The (Cost-)Effectiveness of Physician Assistants Working at the Primary Out of Hours Emergency Service
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 10,161
- 试验地点
- 2
- 主要终点
- Number of patients
研究概览
简要总结
The aim of this study is to explore the effect of substituting General Practitioners (GPs) by Physician Assistants (PAs) in out-of-hours primary care. Effects are measured in terms of the implication for the care model, quality of care delivered by PAs in comparison to GPs; the complaints treated by PAs in comparison to GPs; safety, efficiency and patient satisfaction. Lastly, this study will provide insight in the changes in costs of healthcare.
详细描述
Out-of-hours care in the Netherlands is under pressure. Workload for general practitioners (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 are low complex and not urgent, not all patients necessarily have to be seen by a physician. Shifting care from GPs to physician assistants (PAs) is considered to be a possible method to reduce workload while maintaining high quality and safety of care.
Previous research, on PAs in primary care during office hours, has shown PAs were found to be acceptable, effective and efficient in complementing the work of GPs.
We hypothesize that in a team of PAs and GPs working out-of-hours primary care, the PAs will deliver care to less urgent and complex complaints, deliver quality of care comparable to GPs and their implementation will lead to a reduction in cost of healthcare.
We compare care provided by a team of PAs and GPs with a team of only GPs. Within the team of PAs and GPs we make a comparison between the two healthcare professionals.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Patients (with urgency U2, U3, U4, or U5) requesting an appointment at the primary out of hours emergency service during the weekend between 9.00 and 17.00 hours.
- •Exclusion criteria:
排除标准
- 未提供
结局指标
主要结局
Number of patients
时间窗: 18 months
To measure substitution of healthcare, the number of consultations in the experimental and control group and per discipline will be measured. These data will be derived from the electronic medical records.
Patient characteristics (composite)
时间窗: 18 months
Patient characteristics of patients seen in the experimental and control group and per discipline include age, gender, urgency and type of complaint. These data will be derived from the electronic medical records.
次要结局
- Direct healthcare costs related to care provide by PAs and GPs will be calculated.(18 months)
- Adherence to the practice guidelines for General Practitioners(6 months)
- Knowledge test concerning frequently presented complaints(1 month)
- The number of prescriptions; number of test & investigations ordered and referral to the emergency department(18 months)
- Amount of adverse events and complications(18 months)
- Patient satisfaction questionaire(6 months)