The (Cost-)Effectiveness of Nurse Practitioners Working at the Primary Out of Hours Emergency Service

Radboud University Medical Center

Status: Completed

Conditions: Out of Hours Medical Care; Primary Health Care

Treatments: Other: Other, care provided by Nurse Practitioners

Study type: Interventional

Funder types: Other

Identifiers

NCT01388374

80-82800-98-227

Details and patient eligibility

About

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?

Full description

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.

Enrollment: 12,092 patients

Sex: All

Ages: 1+ year old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

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.

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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12,092 participants in 2 patient groups

General Practitioners Care

No Intervention group

Description:

Usual medical care provided by a general practitioner at the Primary Out of Hours Emergency Service.

Nurse Practitioners Care

Experimental group

Description:

Medical care provided by the Nurse Practitioner at the Primary Out of Hours Emergency Service.

Treatment:

Other: Other, care provided by Nurse Practitioners