The demand and the cost of care are on the rise both in the United States and globally. As people become sensitive to their health statuses, the need for care is rising, and so is the cost of the resources. The healthcare organizations are striving to come up with a sound system that can aid in caring for more patients at a low cost as a strategy to counter the rising cost and demand for healthcare. The introduction of out-of-hours primary care is a product of the effort by healthcare institutions to increase care accessibility at a low price to the population. However, the out-of-hours primary care has done less to reduce the high cost of care and its demand in healthcare sectors. As a result, Van Der Biezen, Adang, Van Der Burgt, Wensing & Laurant (2016), are suggesting a strategy that aims to replace the General Practitioners (GP) with Nurse Practitioners (NP) for out-of-hours primary care. The authors demonstrate whether substituting GPs and NPs can be an excellent strategy to reduce healthcare cost and cater to rising healthcare demand.
Description and Critique of the Research Purpose, Objective, or
Questions
The purpose of this research study is to understand whether it would be a worthy idea or action to replace General Practitioners with Nurse Practitioners in out-of-hours primary care. The authors are concerned about the productivity rate of the Nurse Practitioners and the resource they can use when they have a chance to take control of the out-of-hours primary care. The idea brings to light the best way to reduce the cost of care in out-of-primary care while serving more clients. Based on the main subject of this research study, the authors have set a clear and concise objective. The authors assert that there is a massive workload among the GPs. The GPs are also in their low numbers in the out-of-hours primary care. As a result, the GPs' productivity is low, translating to a high cost of care. The authors assert that the potential replacement of general practitioners should be Nurse practitioners because they have a high production rate in primary care. They also mention that though NPs have a potential of replacing the GPs, only a few researchers have an interest in exploring this option and widening the subject to bring it to the light. Therefore, the authors aim to evaluate whether replacing GPs with NPs can be a feasible strategy. As a result of such explorative background research, the objective set for the research study is precise, coherent to the subject, and comprehensive.
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Description and Critique of the Research Design Including
Strengths/Limitations
Generally, the authors have scored high on the research design section. The purpose of a research design is to provide a plan of study that permits accurate assessment of cause and effect relationships between independent and dependent variables (Van Manen, 2016). Also, a research design functions to ensure that the requisite data following the problem at hand is collected accurately and economically. A research design is a framework and a blueprint for the research study which guides the collection and analysis of data (Van Manen, 2016).
In the research presented by Van Der Biezen et al. ( 2016), there are numerous strengths. First, their design has depicted the subject of the research. The authors use quasi-experiment to determine whether NPs can substitute GPs. The research reveals that NPs can be cost-effective if they replace the GPs. The second strength of the design used by the authors is the use of control and experiment groups for the research study. There is a group in the NPs and GPs and another group comprising of the GPs only. The experiment group being the group consisting of NPs and GPs while the control group composed of the GPs only. By using the control and experiment groups, it implies that the authors use a design that helps them distinguish the NPs and GPs based on the variables that they set to measure or determine by the end of the research study.
The third strength is in the manner the authors have listed the variables and thoroughly explain their intent and how they contribute to the final research results. The authors set variables and list them to make the reader understand them clearly. The variable listed and linked to the research objective and results in the design section are cost, production rate, and resources. The entire design section is made further clearer by elaborating the setting. The setting elaboration is critical in this case because it enables the reader to picture the study's environment. The setting elaboration thus helps in getting a clear understanding of not only the study procedures but also the study subject. The only weakness that is apparent from this section is that there is less elaboration of the differences between the experiment and control groups.
Description and Critique of the Sampling Including Size Determination, Sampling Type, and Sampling Technique/Frame
For any scientific research study, sampling is critical in determining the target group (Van Manen, 2016). The target group is the section of the population that the authors use, that mirrors the population under the study. The strength of a research study should be the sample size. With regards to the sample size, the study in this article scores average. Van Der Biezen et al. ( 2016), use a good sample size for the patients. The patients' population for the study totals to 12,092. A total of 12,092 is a good sample because other than the total number of the patients used, the patient had no specific attributes. It means that there was an excellent demographic characteristic among the participants. However, the authors would have used more of the NPs because they were the core of the study. The research study used only five NPs who had no experience in the out-of-hours primary care. The low number of NPs served as a significant disadvantage because the target was low. The authors also overused the GPs because they totaled to 138 as compared to only five NPs that participated during the research study. Compared to the total number of NPs, the ration was very high. Random sampling is one of the best in accurately providing a non-biased sample size and sample population for a research study. For this study, the use of randomization could be said to give an accurate figure, and this contributed highly to the reliability of the final results as well as the research conclusion.
Description and critique of the data collection
During scientific research, data collection is one of the most critical sections towards getting accurate results and making a reliable conclusion. The data collection for this case was in subdivisions . The entire data collection process anchors on the variables that the study was measuring. Part of the measures were productivity, resources used, and the cost of production per hours. There was no direct questioning or interview. However, the data based on the observation and recording of the measures that were set by the authors.
The approach was necessary because the researchers were much interested in understanding some of the factors that could not be quantified, such as NPs' skills and the rate of work. Further, it was one of the most straightforward approaches because it entailed less effort other than observation and recording the results. However, it was a less structured approach to data collection. The method of data collection the authors chose to use is not elaborated clear on the research article. The authors are not clear on this matter, and it needs the reader to be keen to understand the data collection method the authors have used.
Description and critique of the data analysis plan and results
Data analysis section for any scientific research aims to interpret the crude data and sieve them to get to collect the right data to document as the results. The data analysis for this research was a combination of the content analysis, comparative analysis, and chi-square analysis. The analysis was further subdivided based on the variable that was of concern for the researchers. The resources were analyzed based on the amount used by each staff. For instance, if it was x–rays, the analysis was on the number of times it was in the study. The production per hours was analyzed based on the number of hours a Nurse practitioner or General Practitioner would use to serve a single client. The cost of production was measured depending on the salary and tariffs. There was a comparison of all these data. Besides, the research’s design had an experiment group and the control group. It also based on one group that had GPs only and another group comprising of both NPs and GPs. The analyzed results were compared to each other to come up with valid results.
The objective of the research was to evaluate the effect of substituting GPs with NPs in
Out-of-hours care on resource use, production, and health-care costs. The result thus was to be in line with these objectives. The authors scored high in this case because they have documented results based on the objective set at the beginning of the research. In any research, the researcher must document the answers, the objective, or the questions at the beginning of the research study. Proper research usually has hypothesis listed, and these hypotheses are either affirmed or disapproved at the end of the entire study.
Overall Critique of the Rigor and Validity of the Study
In general, the research study was rigorous. The data collection defines the rigor of a research study, the number of the participants, and the design of the study had follow-up research conducted for five days. The study also had more than 12000 participants, who were under different sections, to get precise results. Also, it had numerous variables to study, whose aim was getting a clear result on each variable, and how it impacts the final results. It means that the entire tidy was rigorous. The research used a Chi-square test for the analysis in addition to content and comparative analysis. Further, the result from this research study was also inline and corresponding to other numerous previous studies on the same subject. It means its validity was good.
References
Van Der Biezen, M., Adang, E., Van Der Burgt, R., Wensing, M., & Laurant, M. (2016). The impact of substituting general practitioners with nurse practitioners on resource use, production, and health-care costs during out-of-hours: a quasi-experimental study. BMC family practice , 17 (1), 132.
Van Manen, M. (2016). Phenomenology of practice: Meaning-giving methods in phenomenological research and writing . Routledge.
