The (Cost-)Effectiveness of Physician Assistants Working at the Primary Out of Hours Emergency Service
연구 개요
상세 설명
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.
연구 유형
등록 (실제)
단계
- 해당 없음
연락처 및 위치
연구 장소
-
-
-
Emmen, 네덜란드, 7824 AA
- Centrale Huisartsendienst Drenthe
-
-
참여기준
자격 기준
공부할 수 있는 나이
- 어린이
- 성인
- 고령자
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
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
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 건강 서비스 연구
- 할당: 무작위화되지 않음
- 중재 모델: 병렬 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
|---|---|
|
간섭 없음: General Practitioners Care
Usual medical care provided by a general practitioner at the out-of-hours primary care service
|
|
|
실험적: Physician Assistants Care
Medical care provided by the Physician Assistant at the out-of-hours primary care service
|
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).
|
연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
Number of patients
기간: 18 months
|
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.
|
18 months
|
|
Patient characteristics (composite)
기간: 18 months
|
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.
|
18 months
|
2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
The number of prescriptions; number of test & investigations ordered and referral to the emergency department
기간: 18 months
|
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.
|
18 months
|
|
Direct healthcare costs related to care provide by PAs and GPs will be calculated.
기간: 18 months
|
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.
|
18 months
|
|
Adherence to the practice guidelines for General Practitioners
기간: 6 months
|
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).
|
6 months
|
|
Amount of adverse events and complications
기간: 18 months
|
The amount of adverse events and complications will be recorded, as well as complaints by the patients.
|
18 months
|
|
Patient satisfaction questionaire
기간: 6 months
|
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)
|
6 months
|
|
Knowledge test concerning frequently presented complaints
기간: 1 month
|
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).
|
1 month
|
공동 작업자 및 조사자
연구 기록 날짜
연구 주요 날짜
연구 시작
기본 완료 (실제)
연구 완료 (실제)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (추정)
연구 기록 업데이트
마지막 업데이트 게시됨 (추정)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
기타 연구 ID 번호
- PA_in_spoedzorg
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .
1차 의료에 대한 임상 시험
-
Cairo University아직 모집하지 않음
-
Capital Medical University완전한Transradial Approach, Primary PCI, ST-segment Elevation 심근경색증중국