Effect of Strategies to Improve General Practitioner-nurse Collaboration and Communication (interprof ACT)

Effects of Strategies to Improve General Practitioner-nurse Collaboration and Communication in Regard to Hospital Admissions of Nursing Home Residents.

Previously,six measures were developed for a better collaboration of general practitioners and nurses in nursing homes in a qualitative multistep bottom-up process. These measures, summarised as the interprof ACT intervention, shall improve the flow of information and the communication between the involved parties and lead to more transparency and effectiveness regarding treatment decisions of nursing home residents.The major aim of this trial is to examine the clinical effectiveness of interprof ACT. The main hypothesis is that implementation of interprof ACT reduces the cumulative incidence of hospitalisations of nursing home residents within 12 months from 50% to 35% (15% absolute reduction).

Study Overview

• Status: Completed
• Conditions: Utilization of Medical Care by Nursing Home Residents
• Intervention / Treatment: Procedure: interprof ACT measures

• Study Type: Interventional
• Enrollment (Actual): 680
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Germany
  • Göttingen, Germany
    • Department of General Practice, University Medical Center Göttingen
  • Göttingen, Germany
    • Organization and Corporate Development, Georg August University Göttingen
  • Hamburg, Germany
    • Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf
  • Lübeck, Germany
    • Institute for Social Medicine and Epidemiology, Nursing Research Group,University of Lübeck

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria Residents:

• at least one GP visit in recent three months or
• two GP visits in recent 6 months or
• admission to the nursing home during the precedent 6 months independently of documented GP contacts
• at least 18 years of age
• written informed consent by the resident or her/his legal guardian

Inclusion Criteria Nursing Homes:

• minimum size of 40 residents
• written consent provided by the nursing home Manager Prior to randomisation

Exclusion Criteria Residents:

- admission for short term care only

Exclusion Criteria Nursing Homes:

- participation in other projects on interprofessional collaboration.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Group; Care of nursing home residents as usual.
Experimental: Interventional Group; Implementation of interprof ACT measures to improve collaboration and communication between general practitioners and nursing staff. Measures are selected and adapted by nursing home management / nurses, GPs and residents' relatives or representatives.	Procedure: interprof ACT measures; Definition of common goals between general practitioner and nursing staff, appointment of a contact person, support in assigning medication, use of name badges worn by GPs and nurses during visits, mandatory availability of contact person, standardized procedures for GPs home visits

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
cumulative number of hospitalisation	Cumulative incidence of hospitalisations from nursing home residents within 12 months	within 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
absolute number of hospitalisations	number of hospitalisations within 12 months	within 12 months
hospital days	Hospital days within 12 months	within 12 months
mortality	mortality within 12 months	within 12 months
potentially inadequate medications	potentially inadequate medications at baseline and for follow-ups at 6 and 12 months	baseline and after 6 and 12 months
Adverse Events	Adverse Events within 12 months	within 12 months
Quality of Life in Alzheimer's Disease scale - Nursing Home version (QoL-AD-NH)	Residents' quality of life at baseline and at 12 months. Scale range is 15 - 60, with higher scores indicating higher QoL.	baseline and after 12 months
Health-related Quality of Life (HRQL) of residents measured by EQ-5D-5L	The EQ-5D-5L consist of two self-rating components: the EQ-5D descriptive system and a visual analogue scale (EQ VAS). The EQ-5D descriptive system measures HRQL on the five dimensions "mobility", "self-care", "usual activities", "pain / discomfort" and "anxiety / depression". On each dimension participants can rate either "no problems" (0), "slight problems" (1), "moderate problems" (2), "severe problems" (3) or "extreme problems" (4), resulting in a score ranging from 0 (best) to 4 (worst). The scores of the single dimensions can be combined to a sum score ranging from 0 (best) to 20 (worst). In addition, so called "utility weights" can be attached to any possible combination of answers on the EQ-5D descriptive system which results in a utility score ranging from 0 (death) to 1 (full HRQL), which is then used to calculate quality-adjusted life years (QALYs). The EQ VAS ranges from 0 (worst imaginable health state) to 100 (best imaginable health state).	baseline and after 12 months
medical services	use of other medical services within 12 months	within 12 months
economic evaluation: efficiency	economic evaluation: efficiency (incremental cost-effectiveness ratio) and cost savings from payer and societal perspective	after 12 months
Quality of inter-professional collaboration according to the Partnership Self-Assessment Tool (PSAT) score	Higher score values indicating better collaboration.	after 12 months
Attitudes towards inter-professional collaboration according to the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSAPNC) score	Higher score values indicating more favourable attitudes.	after 12 months

Collaborators and Investigators

• Sponsor: University Medical Center Goettingen
• Investigators: Principal Investigator: Eva Hummers, Prof. Dr. med., Department of General Practice, University Medical Center Goettingen

Publications and helpful links

General Publications

• Steyer L, Kortkamp C, Muller C, Tetzlaff B, Fleischmann N, Weber CE, Scherer M, Kuhn A, Jarchow AM, Luth F, Kopke S, Friede T, Konig HH, Hummers E, Maurer I, Balzer K. Implementation, mechanisms of change and contextual factors of a complex intervention to improve interprofessional collaboration and the quality of medical care for nursing home residents: study protocol of the process evaluation of the interprof ACT intervention package. Trials. 2022 Jul 8;23(1):561. doi: 10.1186/s13063-022-06476-6.
• Muller C, Hesjedal-Streller B, Fleischmann N, Tetzlaff B, Mallon T, Scherer M, Kopke S, Balzer K, Gartner L, Maurer I, Friede T, Konig HH, Hummers E. Effects of strategies to improve general practitioner-nurse collaboration and communication in regard to hospital admissions of nursing home residents (interprof ACT): study protocol for a cluster randomised controlled trial. Trials. 2020 Nov 5;21(1):913. doi: 10.1186/s13063-020-04736-x.

Study record dates

Study Major Dates

• Study Start (Actual): February 12, 2018
• Primary Completion (Actual): June 12, 2020
• Study Completion (Actual): April 22, 2021

Study Registration Dates

• First Submitted: December 5, 2017
• First Submitted That Met QC Criteria: February 7, 2018
• First Posted (Actual): February 8, 2018

Study Record Updates

• Last Update Posted (Actual): July 14, 2022
• Last Update Submitted That Met QC Criteria: July 13, 2022
• Last Verified: July 1, 2022

More Information

Terms related to this study

• Keywords: interprofessional collaboration; nursing home residents; reduction of hospitalisation
• Other Study ID Numbers: 01811

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No