Improving collaboration between doctors and nurse practitioners to better care for patients with multiple health conditions in primary care
| ISRCTN | ISRCTN49264729 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN49264729 |
| Secondary identifying numbers | RESPIR-23-020 |
- Submission date
- 03/08/2025
- Registration date
- 26/08/2025
- Last edited
- 04/08/2025
- Recruitment status
- Not yet recruiting
- Overall study status
- Ongoing
- Condition category
- Other
Plain English summary of protocol
Background and study aims
People living with multiple chronic illnesses (multimorbidity) often need complex, coordinated care. In France, the Nurse Practitioner (NP) role is being developed to support General Practitioners (GPs) in providing better care to these patients. However, collaboration between GPs and NPs is still new, and there is a need to understand how they can work together effectively.
This study aims to explore and improve collaboration between GPs and NPs in the care of multimorbid patients. It will lead to evidence-based recommendations for building coordinated, interprofessional care pathways.
Who can participate?
The study will involve 20 pairs (dyads) of GPs and NPs already working together in primary care. These participants must be involved in the care of patients with at least two chronic conditions and/or taking five or more medications. They will be recruited from 10 Primary Care Teams (CPTS) in the Île-de-France region.
In the second phase, 20 expert GPs and 20 expert NPs from across France will be invited to take part in the expert consensus panel.
What does the study involve?
The study has four main steps:
1. Literature review on GP-NP collaboration
2. Document analysis of how GP/NP pairs organise their care
3. Qualitative research using:
3.1. Focus groups, where GPs and NPs will discuss barriers and enablers to collaboration
3.2. Quality circles, where GP/NP pairs will reflect on real clinical cases from their practice
4. Formal consensus process (Delphi method) with national experts to agree on key recommendations
What are the possible benefits and risks of participating?
Participants may benefit from reflecting on their own practice, sharing insights with peers, and contributing to the improvement of primary care in France. There are no major risks expected. Discussions will focus on professional practices and remain anonymous in publications. Participants can withdraw at any time without giving a reason.
Where is the study run from?
Société Française de Médecine Générale (SFMG) (France)
When is the study starting and how long is it expected to run for?
January 2025 to July 2027
Who is funding the study?
The study is funded by the French Ministry of Health, through the Direction Générale de l’Offre de Soins (DGOS), as part of a grant awarded via the RESPIR (Regional Support for Research in Primary Care) for proposals managed by the GIRCI Île-de-France (Interregional Clinical Research and Innovation Group).
Who is the main contact?
Julien Le Breton, julien.lebreton@u-pec.fr
Contact information
Public, Scientific, Principal Investigator
Société Française de Médecine Générale (SFMG)
141, avenue de Verdun
Issy-les-Moulineaux
92040
France
 ORCID ID |
0000-0002-7531-1132 |
|---|---|
| Phone | +33 (0)6 64 00 91 07 |
| julien.lebreton@u-pec.fr |
Study information
| Study design | Multicenter observational mixed-methods longitudinal study using qualitative data, documentary analysis, and a Delphi consensus process |
|---|---|
| Primary study design | Observational |
| Secondary study design | Mixed-methods study using qualitative data, documentary analysis, and a Delphi consensus process |
| Study setting(s) | GP practice |
| Study type | Other |
| Scientific title | Interprofessional collaboration between General Practitioners and Nurse Practitioners for the care of multimorbid patients in primary care |
| Study acronym | CIMPA |
| Study objectives | Primary Objective: To develop expert-based recommendations for interprofessional collaboration between general practitioners (GPs) and nurse practitioners (NPs) in the care of multimorbid patients in primary care. These recommendations will aim to: 1. Identify the most frequent clinical situations requiring GP–NP collaboration 2. Define shared goals such as person-centered care and diversification of care 3. Clarify the roles and contributions of each professional (e.g., role definition, teamwork, complementarity, subsidiarity) 4. Address barriers and facilitators to collaboration (e.g., conflict prevention, collaborative attitudes) 5. Outline effective methods of interaction (e.g., co-construction of care, shared decision-making, communication, collaborative leadership) Secondary Objectives: 1. To identify the characteristics of care pathways for multimorbid patients in primary care, especially in situations where collaboration is most needed 2. To explore the barriers and facilitators of interprofessional collaboration between GPs and NPs, including organizational, communicational, and sociocultural dimensions 3. To understand the needs and expectations of patients with multimorbidity and how they influence GP–NP collaboration |
| Ethics approval(s) |
Approved 07/04/2025, Comité Ethique du CNGE (155 rue de Charonne, Paris, 75011, France; +33 (0)1 75 62 22 90; comite-ethique@cnge.Fr), ref: 745 |
| Health condition(s) or problem(s) studied | Multimorbidity, polypharmacy and frailty |
| Intervention | The study has four main steps: 1. Literature review on GP-NP collaboration 2. Document analysis of how GP/NP pairs organise their care 3. Qualitative research using: 3.1. Focus groups, where GPs and NPs will discuss barriers and enablers to collaboration 3.2. Quality circles, where GP/NP pairs will reflect on real clinical cases from their practice 4. Formal consensus process (Delphi method) with national experts to agree on key recommendations |
| Intervention type | Other |
| Primary outcome measure | Level of consensus among experts, assessed through an iterative rating process with feedback, to identify and select points of convergence forming the basis of recommendations, as well as points of divergence or uncertainty, thereby assisting stakeholders (Nurse Practitioners and General Practitioners) in defining the care pathway. All outcome measures will be synthesized and assessed collectively at a single final timepoint, prior to and during the expert consensus phase. |
