The effectiveness of Nurse Practitioners working at a GP cooperative: a study protocol

BMC Family Practice

Study Protocol

Regi van der Burgt¹  Hubertus Vrijhoef²  Miranda Laurant³  Michel Wensing³  Paul Giesen³  Nancy Wijers³  Lisette Schoonhoven⁴  Joke Mintjes⁵ 

[1] Foundation for Development of Quality Care in General Practice, Eindhoven, The Netherlands;Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands;Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. box 9101, 6500, Nijmegen, HB, The Netherlands;Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. box 9101, 6500, Nijmegen, HB, The Netherlands;Faculty of Health Sciences, University of Southampton, Southampton, UK;University of Applied Sciences, Nijmegen, The Netherlands;

关键词: Substitution;    General practitioner;    Nurse practitioner;    Out of hours care;    Quality;    Safety;    Costs;   

DOI  :  10.1186/1471-2296-13-75

 received in 2012-06-20, accepted in 2012-07-26,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundIn many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high) accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting.DesignA quasi experimental study is undertaken at one “general practitioner cooperative” to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012.MethodsData will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals) and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes are: patient satisfaction; general practitioners workload; quality and safety of care and barriers and facilitators.DiscussionThe study will provide evidence whether substitution of care in out-of-hours setting is safe and efficient and give insight into barriers and facilitators related to the introduction of nurse practitioners in out-of-hours setting.Trial registrationClinicalTrials.gov ID NCT01388374

【 授权许可】

CC BY   
© Wijers et al.; licensee BioMed Central Ltd. 2012