Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P,O, box 9101, Nijmegen 6500, HB, The Netherlands.
BMC Fam Pract. 2012 Aug 7;13:75. doi: 10.1186/1471-2296-13-75.
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.
在许多国家，非工作时间的医疗保健面临着严峻的挑战，包括全科医生短缺、工作量大、工作时间外工作动力降低以及对非工作时间医疗保健的需求增加。应对这些挑战的一种方法是引入护士从业者作为医生的替代者，以保持（高）非工作时间医疗保健的可及性和安全性。尽管护士从业者已被证明在白天的初级保健中提供同样安全和高效的护理，但在更复杂的非工作时间初级保健中，替代是否有效和高效尚不清楚。本研究旨在评估在非工作时间初级保健环境中，将护理从全科医生替代为护士从业者的效果。
在一家“全科医生合作社”进行准实验研究，为荷兰东南部的 304000 人提供非工作时间的医疗保健。在实验条件下，由一名护士从业者和四名全科医生组成的团队提供患者护理；其中，护士从业者在周末的一天（上午 10 点至下午 5 点）代替一名全科医生。在对照条件下，由五名全科医生组成的团队在周末的另一天（上午 10 点至下午 5 点）提供患者护理。研究期为 15 个月，从 2011 年 4 月至 2012 年 7 月。
将使用一系列方法收集关于多种不同结果的数据。我们的主要结果是护理替代。这是通过在 GP 合作社就诊的患者数量和特征来计算的。我们将在实验条件和对照条件下比较两名专业人员接诊的患者数量、投诉类型、资源利用情况（如处方、检查、调查、转诊）和等待时间。这些数据来自患者的电子病历。次要结果是：患者满意度；全科医生工作量；护理质量和安全性；以及障碍和促进因素。
该研究将提供证据，证明非工作时间护理替代是否安全有效，并深入了解在非工作时间环境中引入护士从业者的相关障碍和促进因素。
ClinicalTrials.gov ID NCT01388374。
