The effectiveness of Nurse Practitioners working at a GP cooperative: a study protocol
In 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.
A 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.
Data 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.
The 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.
ClinicalTrials.gov ID NCT01388374
- van Uden, CJ, Giesen, PH, Metsemakers, JF, Grol, RP (2006) Development of out-of-hours primary care by general practitioners (GPs) in The Netherlands: from small-call rotations to large-scale GP cooperatives. Fam Med 38: pp. 565-569
- Huibers, L, Giesen, P, Wensing, M, Grol, R (2009) Out-of-hours care in western countries: assessment of different organizational models. BMC Health Serv Res 9: pp. 105 CrossRef
- Grol, R, Giesen, P, van Uden, C (2006) After-hours care in the United Kingdom, Denmark, and the Netherlands: new models. Health Aff (Millwood) 25: pp. 1733-1737 CrossRef
- Giesen, P, Smits, M, Huibers, L, Grol, R, Wensing, M (2011) Quality of after-hours primary care in the Netherlands: a narrative review. Ann Intern Med 155: pp. 108-113
- van Steenwijk, P, van der Sterren, E, van Vugt, C (2010) Samenwerking huisartsenposten en spoedeisende hulp (SEH): Inventarisatie van huidige situatie. Vereniging Huisartsenposten Nederland & IQ healthcare.
- Leibowitz, R, Day, S, Dunt, D (2003) A systematic review of the effect of different models of after-hours primary medical care services on clinical outcome, medical workload, and patient and GP satisfaction. Fam Pract 20: pp. 311-317 CrossRef
- Giesen, P, Mokkink, H, Ophey, G, Drijver, R, Grol, R, van den Bosch, W (2005) Hoe urgent is de gepresenteerde morbiditeit op de Centrale Huisartsenpost?. Huisarts Wetenschap 48: pp. 207-210 CrossRef
- Giesen, P, Huibers, L, Krol, M (2011) Patiënten contacten op de huisartsenpost: trends 2004-2010. Huisarts Wetenschap 54: pp. 1-5 CrossRef
- Accident & emergency care: room for improvements. The Hague. pp. 1-57
- van Uden, CJ, Winkens, RA, Wesseling, GJ, Crebolder, HF, van Schayck, CP (2003) Use of out of hours services: a comparison between two organisations. Emerg Med J 20: pp. 184-187 CrossRef
- Giesen, P, Franssen, E, Mokkink, H, van den Bosch, W, van Vugt, A, Grol, R (2006) Patients either contacting a general practice cooperative or accident and emergency department out of hours: a comparison. Emerg Med J 23: pp. 731-734 CrossRef
- Moll van Charante, EP, van Steenwijk-Opdam, PC, Bindels, PJ (2007) Out-of-hours demand for GP care and emergency services: patients' choices and referrals by general practitioners and ambulance services. BMC Fam Pract 8: pp. 46 CrossRef
- van Uden, CJ, Winkens, RA, Wesseling, G, Fiolet, HF, van Schayck, OC, Crebolder, HF (2005) The impact of a primary care physician cooperative on the caseload of an emergency department: the Maastricht integrated out-of-hours service. J Gen Intern Med 20: pp. 612-617 CrossRef
- Giesbers, S, Smits, M, Giesen, P (2011) Zelfverwijzers SEH jagen zorgkosten op. Medisch Contact 66: pp. 587-589
- Dierick-van Daele, AT, Metsemakers, JF, Derckx, EW, Spreeuwenberg, C, Vrijhoef, HJ (2009) Nurse practitioners substituting for general practitioners: randomized controlled trial. J Adv Nurs 65: pp. 391-401 CrossRef
- Laurant, M, Reeves, D, Hermens, R, Braspenning, J, Grol, R, Sibbald, B (2004) Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev.
- Het (ondersteunend) team in de huisartsenvoorziening.
