The Effect of Substitution of Out-of-hours Care From General Practitioners to Nurse Practitioners

Not Applicable

Completed

• Conditions: Primary Healthcare; Out-of-hours Care Services
• Interventions: Other: care provided by Nurse Practitioners

• Registration Number: NCT02407847
• Lead Sponsor: Radboud University Medical Center

Brief Summary

The aim of this study is to explore the effects of substitution in out-of-hours primary care. In consecutive stages an extra General Practitioner (GP) is substituted by a Nurse Practitioner (NP) aiming at replacing 3 out of 4 GPs by NPs. Effects are measured in terms of feasibility and cost-efficiency.

Detailed Description

Out-of-hours care in the Netherlands is under pressure. Workload for GPs during out-of-hours care is high and there are concerns about maintaining the quality of care. Since 80% of the complaints shown in out-of-hours care is neither complex nor urgent not all patients necessarily have to be seen by a GP.

A previous study (ID: 80-82800-98-227) indicated that shifting care from GPs to NPs is possible in terms of safety and quality of care and resulted in cost savings due to less treatment. In that study 4 GPs and 1 NP provided care in the experimental condition and 5 GPs provided care in the control condition. Based on the results it is hypothesized that NPs are competent to diagnose and treat at least 75% of the complaints shown in out-of-hours primary care. Substituting more GPs by NPs in out-of-hours care will probably lead to more cost savings.

In the current study care delivered and direct healthcare costs are compared between different team compositions. In the experimental condition care is provided by a team of NPs and GPs. The intervention starts with a team of 4 professionals in both the experimental (3 GPs and 1 NP) and the control (4 GPs) condition; in consecutive stages an extra GP is substituted by an NP aiming at replacing 3 out of 4 GPs with by NPs.

Control: 4 GPs

Stage 1: experimental: 3 GPs \& 1 NP

Stage 2: experimental: 2 GPs \& 2 NPs

Stage 3: experimental: 1 GP \& 3 NPs

Both feasibility and cost-efficiency will lead to recommendations on the optimal balance in a team between GPs and NPs.

Study Timeline

• Study Start: 2014-05
• Study First Submitted: 2015-03-31
• Study First Submitted QC: 2015-04-02
• Study First Posted: 2015-04-03
• Primary Completion: 2016-01
• Study Completion: 2016-01
• Status Verified: 2016-04
• Last Update Submitted: 2016-04-06
• Last Update Posted: 2016-04-07

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 9647

Inclusion Criteria

• Patients (with urgencylevel U2, U3, U4, or U5) requesting an appointment at the primary out-of-hours service during the weekend between 10am and 6pm.

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Exclusion Criteria

• None

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Nurse Practitioners Care	care provided by Nurse Practitioners	Medical care provided by both Nurse Practitioners and General Practitioners at the Primary Out-of-Hours Service.

Primary Outcome Measures

Name	Time	Method
The number of consultations per healthcare provider.	18 months	To measure substitution of healthcare, the number of consultations per in the experimental and control group, and per healthcare provider will be measured. These data will be derived from electronic medical records.

Secondary Outcome Measures

Name	Time	Method
Patient characteristics (composite)	18 months	Patient characteristics of patients seen in the experimental and control group and per healthcare provider include age, gender, urgency and type of complaint. These data will be derived from electronic medical records.
Direct healthcare costs related to care provide by NPs and GPs will be calculated.	18 months	Costs related to care provided in the experimental and control group, and per discipline will be calculated, including number of consultations, resource use, referrals, and prescriptions.
The number of prescriptions; number of test & investigations ordered and referral to the emergency department.	18 months	The performance of the two conditions as well as the healthcare providers will be measures by number of prescriptions; number of test \& investigations ordered and referral to the emergency department. These data will be derived from electronic medical records.
Number and characteristics of patients and experienced workload.	18 months	Objective workload will be measured by the numbers of consults, taking into account the urgency levels of the complaints and type of complaint. These data will be derived from electronic medical records. Subjective workload will be measured by interviews and focusgroups.

Trial Locations

Locations (1)

Centrale Huisartsen Post (CHP); 🇳🇱 Eindhoven, Noord-Brabant, Netherlands