The (Cost-)Effectiveness of Physician Assistants Working at the Primary Out of Hours Emergency Service
調査の概要
詳細な説明
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.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Emmen、オランダ、7824 AA
- Centrale Huisartsendienst Drenthe
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参加基準
適格基準
就学可能な年齢
- 子
- 大人
- 高齢者
健康ボランティアの受け入れ
受講資格のある性別
説明
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
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：ヘルスサービス研究
- 割り当て：非ランダム化
- 介入モデル：並列代入
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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介入なし：General Practitioners Care
Usual medical care provided by a general practitioner at the out-of-hours primary care service
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実験的：Physician Assistants Care
Medical care provided by the Physician Assistant at the out-of-hours primary care service
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Patients will receive care at the out-of-hours primary care service by a Physician Assistant instead of a General Practitioner (substitution of care from physicians to nurses).
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Number of patients
時間枠：18 months
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To measure substitution of healthcare, the number of consultations in the experimental and control group and per discipline will be measured.
These data will be derived from the electronic medical records.
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18 months
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Patient characteristics (composite)
時間枠：18 months
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Patient characteristics of patients seen in the experimental and control group and per discipline include age, gender, urgency and type of complaint.
These data will be derived from the electronic medical records.
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18 months
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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The number of prescriptions; number of test & investigations ordered and referral to the emergency department
時間枠：18 months
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The performance of the two conditions as well as the disciplines will be measures by number of prescriptions; number of test & investigations ordered and referral to the emergency department.
These data will be derived from the electronic medical records.
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18 months
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Direct healthcare costs related to care provide by PAs and GPs will be calculated.
時間枠：18 months
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Costs related to care provided in the experimental and control group, and per discipline will be calculated, including number of consultations, resource use, referrals, and prescriptions.
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18 months
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Adherence to the practice guidelines for General Practitioners
時間枠：6 months
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Adherence of the PA to the practice guidelines for General Practitioners will be measured by video recordings of in total 30 consultations/visits of the PA.
Two independent General Practitioners will score the adherence by a list of indicators.
Outcomes will be compared by scores of GPs and Nurse Practitioners (measured in previous research).
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6 months
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Amount of adverse events and complications
時間枠：18 months
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The amount of adverse events and complications will be recorded, as well as complaints by the patients.
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18 months
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Patient satisfaction questionaire
時間枠：6 months
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Patient satisfaction will be measured using an abridgment of the CQ-index questionnaire.
During the intervention period 200 questionnaires will be sent to patients who had either a consult with the PA or with the GP at the out-of-hours primary care service.
Results will be compared with results on the CQ-index of the GP and NP (measured in previous research)
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6 months
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Knowledge test concerning frequently presented complaints
時間枠：1 month
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Knowledge of PAs will be measured with regard to a number of frequently presented complaints by using a knowledge test.
Results are compared with the results on the knowledge test of GPs and NPs (measured in previous research).
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1 month
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協力者と研究者
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
- PA_in_spoedzorg
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
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