Effects of care of multimorbid patients in general practices by advanced practice nurses (FAMOUS): study protocol for a nonrandomized controlled trial

BMC Health Services Research · 6 authors, 3 centres

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TL;DR

This study protocol describes a nonrandomized controlled trial to evaluate the integration of advanced practice nurses (APNs) into primary care for multimorbid patients in Germany, aiming to assess if this optimizes patient care and reduces general practitioner workload.

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This paper presents the protocol for a nonrandomized controlled trial (FAMOUS) evaluating the integration of advanced practice nurses (APNs) into primary care for multimorbid patients in Germany. The intervention group (n=817) will receive care including APN-led assessment and care plan implementation for 12 months, while the control group (n=1634) will receive standard care. A mixed-methods approach includes qualitative interviews with patients, GPs, and APNs. Internal evaluation will use standardized questionnaires and longitudinal data. Limitations include the nonrandomized, nonblinded design and the reliance on routine data for primary endpoints. The study aims to provide evidence on whether APN integration can optimize care for multimorbid patients and reduce GP workload in a real-world setting.

STUDY TYPE

other

SPECIALTY

family medicine

SUMMARISED BY

AI pipeline

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100% · A

ORIGINAL PAPER

PMC10189994

Effects of care of multimorbid patients in general practices by advanced practice nurses (FAMOUS): study protocol for a nonrandomized controlled trial

BMC Health Services Research

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ABSTRACT

Background Multimorbidity is a common phenomenon among patients treated in general practices. Key challenges within this group include functional difficulties, polypharmacy, treatment burden, fragmentation of care, reduced quality of life and increased health care utilization. These problems cannot be solved in the short consultation time of a general practitioner (GP) since there is an increasing shortage of GPs. In many countries, advanced practice nurses (APNs) are successfully integrated into primary health care for multimorbid patients. The objective of this study is to examine whether the integration of APNs in the primary care of multimorbid patients in Germany leads to optimized care of the target group and to a reduction in the workload of the GPs. Methods The intervention includes the integration of APNs into the care for multimorbid patients in general practice for twelve months. Qualifications for APNs include a master's level academic degree and 500 hours of project-specific training. Their tasks include in-depth assessment, preparation, implementation, monitoring and evaluation of a person-centred and evidence-based care plan. In this nonrandomized controlled trial, a prospective multicentre mixed methods study will be performed. The main inclusion criterion was the cooccurrence of three chronic diseases. For data collection in the intervention group ( n = 817), routine data from health insurance companies and association of statutory health insurance physicians (ASHIP) will be used, as well as qualitative interviews. In addition, the intervention will be assessed through documentation of the care process and standardized questionnaires using a longitudinal design. The control group ( n = 1634) will receive standard care. For the evaluation, routine data from health insurance companies are matched at a ratio of 1:2. Outcomes will be measured using emergency contacts and GP visits, treatment costs, health status of the patients and the satisfaction of parties involved. The statistical analyses will include Poisson regression to compare outcomes between the intervention and control groups. Descriptive and analytical statistical methods will be used in the longitudinal analysis of the intervention group data. Cost analysis will compare total costs and subgroup costs between the intervention and control groups. Qualitative data will be analysed using content analysis. Discussion Challenges to this protocol could include the political and strategic environment as well as the planned number of participants. Trial registration DRKS00026172 on DRKS.

CITATION EXPORT

Renate Stemmer, Britta Büchler, Matthias Büttner et al.. Effects of care of multimorbid patients in general practices by advanced practice nurses (FAMOUS): study protocol for a nonrandomized controlled trial. BMC Health Services Research. (2023). https://doi.org/10.1186/s12913-023-09460-1

AUTHORS

6 · 3 CENTRES

Renate Stemmer, Britta Büchler, Matthias Büttner, Christina Dera-Ströhm, Joachim Klein, Emilio Gianicolo

1grid.448681.70000 0000 9856 607XFaculty of Health Care and Nursing, Catholic University of Applied Sciences Mainz, Mainz, Germany
2grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
3grid.5326.20000 0001 1940 4177Institute of Clinical Physiology, National Research Council, Lecce, Italy