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| Name | Class |
|---|---|
| ZonMw: The Netherlands Organisation for Health Research and Development | OTHER |
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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:
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.
However, specific scientific evidence for this is lacking.
In this study we examine whether substitution of care from GPs to NPs in a primary out of hours care setting can contribute to a more accessible and efficient patient care. Also the feasibility of implementing NPs in a primary our of hours setting is examined.
Comparison: Care provided by the Nurse Practitioner will be compared to care provided by a General Practitioner.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| General Practitioners Care | No Intervention | Usual medical care provided by a general practitioner at the Primary Out of Hours Emergency Service. | |
| Nurse Practitioners Care | Experimental | Medical care provided by the Nurse Practitioner at the Primary Out of Hours Emergency Service. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Other, care provided by Nurse Practitioners | Other | Patients will receive care at the Primary Out of Hours Emergency Service by a Nurse Practitioner instead of a General Practitioner (substitution of care from physicians to nurses). |
| Measure | Description | Time Frame |
|---|---|---|
| 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 |
| Measure | Description | Time Frame |
|---|---|---|
| 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. |
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Inclusion Criteria:
Exclusion Criteria (patients seen by a NP):
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| Name | Affiliation | Role |
|---|---|---|
| M.G.H. Laurant, Dr. | IQ healthcare, UMC St Radboud | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centrale Huisartsen Post (CHP) | Eindhoven | North Brabant | 5623 EJ | Netherlands |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Bos N et al (2009). Het gebruik van spoedzorg Regio Utrecht 2009. Utrecht: Julius Centrum. | ||
| Background | Giesen P, et al (2007). Medische zorg buiten kantooruren: de huisartsenpost of de spoedeisende eerste hulp? Huisarts Wet;50(5):202-6. | ||
| Background | Ministerie van VWS. Beleidsvisie acute zorg. Oktober 2003. | ||
| Background | VHN (2009). Benchmarkbulletin 2008. Utrecht: VHN. | ||
| Background | Giesen P, et al (2005). How urgent is the presented morbidity on the GP cooperative? Huisarts Wet; 48: 207-10. | ||
| Background | De Jongh M & Welling G (2009). Analyse zorgvraag Huisartsenpost Eindhoven. Eindhoven: De Centrale Huisartsenposten Zuidoost Brabant | ||
| Background | Giesen P, et al (2009). Te snel naar de huisartsenpost. Medisch Cont; 64(6)239-42. | ||
| Background | IGZ (2004). Spoedeisende hulpverlening; haastige spoed niet overal goed. Den Haag: IGZ |
| Label | URL |
|---|---|
| Projectdescription and dutch documentation related to the project | View source |
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| 15 months |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
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