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Nurse practitioner in General Practice: The Expedition

Nurse practitioner in General Practice: The Expedition. A .T. M. Dierick- van Daele, J.F.M. Metsemakers, E.W.C.C. Derckx, C. Spreeuwenberg, H.J.M. Vrijhoef 14 May Copenhagen. Project Nurse Practitioner in General Practice (NPGP). Background Increasing and changing demand of care

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Nurse practitioner in General Practice: The Expedition

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  1. Nurse practitioner in General Practice:The Expedition A .T. M. Dierick- van Daele, J.F.M. Metsemakers, E.W.C.C. Derckx, C. Spreeuwenberg, H.J.M. Vrijhoef 14 May Copenhagen

  2. Project Nurse Practitioner in General Practice (NPGP) Background • Increasing and changing demand of care • Need to increasing service capacity • Shortness of physicians Literature review • NP: high quality of care/ higher patient satisfaction • NP: limited evidence for cost effectiveness

  3. Definition nurse practitioner (NP) • registered nurses • additional education and training - i.e. Master in Advanced Nursing Practice • expanded scope of practice • working in specific settings

  4. 1. Patient care diagnosing, prescribing, and treating medical conditions of patients with common complaints 2. Collaboration coordination of care, professional collaboration 3. Quality of the care projects and research, evidence based practice, education Training program

  5. Specified set of common complaints • respiratory and throat complaints • ear and nose complaints • musculoskeletal complaints and skin injuries • urological complaints • gynaecological complaints • sexual transmitted diseases • geriatric problems

  6. Objective • To evaluate effects on the process and outcomes of care as provided by GPs or specially trained NPs for patients at first point of contact.

  7. Research method

  8. Randomised controlled trial Patients: > 16 years, common complaints, initial consultation Within NPGP-project: Intervention group: NP consultation Reference group : GP consultation Outside NPGP-project: External reference group: GP consultation (costs only) • Patients: • common complaints • > 16 years old • initial consultation

  9. Participants • 15 general practices within the NPGP project: • Twelve NPs • Twelve lectured GPs • 31 GPs Five external reference practices outside the NPGP project - 17 GPs • Region: Southern of The Netherlands

  10. Outcome and data collection Quality of the care: • Patient perceptions Questionnaires (T1, T2) • Effectiveness of the consultation Questionnaires (T0, T2) • Compliance practice guidelines Data-extraction Costs: • Medical consumption Data-extraction • Follow up consultation Questionnaire (T2) • Time of duration Stopwatch • Presence of illness Questionnaire (T2)

  11. Calculation of costs Direct costs within health care sector: • Medical consumption • Follow up consultation • Time of duration • Salary costs Costs outside the health care sector: • Productivity costs

  12. Analyses • Descriptive statistics • Two tailed T-test, Chi-squared test, ANOVA • Bootstrapping • Sensitivity analysis, subgroup analysis, linear regression and mixed model analysis

  13. Results

  14. Flowchart

  15. Patient characteristics

  16. NP consultations versus GP consultations (NPGP practices) No significant differences in: • Patient perspections (Likert scale 0-10: mean 8.2 both groups) • Effect of the treatment, compliance practice guidelines, medical consumption, presence of illness Significant differences in: • Advice follow up consultation (NP 50%; GP 41%) • Follow up consultation (NP 23.5%; GP 18.5%) • Time of duration (NP 12.2 min; GP 9.2 min)

  17. *kosten gebaseerd op recepten, aanvullend diagnostisch onderzoek, verwijzingen, vervolgconsulten, duur van het consult, salaris-en opleidingskosten **inclusief productiviteitskosten Costs per consultation within NPGP practices

  18. *kosten gebaseerd op recepten, aanvullend diagnostisch onderzoek, verwijzingen, vervolgconsulten, duur van het consult, salaris-en opleidingskosten **inclusief productiviteitskosten Costs per consultations: NPGP practices vs reference practices

  19. Costs including productivity costs (patients <65 years old) • NP consultations vs GP consultations: within NPGP practices: • NP consultations € 9.18 cheaper (P<0.001) • Consultations within NPGP practices vs consultations ext. reference practices: • Consultations within NPGP practices € 2.60 cheaper (P 0.13)

  20. Conclusion NPs provide equivalent quality of care than GP by a specified set of common complaints NPs are likely to generate less costs than GPs NPs contribute to the accessibility and availability of primary care NP could also lead to GPs having more time for patients with chronic diseases or multi morbidity

  21. Reconsiderations • Elements of a HTA -study • Meaning of cost differences • Exploration of factors influencing costs • Attention for implementation

  22. Take care Thank you for your attention…

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