- Giesen, P, Braspenning, J (2004) Huisartsenpost: gewone klachten met acuut karakter. Huisarts Wetenschap 47: pp. 177 CrossRef
- Giesen, P, Hammink, A, Mulders, A, Oude Bos, A (2009) Te snel naar de huisartsenpost. Medisch Contact 64: pp. 239-249
- van Ierland, Y, van Veen, M, Huibers, L, Giesen, P, Moll, HA (2011) Validity of telephone and physical triage in emergency care: the Netherlands Triage System. Fam Pract 28: pp. 334-341 CrossRef
- den Boer-Wolters, D, Knol, MJ, Smulders, K, de Wit, NJ (2010) Frequent attendance of primary care out-of-hours services in the Netherlands: characteristics of patients and presented morbidity. Fam Pract 27: pp. 129-134 CrossRef
- Huibers, L, Keizer, E, Giesen, P, Grol, R, Wensing, M (2012) Nurse telephone triage: good quality associated with appropriate decisions. Family Practice 0: pp. 1-6
- Toemen, T (2006) Master of ANP-Huisartsenzorg 2004-2006: overzicht inhoud en ICPC-codes modules patiëntenzorg huisartsgeneeskunde. Stichting KOH Fontys Hogescholen, Eindhoven
- Ram, P, Grol, R, Rethans, JJ, Schouten, B, van der Vleuten, C, Kester, A (1999) Assessment of general practitioners by video observation of communicative and medical performance in daily practice: issues of validity, reliability and feasibility. Med Educ 33: pp. 447-454 CrossRef
- van Thiel, J, Ram, P, van Dalen, J (2003) Maas-Global Manual 2000. Maastricht University, In. Maastricht
- Reinders, ME, Blankenstein, AH, van Marwijk, HW, Knol, DL, Ram, P, van der Horst, HE, de Vet, HC, van der Vleuten, CP (2011) Reliability of consultation skills assessments using standardised versus real patients. Med Educ 45: pp. 578-584 CrossRef
- Hammink, A, Giesen, P (2010) CQ-index huisartsenposten. Meetinstrumentontwikkeling en onderzoek naar discriminerend vermogen. Scientific Institute of Quality of Healthcare (IQ healthcare). pp. 79
- EuroQol—a new facility for the measurement of health-related quality of life. Health Pol 16: pp. 199-208 CrossRef
- Giesen, P, Huibers, AMJ, Wensing, MJP (2008) Kwaliteitsmeetsysteem Huisartsenposten; Rapport over ontstaan, uitkomsten en toekomst. UMC St Radboud, IQ healthcare, Nijmegen
- Huisartsopleiding Nederland. http://www.huisartsopleiding.nl/content.asp
- Hakkaaer-van Roijen, L, Tan, S, Bouwmans, CAM (2010) Handleiding voor Kostenonderzoek. Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. Health care Insurance Council, Rotterdam
- Dierick-van Daele, AT (2010) The Introduction of the Nurse Practitioner in General Practice. University of Maastricht, Maastricht
- Boeije, H (2002) A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant 36: pp. 391-409 CrossRef
- Hansen, EH, Hunskaar, S (2011) Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios. BMJ Qual Saf 20: pp. 390-396 CrossRef
- Lattimer, V, Sassi, F, George, S, Moore, M, Turnbull, J, Mullee, M, Smith, H (2000) Cost analysis of nurse telephone consultation in out of hours primary care: evidence from a randomised controlled trial. BMJ 320: pp. 1053-1057 CrossRef
- Ezra, DG, Mellington, F, Cugnoni, H, Westcott, M (2005) Reliability of ophthalmic accident and emergency referrals: a new role for the emergency nurse practitioner?. Emerg Med J 22: pp. 696-699 CrossRef
- Henderson, NC, Cookson, DT, Plumley, R, Cairns, M, Paterson-Brown, S (1999) The influence of a nurse practitioner on out of hours work intensity for surgical house officers. Scott Med J 44: pp. 52-53
- Mason, S, O'Keeffe, C, Coleman, P, Edlin, R, Nicholl, J (2007) Effectiveness of emergency care practitioners working within existing emergency service models of care. Emerg Med J 24: pp. 239-243 CrossRef
- O'Hara, R, O'Keeffe, C, Mason, S, Coster, JE, Hutchinson, A (2012) Quality and safety of care provided by emergency care practitioners. Emerg Med J 29: pp. 327-332 CrossRef
- Oakley, A, Strange, V, Bonell, C, Allen, E, Stephenson, J (2006) Process evaluation in randomised controlled trials of complex interventions. BMJ 332: pp. 413-416 CrossRef
- Dierick-van Daele, AT, Metsemakers, JF, Derckx, EW, Spreeuwenberg, C, Vrijhoef, HJ (2008) Nurse Practitioner in de huisartsenpraktijk: Onderzoeksrapport. Maastricht UMC+, Maastricht
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2296/13/75/prepub
- The effectiveness of Nurse Practitioners working at a GP cooperative: a study protocol
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
BMC Family Practice
- Online Date
- August 2012
- Online ISSN
- BioMed Central
- Additional Links
- General practitioner
- Nurse practitioner
- Out of hours care
- Author Affiliations
- 1. Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. box 9101, Nijmegen, 6500, HB, The Netherlands
- 2. Faculty of Health Sciences, University of Southampton, Southampton, UK
- 3. Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
- 4. Foundation for Development of Quality Care in General Practice, Eindhoven, The Netherlands
- 5. University of Applied Sciences, Nijmegen, The Netherlands