

Study PHCs will receive an additional health provider - a mid-level provider. Study participants who live in the community served by the study PHC will receive a conditional cash transfer if they use services provided by the study PHC.

Group Type EXPERIMENTAL

Mid-level provider

Intervention Type OTHER

Study primary health centers will be staffed with an additional mid-level provider

Conditional Cash Transfer

Intervention Type BEHAVIORAL

Study participants (who are pregnant women) will receive a cash transfer conditional upon: registering for and attending antenatal care in the study clinic, giving birth in the study clinic and completing a postnatal visit with the new infant

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Physician

Study primary health centers will be staffed with an additional physician

Intervention Type OTHER

Mid-level provider

Study primary health centers will be staffed with an additional mid-level provider

Intervention Type OTHER

Conditional Cash Transfer

Study participants (who are pregnant women) will receive a cash transfer conditional upon: registering for and attending antenatal care in the study clinic, giving birth in the study clinic and completing a postnatal visit with the new infant

Intervention Type BEHAVIORAL