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