The (Cost-)Effectiveness of Physician Assistants Working at the Primary Out of Hours Emergency Service

Radboud University Medical Center

Status: Completed

Conditions: Out-of-hours Medical Care; Primary Healthcare

Treatments: Other: Care provided by Physician Assistants

Study type: Interventional

Funder types: Other

Identifiers

NCT02417181

PA_in_spoedzorg

Details and patient eligibility

About

The aim of this study is to explore the effect of substituting General Practitioners (GPs) by Physician Assistants (PAs) in out-of-hours primary care. Effects are measured in terms of the implication for the care model, quality of care delivered by PAs in comparison to GPs; the complaints treated by PAs in comparison to GPs; safety, efficiency and patient satisfaction. Lastly, this study will provide insight in the changes in costs of healthcare.

Full description

Out-of-hours care in the Netherlands is under pressure. Workload for general practitioners (GPs) during out-of-hours care is high and there are concerns about maintaining the quality of care. Since 80% of the complaints shown in out-of-hours care are low complex and not urgent, not all patients necessarily have to be seen by a physician. Shifting care from GPs to physician assistants (PAs) is considered to be a possible method to reduce workload while maintaining high quality and safety of care.

Previous research, on PAs in primary care during office hours, has shown PAs were found to be acceptable, effective and efficient in complementing the work of GPs.

We hypothesize that in a team of PAs and GPs working out-of-hours primary care, the PAs will deliver care to less urgent and complex complaints, deliver quality of care comparable to GPs and their implementation will lead to a reduction in cost of healthcare.

We compare care provided by a team of PAs and GPs with a team of only GPs. Within the team of PAs and GPs we make a comparison between the two healthcare professionals.

Enrollment: 10,161 patients

Sex: All

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Patients (with urgency U2, U3, U4, or U5) requesting an appointment at the primary out of hours emergency service during the weekend between 9.00 and 17.00 hours.

Exclusion criteria

• None

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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10,161 participants in 2 patient groups

General Practitioners Care

No Intervention group

Description:

Usual medical care provided by a general practitioner at the out-of-hours primary care service

Physician Assistants Care

Experimental group

Description:

Medical care provided by the Physician Assistant at the out-of-hours primary care service

Treatment:

Other: Care provided by Physician Assistants