Skip to main content
OpenTrials
Completed

NCT Number: NCT02417181

The (Cost-)Effectiveness of Physician Assistants Working at the Primary Out of Hours Emergency Service

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.

Completed

Looking for future studies?

Notify Me

Key information

Conditions

Primary Healthcare Out-of-hours Medical Care

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Centrale Huisartsendienst Drenthe

Emmen, 7824 AA, Netherlands

About this study

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.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

Care provided by Physician Assistants

Other

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).

Primary outcomes

  1. Number of patients

    Time frame: 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.

  2. Patient characteristics (composite)

    Time frame: 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.

Secondary outcomes

  1. The number of prescriptions; number of test & investigations ordered and referral to the emergency department

    Time frame: 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.

  2. Direct healthcare costs related to care provide by PAs and GPs will be calculated.

    Time frame: 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.

  3. Adherence to the practice guidelines for General Practitioners

    Time frame: 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).

  4. Amount of adverse events and complications

    Time frame: 18 months

    The amount of adverse events and complications will be recorded, as well as complaints by the patients.

  5. Patient satisfaction questionaire

    Time frame: 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. Knowledge test concerning frequently presented complaints

    Time frame: 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).

Sponsors and collaborators

Lead sponsor

Radboud University Medical Center

Other

Collaborators

  • GP Cooperative Emmen (CHD Emmen)
  • Stichting Kwaliteit en Ontwikkeling Huisartsenzorg

Registry information

Important dates

Study start
2014
Primary completion
2016
Study completion
2016
First posted
Apr 15, 2015
Registry last updated
Apr 7, 2016

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.