Effect of Strategies to Improve General Practitioner-nurse Collaboration and Communication

University Medical Center Goettingen680 enrolled

Overview

Previously,six measures were developed for a better collaboration of general practitioners and nurses in nursing homes in a qualitative multistep bottom-up process. These measures, summarised as the interprof ACT intervention, shall improve the flow of information and the communication between the involved parties and lead to more transparency and effectiveness regarding treatment decisions of nursing home residents.The major aim of this trial is to examine the clinical effectiveness of interprof ACT. The main hypothesis is that implementation of interprof ACT reduces the cumulative incidence of hospitalisations of nursing home residents within 12 months from 50% to 35% (15% absolute reduction).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

680

Conditions

Utilization of Medical Care by Nursing Home Residents

Interventions

Definition of common goals between general practitioner and nursing staff, appointment of a contact person, support in assigning medication, use of name badges worn by GPs and nurses during visits, mandatory availability of contact person, standardized procedures for GPs home visits

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria Residents: * at least one GP visit in recent three months or * two GP visits in recent 6 months or * admission to the nursing home during the precedent 6 months independently of documented GP contacts * at least 18 years of age * written informed consent by the resident or her/his legal guardian Inclusion Criteria Nursing Homes: * minimum size of 40 residents * written consent provided by the nursing home Manager Prior to randomisation Exclusion Criteria Residents: \- admission for short term care only Exclusion Criteria Nursing Homes: \- participation in other projects on interprofessional collaboration.

Locations (4)

Department of General Practice, University Medical Center Göttingen

Göttingen, Germany

Organization and Corporate Development, Georg August University Göttingen

Göttingen, Germany

Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf

Hamburg, Germany

Institute for Social Medicine and Epidemiology, Nursing Research Group,University of Lübeck

Lübeck, Germany

Outcomes

Primary Outcomes

cumulative number of hospitalisation

Cumulative incidence of hospitalisations from nursing home residents within 12 months

Time frame: within 12 months

Secondary Outcomes

absolute number of hospitalisations

number of hospitalisations within 12 months

Time frame: within 12 months

hospital days

Hospital days within 12 months

Time frame: within 12 months

mortality

mortality within 12 months

Time frame: within 12 months

potentially inadequate medications

potentially inadequate medications at baseline and for follow-ups at 6 and 12 months

Time frame: baseline and after 6 and 12 months

Adverse Events

Adverse Events within 12 months

Time frame: within 12 months

Quality of Life in Alzheimer's Disease scale - Nursing Home version (QoL-AD-NH)

Residents' quality of life at baseline and at 12 months. Scale range is 15 - 60, with higher scores indicating higher QoL.

Time frame: baseline and after 12 months

Health-related Quality of Life (HRQL) of residents measured by EQ-5D-5L

The EQ-5D-5L consist of two self-rating components: the EQ-5D descriptive system and a visual analogue scale (EQ VAS). The EQ-5D descriptive system measures HRQL on the five dimensions "mobility", "self-care", "usual activities", "pain / discomfort" and "anxiety / depression". On each dimension participants can rate either "no problems" (0), "slight problems" (1), "moderate problems" (2), "severe problems" (3) or "extreme problems" (4), resulting in a score ranging from 0 (best) to 4 (worst). The scores of the single dimensions can be combined to a sum score ranging from 0 (best) to 20 (worst). In addition, so called "utility weights" can be attached to any possible combination of answers on the EQ-5D descriptive system which results in a utility score ranging from 0 (death) to 1 (full HRQL), which is then used to calculate quality-adjusted life years (QALYs). The EQ VAS ranges from 0 (worst imaginable health state) to 100 (best imaginable health state).

Time frame: baseline and after 12 months

medical services

use of other medical services within 12 months

Time frame: within 12 months

economic evaluation: efficiency

economic evaluation: efficiency (incremental cost-effectiveness ratio) and cost savings from payer and societal perspective

Time frame: after 12 months

Quality of inter-professional collaboration according to the Partnership Self-Assessment Tool (PSAT) score

Higher score values indicating better collaboration.

Time frame: after 12 months

Attitudes towards inter-professional collaboration according to the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSAPNC) score

Higher score values indicating more favourable attitudes.

Time frame: after 12 months