Clinical trial NCT02407847: The Effect of Substitution of Out-of-hours Care From General Practitioners to Nurse Practitioners
Official title: The (Cost-)Effectiveness of Substitution in Out-of-hours Primary Care; Towards an Optimal Balance Between General Practitioners and Nurse Practitioners.
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Out-of-hours Care Services
Primary Healthcare
Keywords: Nurse practitioners
Primary healthcare
Emergency Medical Services
Substitution of care
Lead sponsor: Radboud University Medical Center
Sponsor class: OTHER
Collaborators: name: Stichting Kwaliteit en Ontwikkeling Huisartsenzorg
name: Centrale Huisartsenpost Eindhoven (CHP)
First posted: 2015-04-03
Enrollment: 9647
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 effects of substitution in out-of-hours primary care. In consecutive stages an extra General Practitioner (GP) is substituted by a Nurse Practitioner (NP) aiming at replacing 3 out of 4 GPs by NPs. Effects are measured in terms of feasibility and cost-efficiency.

Detailed description: Out-of-hours care in the Netherlands is under pressure. Workload for 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 is neither complex nor urgent not all patients necessarily have to be seen by a GP.

A previous study (ID: 80-82800-98-227) indicated that shifting care from GPs to NPs is possible in terms of safety and quality of care and resulted in cost savings due to less treatment. In that study 4 GPs and 1 NP provided care in the experimental condition and 5 GPs provided care in the control condition. Based on the results it is hypothesized that NPs are competent to diagnose and treat at least 75% of the complaints shown in out-of-hours primary care. Substituting more GPs by NPs in out-of-hours care will probably lead to more cost savings.

In the current study care delivered and direct healthcare costs are compared between different team compositions. In the experimental condition care is provided by a team of NPs and GPs. The intervention starts with a team of 4 professionals in both the experimental (3 GPs and 1 NP) and the control (4 GPs) condition; in consecutive stages an extra GP is substituted by an NP aiming at replacing 3 out of 4 GPs with by NPs.

Control: 4 GPs

Stage 1: experimental: 3 GPs \& 1 NP

Stage 2: experimental: 2 GPs \& 2 NPs

Stage 3: experimental: 1 GP \& 3 NPs

Both feasibility and cost-efficiency will lead to recommendations on the optimal balance in a team between GPs and NPs.

Eligibility criteria: Inclusion Criteria:

* Patients (with urgencylevel U2, U3, U4, or U5) requesting an appointment at the primary out-of-hours service during the weekend between 10am and 6pm.

Exclusion Criteria:

* None

Primary outcomes:
measure: The number of consultations per healthcare provider.
timeFrame: 18 months
Secondary outcomes:
measure: Number and characteristics of patients and experienced workload.
timeFrame: 18 months
measure: Direct healthcare costs related to care provide by NPs and GPs will be calculated.
timeFrame: 18 months
measure: Patient characteristics (composite)
timeFrame: 18 months
measure: The number of prescriptions; number of test & investigations ordered and referral to the emergency department.
timeFrame: 18 months
Other outcomes:
Locations:
city: Eindhoven
country: Netherlands
facility: Centrale Huisartsen Post (CHP)
state: Noord-Brabant
Study officials:
References:
citation: van der Biezen M, Wensing M, van der Burgt R, Laurant M. Towards an optimal composition of general practitioners and nurse practitioners in out-of-hours primary care teams: a quasi-experimental study. BMJ Open. 2017 May 30;7(5):e015509. doi: 10.1136/bmjopen-2016-015509.