The (Cost-)Effectiveness of Physician Assistants Working at the Primary Out of Hours Emergency Service
6 april 2016 uppdaterad av: Radboud University Medical Center
The aim of this study is to explore the effect of substituting General Practitioners (GPs) by Physician Assistants (PAs) in out-of-hours primary care.
Effects are measured in terms of the implication for the care model, quality of care delivered by PAs in comparison to GPs; the complaints treated by PAs in comparison to GPs; safety, efficiency and patient satisfaction.
Lastly, this study will provide insight in the changes in costs of healthcare.
Studieöversikt
Status
Avslutad
Betingelser
Intervention / Behandling
Detaljerad beskrivning
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.
Studietyp
Interventionell
Inskrivning (Faktisk)
10161
Fas
- Inte tillämpbar
Kontakter och platser
Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.
Studieorter
-
-
-
Emmen, Nederländerna, 7824 AA
- Centrale Huisartsendienst Drenthe
-
-
Deltagandekriterier
Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.
Urvalskriterier
Åldrar som är berättigade till studier
- Barn
- Vuxen
- Äldre vuxen
Tar emot friska volontärer
Ja
Kön som är behöriga för studier
Allt
Beskrivning
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
Studieplan
Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Hälsovårdsforskning
- Tilldelning: Icke-randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
|---|---|
|
Inget ingripande: General Practitioners Care
Usual medical care provided by a general practitioner at the out-of-hours primary care service
|
|
|
Experimentell: 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).
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Number of patients
Tidsram: 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)
Tidsram: 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
|
Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
The number of prescriptions; number of test & investigations ordered and referral to the emergency department
Tidsram: 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.
Tidsram: 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
Tidsram: 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
Tidsram: 18 months
|
The amount of adverse events and complications will be recorded, as well as complaints by the patients.
|
18 months
|
|
Patient satisfaction questionaire
Tidsram: 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
Tidsram: 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
|
Samarbetspartners och utredare
Det är här du hittar personer och organisationer som är involverade i denna studie.
Studieavstämningsdatum
Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.
Studera stora datum
Studiestart
1 april 2014
Primärt slutförande (Faktisk)
1 januari 2016
Avslutad studie (Faktisk)
1 januari 2016
Studieregistreringsdatum
Först inskickad
31 mars 2015
Först inskickad som uppfyllde QC-kriterierna
10 april 2015
Första postat (Uppskatta)
15 april 2015
Uppdateringar av studier
Senaste uppdatering publicerad (Uppskatta)
7 april 2016
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
6 april 2016
Senast verifierad
1 april 2016
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- PA_in_spoedzorg
Denna information hämtades direkt från webbplatsen clinicaltrials.gov utan några ändringar. Om du har några önskemål om att ändra, ta bort eller uppdatera dina studieuppgifter, vänligen kontakta register@clinicaltrials.gov. Så snart en ändring har implementerats på clinicaltrials.gov, kommer denna att uppdateras automatiskt även på vår webbplats .