چکیده (انگلیسی):

Background:The pressure in out-of-hours primary care is high due to an increasing demand for care and rising
health-care costs. During the daytime, substituting general practitioners (GPs) with nurse practitioners (NPs) shows
positive results to contribute to these challenges. However, there is a lack of knowledge about the impact during
out-of-hours. The current study aims to provide an insight into the impact of substitution on resource use,
production and direct health-care costs during out-of-hours.
Methods:At a general practitioner cooperative (GPC) in the south-east of the Netherlands, experimental teams
with four GPs and one NP were compared with control teams with five GPs. In a secondary analysis, GP care versus
NP care was also examined. During a 15-month period all patients visiting the GPC on weekend days were
included. The primary outcome was resource use including X-rays, drug prescriptions and referrals to the
Emergency Department (ED). We used logistic regression to adjust for potential confounders. Secondary outcomes
were production per hour and direct health-care costs using a cost-minimization analysis.
Results:We analysed 6,040 patients in the experimental team (NPs: 987, GPs: 5,053) and 6,052 patients in the
control team. There were no significant differences in outcomes between the teams. In the secondary analysis, in
the experimental team NP care was associated with fewer drug prescriptions (NPs 37.1 %, GPs 43 %,p< .001) and
fewer referrals to the ED (NPs 5.1 %, GPs 11.3 %, p= .001) than GP care. The mean production per hour was 3.0
consultations for GPs and 2.4 consultations for NPs (p< .001). The cost of a consultation with an NP was€3.34 less
than a consultation with a GP (p= .02).
Conclusions:These results indicated no overall differences between the teams. Nonetheless, a comparison of type
of provider showed that NP care resulted in lower resource use and cost savings than GP care.
To find the optimal balance between GPs and NPs in out-of-hours primary care, more research is needed on the
impact of increasing the ratio of NPs in a team with GPs on resource use and health-care costs.
Trial registration:ClinicalTrials.gov ID NCT01388374.