Clinical trial NCT02212171: TRIAP: Is Triage by Healthcare Mini-teams Effective to Improve Efficiency in Primary Health Care?
Official title: TRIAP: Is Triage by Healthcare Mini-teams Effective to Improve Efficiency in Primary Health Care?
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Organization of Health Service
Lead sponsor: Basque Health Service
Sponsor class: OTHER_GOV
First posted: 2014-08-08
Enrollment: 10000
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: Background: With new challenges for healthcare, there is a clear consensus among experts on the need to introduce changes in the organization of care in health centres to address the problems of over-attendance, bureaucratization and other emerging issues that require growing amounts of attention. However, there has been insufficient research into possible models and the impact of their adoption.

The objective is to assess the feasibility and effectiveness of the TRIAP intervention, a new organizational model based on triage and healthcare mini-teams (two general practitioners/pediatricians, two nurses and one member of the administrative staff) compared to the current model, aiming to achieve a correct classification of the healthcare needs of the primary care population and direct them to the most suitable professional.

In addition, the implementation research objective is to identify the facilitators for and barriers to the implementation of the intervention in the context of primary care.

Methods/ design: This is a quasi-experimental controlled clinical trial to be performed in 14 healthcare mini-teams (7 intervention and 7 control groups) from 8 health centres in the Basque Healthcare Service (Osakidetza) Interior Health Region.

The results will be assessed using the data on morbidity-adjusted attendance of users to their family doctor, number of referral, addition of new activities to the portfolio of services, and patient perception and professional satisfaction. All the variables will be measured at baseline and at the end of the intervention, 24 months later.

Using covariance analysis models, the investigators will estimate the effect attributable to the intervention by analyzing differences in changes between the two groups, and calculating the 95% confidence interval, adjusting the comparisons for baseline values. The investigators will also adjust for potential confounding and effect-modifying variables.

Nominal groups will be held at the end of the intervention with the participation of all the agents involved in intervention centres to identify the facilitators for and barriers to the implementation of the intervention.

Discussion: There is a need to develop new forms of organization in primary care services to respond to new healthcare demands. To pursue this aim, changes have to be introduced in the organization of healthcare within health centres, redefining the roles of primary care professionals and refocusing their activity towards population health needs, seeking greater efficiency in health services.


Eligibility criteria: Inclusion Criteria:

* The study populations are patients of the seven mini-teams established, these professionals being responsible for the GP lists in the health centres of San Miguel in Basauri, Miraballes and Ondarroa, and the paediatric list in Etxebarri health centre. The control units are from the health centres of Basauri-Ariz, Arratia, Amorebieta and Bermeo, all located in the Interior Health Region.

Exclusion Criteria:

-

Primary outcomes:
measure: Patients attendance
timeFrame: Baseline and at 24 months
Secondary outcomes:
measure: Patients referral: number of patient referrals by GPs and paediatricians in accordance to the Adjusted Clinical Groups [ACG] Case-Mix System.
timeFrame: Baseline and at 24 months
measure: New activities added to the current portfolio of services
timeFrame: Baseline and at 24 months
measure: Patient satisfaction
timeFrame: Baseline and at 24 months
measure: Satisfaction of health professionals
timeFrame: Baseline and at 24 months
Other outcomes:
Locations:
city: Vitoria
country: Spain
facility: Basque Healthcare Service
Study officials:
References: