A Study on the (Cost-)Effectiveness of Nurse Practitioners Working at the Primary Out of Hours Emergency Service and the Feasibility of Implementing These Nurses
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 12,092
- 试验地点
- 1
- 主要终点
- Accessibility of care
研究概览
简要总结
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:
- 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.
- How efficient is the implementation of NPs in the primary out of hours services?
- What is the feasibility of the implementation of NPs in the out of hours services? And under which conditions?
- What are the barriers and facilitating factors considering the implementation of NPs?
详细描述
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.
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
- 年龄范围
- 1 Year 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •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.
排除标准
- •(patients seen by a NP):
- •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.
研究组 & 干预措施
General Practitioners Care
Usual medical care provided by a general practitioner at the Primary Out of Hours Emergency Service.
Nurse Practitioners Care
Medical care provided by the Nurse Practitioner at the Primary Out of Hours Emergency Service.
干预措施: Other, care provided by Nurse Practitioners (Other)
结局指标
主要结局
Accessibility of care
时间窗: 15 months
Number of patients that have a consult at the Primary Out of Hours Emergency Service; Waiting time; Productivity by NPs in comparison with productivity by GPs.
次要结局
- Patient satisfaction(15 months)
- Cost-analysis(15 months)
- Feasibility(15 months)
- Efficiency of care(15 months)
- Knowledge/competence of the NPs(15 months)
- Workload(15 months)
- Quality and safety of care(15 months)