None listed
Conditions
Brief summary
Residential aged care facilities (RACF) have difficulty accessing timely primary care for their residents. A solution within RACFs is to employ Nurse Practitioners (NPs) to supplement GP services. Evidence suggests that NP models within RACFs positively impact resident well-being. The current research evaluates impact, acceptability, and feasibility outcomes for 5 RACFs where an NP model of care is active. The impact of the NP program is evaluated by comparing resident health outcomes (e.g. hospitalisations, polypharmacy, falls) routinely collected for the 5 intervention RACFs against 5 matched control sites without an NP program, for 12 months prior to and during the intervention. A sample of staff, residents, NPs, and GPs will also participate in qualitative interviews assessing acceptability of the program. It is expected that resident outcomes will be improved for the NP sites during the program relative to prior and compared to control.
Interventions
A pilot Nurse Practitioner (NP) Program is being evaluated at Residential Aged Care Facilities (RACFs) in the Hunter New England Local Health District. This program is designed to supplement the primary health care provided by General Practitioners (GPs) in RACFs as a means of providing more efficient access to services as they are needed by RACF residents.
In this pilot intervention, NPs with collaborative GP agreements are to routinely visit 5 RACF sites. Services provided by the NPs fall wit
A pilot Nurse Practitioner (NP) Program is being evaluated at Residential Aged Care Facilities (RACFs) in the Hunter New England Local Health District. This program is designed to supplement the primary health care provided by General Practitioners (GPs) in RACFs as a means of providing more efficient access to services as they are needed by RACF residents. In this pilot intervention, NPs with collaborative GP agreements are to routinely visit 5 RACF sites. Services provided by the NPs fall within their usual scope of care, with the intervention assessing the feasibility and acceptability of these services being delivered in an RACF context. This means that the NPs do not require any additional training and will not be providing any 'new' service, but rather that the service will be newly implemented in this setting. RACFs in the intervention group will have access to the NP service. NPs seek a collaborative agreement from GPs of residents within these RACFs. This allows the NP to work collaboratively with the GP to provide primary care services. NPs are eligible to bill the Medicare Benefits Schedule for a range of services, and there are no costs incurred by residents. NPs will attend each intervention RACF 0.5-2 days a week (depending on number of residents) and be available to provide services for residents whose doctors have signed the agreement. Services will vary based on residents’ needs but may include advance care planning, wound management, chronic disease care, medication management, and referral. NPs will provide care as required to the residents, meaning that individual care sessions will typically range from 20 minutes to 1 hour, but will be dependent on the varying needs of each resident over time. The service is aimed at increasing timely access to primary care within the residential aged care setting. The NP program will run for 12 months at each intervention facility. The NPs will log their patient care files and details of their sessions with residents in the facility resident files. These files will be used to monitor uptake and adherence to the program.
Sponsors
University of Newcastle
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Residential Aged Care Facilities (RACFs): To be included in the study RACFs will be located in the Greater Hunter Region, receive the Aged Care Emergency Program, and be willing to participate in the intervention (if an intervention site). Aged Care Residents (intervention and control sites) Residential Aged Care Participants will be aged 65 years and older, however, it is expected that most will be aged 85 years or older. These participants will contribute via access to routinely collected data held within their aged care files. Inclusion criteria: All residents living at a participating facility will be eligible to receive NP services if their GP signs a collaborative agreement and for data inclusion sourced from HNELHD Residential Aged Care Facility (RACF) Registered Nurse (RN) staff Registered nurses from intervention sites will be invited to participate in semi-structured interviews to contribute to the evaluation of the acceptability of the NP service. Inclusion criteria: RACF staff will be eligible if they have been employed at a participating intervention site during the trial period and are employed as a Registered Nurse. General Practitioners GPs who have patients that reside at an RACF intervention site will be invited to participate in a online/phone survey and/or an interview to contribute to the evaluation of the acceptability of the NP service. Inclusion criteria: GPs who have patients who reside at participating intervention RACFs and who have collaborative agreements with the NPs involved in the program will be eligible to participate. Nurse Practitioners The Nurse Practitioners involved in the implementation will be invited to participate in a qualitative interview to contribute to the evaluation of NP service implementation. Inclusion criteria: Nurse practitioners who are involved in delivery of the intervention will be eligible to participate
Exclusion criteria
Aged Care Residents: Residents who are considered too unwell by RACF staff or who are unable to provide independent consent for the interview will be excluded following the Capacity to Consent process which clarifies that the participant understands what the research involves and is aware of what they are consenting to before consent is sought. This is completed using a structured Capacity to Consent form which asks the resident a number of specific questions about what the research will involve and checks for accuracy of understanding. Residential Aged Care Facility (RACF) Registered Nurse (RN) staff : RACF staff who were employed at a participating intervention site but are not employed as Registered Nurses will be excluded from participation. General Practitioners: GPs who have patients who reside at participating intervention RACFs but do not have collaborative agreements with NPs involved in the program will be excluded from participation.
Outcome results
None listed