Primary Health Care Clinical Trial
Official title:
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
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:
1. 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.
2. How efficient is the implementation of NPs in the primary out of hours services?
3. What is the feasibility of the implementation of NPs in the out of hours services? And
under which conditions?
4. What are the barriers and facilitating factors considering the implementation of NPs?
Status | Completed |
Enrollment | 12092 |
Est. completion date | October 2012 |
Est. primary completion date | July 2012 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | Both |
Age group | 1 Year and older |
Eligibility |
Inclusion Criteria: - 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. Exclusion Criteria (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. |
Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research
Country | Name | City | State |
---|---|---|---|
Netherlands | Centrale Huisartsen Post (CHP) | Eindhoven | Noord-Brabant |
Lead Sponsor | Collaborator |
---|---|
Radboud University | ZonMw: The Netherlands Organisation for Health Research and Development |
Netherlands,
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* Note: There are 63 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Accessibility of care | 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. | 15 months | No |
Secondary | Quality and safety of care | Quality and safety of care will be measured by video/audio recording. In total, 60 consultations/visits will be recorded. 30 of the General Practitioner and 30 of the Nurse Practitioner. The care between these two disciplines will be compared according to the practice guidelines for General Practitioners (list of indicators). Furthermore, we report the amount of adverse events and complications. Also complaints by the patients will be recorded. |
15 months | Yes |
Secondary | Patient satisfaction | Patient satisfaction will be measured by a questionnaire (CQ-index). At baseline and three times during the intervention period questionnaires will be sent to patients who had a consult at the Primary Out of Hours Emergency Service. | 15 months | No |
Secondary | Feasibility | Barriers and facilitators will be explored. We collect this information through semi-structured interviews with GPs, practice assistants, NPs and physicians working at the Primary Out of Hours Emergency Service. | 15 months | No |
Secondary | Efficiency of care | To measure the efficiency of healthcare, we will measure type of consultation; duration of the consult; type of care provider; number of patients; number of prescriptions; number of test & investigations ordered, referral to other healthcare providers and the emergency department. These data will be derived from the electronic medical records and patient questionnaires. |
15 months | No |
Secondary | Workload | Objective workload will be measured by the numbers of consults, taking into account the urgency levels of the complaints. This data will be derived from the electronic medical records Subjective workload will be measured by a questionnaire. General practitioners as well as the practice assistants at the Primary Out of Hours Emergency Service receive a questionnaire before and after the intervention period to measure satisfaction with care and workload issues |
15 months | No |
Secondary | Knowledge/competence of the NPs | After 9 months, we will measure the knowledge of NPs with regard to a number of frequently presented complaints. We will use a 'knowledge test' used to examine the knowledge of GP trainees. Besides NPs also a random selection of GPs (with similar experience of practice) will be invited to fill in the knowledge test. | 15 months | No |
Secondary | Cost-analysis | All costs related to care provided by NPs and GPs will be calculated, including number of consultations, resource use, referrals, etc. We will also include the costs for training of GPs and NPs. The EQ-D5 will be used as standardized measure for health status of the patient. |
15 months | No |
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