Clinical trial NCT02417181: The (Cost-)Effectiveness of Physician Assistants Working at the Primary Out of Hours Emergency Service
Official title: The (Cost-)Effectiveness of Physician Assistants Working at the Primary Out of Hours Emergency Service
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Primary Healthcare
Out-of-hours Medical Care
Keywords: Physician assistants
Out-of-hours medical care
Primary healthcare
Emergency Medical Services
Lead sponsor: Radboud University Medical Center
Sponsor class: OTHER
Collaborators: name: Stichting Kwaliteit en Ontwikkeling Huisartsenzorg
name: GP Cooperative Emmen (CHD Emmen)
First posted: 2015-04-15
Enrollment: 10161
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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.

Detailed 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.

Eligibility criteria: 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

Primary outcomes:
measure: Number of patients
timeFrame: 18 months
measure: Patient characteristics (composite)
timeFrame: 18 months
Secondary outcomes:
measure: The number of prescriptions; number of test & investigations ordered and referral to the emergency department
timeFrame: 18 months
measure: Direct healthcare costs related to care provide by PAs and GPs will be calculated.
timeFrame: 18 months
measure: Adherence to the practice guidelines for General Practitioners
timeFrame: 6 months
measure: Amount of adverse events and complications
timeFrame: 18 months
measure: Patient satisfaction questionaire
timeFrame: 6 months
measure: Knowledge test concerning frequently presented complaints
timeFrame: 1 month
Other outcomes:
Locations:
city: Emmen
country: Netherlands
facility: Centrale Huisartsendienst Drenthe
Study officials:
References: