Organization of Health Service Clinical Trial
Official title:
TRIAP: Is Triage by Healthcare Mini-teams Effective to Improve Efficiency in Primary Health Care?
Background: With new challenges for healthcare, there is a clear consensus among experts on
the need to introduce changes in the organization of care in health centres to address the
problems of over-attendance, bureaucratization and other emerging issues that require
growing amounts of attention. However, there has been insufficient research into possible
models and the impact of their adoption.
The objective is to assess the feasibility and effectiveness of the TRIAP intervention, a
new organizational model based on triage and healthcare mini-teams (two general
practitioners/pediatricians, two nurses and one member of the administrative staff) compared
to the current model, aiming to achieve a correct classification of the healthcare needs of
the primary care population and direct them to the most suitable professional.
In addition, the implementation research objective is to identify the facilitators for and
barriers to the implementation of the intervention in the context of primary care.
Methods/ design: This is a quasi-experimental controlled clinical trial to be performed in
14 healthcare mini-teams (7 intervention and 7 control groups) from 8 health centres in the
Basque Healthcare Service (Osakidetza) Interior Health Region.
The results will be assessed using the data on morbidity-adjusted attendance of users to
their family doctor, number of referral, addition of new activities to the portfolio of
services, and patient perception and professional satisfaction. All the variables will be
measured at baseline and at the end of the intervention, 24 months later.
Using covariance analysis models, the investigators will estimate the effect attributable to
the intervention by analyzing differences in changes between the two groups, and calculating
the 95% confidence interval, adjusting the comparisons for baseline values. The
investigators will also adjust for potential confounding and effect-modifying variables.
Nominal groups will be held at the end of the intervention with the participation of all the
agents involved in intervention centres to identify the facilitators for and barriers to the
implementation of the intervention.
Discussion: There is a need to develop new forms of organization in primary care services to
respond to new healthcare demands. To pursue this aim, changes have to be introduced in the
organization of healthcare within health centres, redefining the roles of primary care
professionals and refocusing their activity towards population health needs, seeking greater
efficiency in health services.
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Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research