| Secondary outcome measures | 1. Patients’ needs and demands according to clinical situations and their impact on interprofessional collaboration between General Practitioners (GPs) and Nurse Practitioners (NPs): To identify patients’ needs and demands, clinical and care data associated with the most frequent pathologies in multimorbid patients in primary care will be collected and analyzed 2. Barriers and facilitators to interprofessional collaboration between GPs and NPs: To identify barriers and facilitators, the areas of interest will include professional organization, communication between professionals, collaboration and professional boundaries, patient pathologies and behaviors, as well as social and societal factors All outcome measures will be synthesized and assessed collectively at a single final timepoint, prior to and during the expert consensus phase |
| Overall study start date | 15/01/2025 |
| Completion date | 01/07/2027 |
Eligibility
| Participant type(s) | Health professional |
|---|---|
| Age group | Adult |
| Lower age limit | 25 Years |
| Upper age limit | 75 Years |
| Sex | Both |
| Target number of participants | 80 |
| Key inclusion criteria | GP/NP dyads involved in the management of: 1. Patients with multimorbidity (≥2 chronic conditions) and/or 2. Patients with polypharmacy (≥5 medications) General Practitioners (GPs): 1. Practicing in private settings (solo or group practices, multidisciplinary health centers) or salaried positions (community health centers) 2. Working under the standard public sector contract (sector 1) 3. Without any particular alternative practice arrangement 4. Operating within Primary Care Teams (CPTS – see list of investigator centers) 5. Having provided informed consent to participate Nurse Practitioners (NPs): 1. Practicing in private settings (solo or group nursing practices, multidisciplinary health centers) or salaried positions (community health centers) 2. Operating within Primary Care Teams (CPTS – see list of investigator centers) 3. Having provided informed consent to participate |
| Key exclusion criteria | GP/NP dyads including: 1. General Practitioners (GPs) practicing under Sector 2 contracts (with fees exceeding standard public rates) 2. GPs with alternative or non-standard modes of practice (e.g., concierge medicine, exclusive telemedicine practice, or any model outside conventional primary care organization) |
| Date of first enrolment | 01/10/2025 |
| Date of final enrolment | 01/06/2026 |
Locations
Countries of recruitment
- France
Study participating centres
93120
France
94240
France
94370
France
94100
France
77920
France
91860
France
77120
France
78130
France
78200
France
78180
France
Sponsor information
Research organisation
141 avenue de Verdun
Issy-les-Moulineaux
92040
France
| Phone | +33 (0)1 41 90 98 20 |
|---|---|
| sfmg@sfmg.org | |
| Website | https://www.sfmg.fr |
Funders
Funder type
Government
Government organisation / National government
- Alternative name(s)
- DGOS
- Location
- France
Results and Publications
| Intention to publish date | 01/07/2027 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Available on request |
| Publication and dissemination plan | 1. Publications: 1.1. Prepare and submit a main manuscript detailing the study methodology, results, and conclusions to a peer-reviewed journal, preferably open access. 1.2. Publish additional articles focused on specific aspects or secondary analyses, if applicable. Always reference the ISRCTN registration number in publications for transparency. 2. Conferences: 2.1. Present study findings as oral presentations or posters at relevant national and international conferences related to medical imaging and healthcare. 2.2. Participate in symposia and workshops targeting healthcare professionals involved in the field. 3. Training Institutions for Healthcare Professionals: 3.1. Share results and insights through seminars, workshops, and continuing education sessions at healthcare training institutions. 3.2. Collaborate with medical schools and professional training centers to incorporate study findings into their curricula or professional development programs. |
| IPD sharing plan | The datasets generated and/or analysed during the current study will be made available upon reasonable request from the coordinating institution. Contact person: Julien Le Breton, Study Coordinator Société Française de Médecine Générale (SFMG) j.le.breton.com@gmail.com Type of data that will be shared: Anonymised individual participant data (IPD) including qualitative transcripts (focus groups, quality circles), coded interview data, and metadata from document analysis. When the data will become available: Within 6 months after publication of the main study results. For how long the data will be available: For a period of 2 years after publication. Access criteria: Data will be shared with qualified researchers affiliated with academic or healthcare institutions, upon submission and approval of a data access request outlining the proposed secondary analysis. Mechanism for data access: Requests should be submitted by email to the study contact. A data-sharing agreement (DSA) will be required to ensure data use complies with ethical, legal, and confidentiality obligations. Consent and anonymisation: No individual patient data is collected directly. The data concern healthcare professionals, and all identifiable information will be fully anonymised before sharing. Participants have been informed of potential secondary data use during the consent process. Ethical or legal restrictions: Data sharing is subject to compliance with GDPR and French data protection laws. Any qualitative data will be reviewed to ensure full de-identification prior to release. Additional comments: The data will not be deposited in a public repository due to confidentiality considerations, but access can be granted on a case-by-case basis through controlled procedures. |
Editorial Notes
04/08/2025: Study's existence confirmed by the Comité Ethique du CNGE.
