Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein 21, 6525 Nijmegen, EZ, the Netherlands.
Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein 21, 6525 Nijmegen, EZ, the Netherlands; HAN University of Applied Sciences, Faculty of Health and Social Studies, Kapittelweg 33, 6525 Nijmegen, EN, the Netherlands.
Int J Nurs Stud. 2020 Apr;104:103445. doi: 10.1016/j.ijnurstu.2019.103445. Epub 2019 Sep 28.
General practitioners experience a high workload during out-of-hours care. A possible solution is the shifting of care to nurse practitioners.
To provide insight into patient- and care characteristics, safety, efficiency, and patient satisfaction of substituting general practitioners with nurse practitioners for home visits by out-of-hours primary care services.
Quasi-experimental non-randomised study comparing home visits by nurse practitioners (intervention group; one out-of-hours care service) with home visits by general practitioners (control group; two out-of-hours care services) for 24 protocolised health problems.
Three out-of-hours primary care services in the East of the Netherlands.
1601 patients who received a home visit by a nurse practitioner (N = 386) or a general practitioner (N = 1215). Of these patients, 639 gave informed consent to be included in the protocol adherence assessment and follow-up record review (nurse practitioner: N = 358; general practitioner: N = 281).
Five nurse practitioners with experience in ambulance care were recruited and trained. From September 2016 to March 2017 the nurse practitioners took over home visits under supervision of a general practitioners. This was evaluated using: (1) data-extraction from the patient registration system, (2) follow-up record review in the patients' general practices, and (3) patient satisfaction survey. Two general practitioners independently assessed protocol adherence based on the extracted registration data.
Nurse practitioners prescribed medication significantly less often than general practitioners (19.9% versus 30.6%), and referred patients significantly more often to the hospital (24.1% versus 15.9%). The mean length of the home visit was significantly longer for nurse practitioners (34.1 versus 21.1 min). Nurse practitioners adhered to the protocol significantly more often than general practitioners (84.9% versus 76.2%) and their medication prescribing was significantly more often appropriate (93.7% versus 79.5%). There were no differences in the number of missed diagnoses and complications. The number of follow-up contacts was also similar in both groups. Patient satisfaction was generally high and significantly higher for nurse practitioners on several items.
Nurse practitioners with experience in ambulance care can safely, efficiently, and satisfactorily perform low complex out-of-hours primary care home visits. It is recommended to study the safety and efficiency of nurse practitioners' home visits in other regions and with nurse practitioners with different educational levels and different specialisations. In addition, we recommend to evaluate the cost-effectiveness and if it leads increased quality of care.
全科医生在非工作时间的护理工作中承担着较高的工作量。一种可能的解决方案是将护理工作转移给护士从业者。
深入了解替代非工作时间初级保健服务的家庭访问的全科医生，由护士从业者进行家庭访问，以了解患者和护理特点、安全性、效率和患者满意度。
比较护士从业者（干预组；一个非工作时间的初级保健服务）和全科医生（对照组；两个非工作时间的初级保健服务）进行的 24 项协议健康问题的家庭访问的准实验非随机研究。
荷兰东部的三个非工作时间的初级保健服务。
接受护士从业者（N=386）或全科医生（N=1215）家庭访问的 1601 名患者。其中，639 名患者同意在协议依从性评估和随访记录审查中被纳入（护士从业者：N=358；全科医生：N=281）。
招募并培训了 5 名具有救护经验的护士从业者。从 2016 年 9 月到 2017 年 3 月，护士从业者在全科医生的监督下接管了家庭访问。这是通过以下方式进行评估的：（1）从患者登记系统中提取数据，（2）在患者的常规实践中进行随访记录审查，以及（3）患者满意度调查。两名全科医生根据提取的登记数据独立评估协议依从性。
护士从业者开具药物的频率明显低于全科医生（19.9%对 30.6%），并将患者转诊到医院的频率明显更高（24.1%对 15.9%）。护士从业者的家访平均时间明显更长（34.1 对 21.1 分钟）。护士从业者遵守协议的频率明显高于全科医生（84.9%对 76.2%），他们的药物处方明显更合适（93.7%对 79.5%）。在漏诊和并发症的数量上没有差异。两组的随访次数也相似。患者满意度普遍较高，对护士从业者的几个项目满意度明显更高。
具有救护经验的护士从业者可以安全、高效、满意地进行低复杂度的非工作时间初级保健家庭访问。建议在其他地区和具有不同教育水平和不同专业的护士从业者中研究护士从业者家庭访问的安全性和效率。此外，我们建议评估成本效益，如果它能提高护理质量。
