Transforming GP practices into multiprofessional primary care centers: The role of nursing professionals (PRIMA) – study protocol for a multicenter non-randomized, controlled, parallel-group intervention study
- 1Department of Health Economics, Technical University of Munich, Munich, Germany
- 2Institute of General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
- 3Institute for Health and Social Research Berlin, Germany
Abstract
Background: Germany faces increasing challenges in primary care due to demographic change, workforce shortages, and the growing prevalence of chronic conditions. Integrating nursing professionals into primary care teams may improve continuity, comprehensiveness, and efficiency of care, but evidence for the German setting remains limited. The PRIMA project (DRKS00039104) implements a new care model that transforms general practices into multiprofessional primary care centers integrating specially trained nursing professionals. The objective is a productivity- and quality-oriented reorganization of care for patients with chronic diseases. The intervention targets patients with high-risk chronic diseases. Core elements include extended nursing services, subsidiary task allocation within the practice team, structured organizational development, and optional use of a medical triage software. Methods: Effectiveness and health-economic outcomes are evaluated in a prospective, quasi-experimental, controlled study under real-world conditions. The intervention group includes patients from 20 participating practices; the control group is matched using routine claims data. The primary endpoint is the number of ambulatory care–sensitive emergency cases after 12 months, analyzed intention-to-treat. Secondary outcomes include healthcare utilization, mortality, continuity, and coordination of care. Statistical analyses will account for confounding and clustering at practice and patient level. The health economic evaluation will estimate incremental cost-effectiveness ratios based on ambulatory and total healthcare costs. A parallel process evaluation uses longitudinal mixed-methods. It comprises interviews, activity logs and focus groups, and surveys among patients, their relatives, practice teams and collaborators. Key aspects assessed include implementation facilitators and barriers, organizational development and interprofessional collaboration, nurse role development, and patient quality of life and treatment satisfaction. Discussion: Findings are highly relevant for strengthening primary care in Germany and internationally, where multidisciplinary primary care centers are increasingly promoted. If successful, the intervention could reduce emergencies and improve patient outcomes, serving as a scalable model and informing policy and reimbursement strategies.
Related
- The cardiac intervention imaging clinical trial of an intracardiac ultrasound catheter and ultrasound system: the multicenter, randomized, INTELICE trial protocol.
- A mechanism-oriented immersive virtual reality intervention for psychological distress and helplessness-related processes in hospitalized older adults: study protocol for a multicenter randomized controlled trial
- Digital training to support delivery of an evidence-based cardiac rehabilitation programme for heart failure: a mixed-methods evaluation of healthcare professionals' training experiences and intervention fidelity.
- Transforming diet in the workplace: effectiveness of a stage of change–based dietary intervention for sedentary office workers in Southern Sri Lanka – a cluster randomised trial
- A Personalized Recovery Intervention to Support Sleep Health in Emergency Healthcare Professionals
BibTeX
@article{naß2026transforming,
title = {{Transforming GP practices into multiprofessional primary care centers: The role of nursing professionals (PRIMA) – study protocol for a multicenter non-randomized, controlled, parallel-group intervention study}},
author = {Philipp Naß and Wiebke Schüttig and Amelie Flothow and Marie Coors and Leonie Sundmacher and Regina Stolz and Anika Klein and Stefanie Joos and Iris an der Heiden and Ann-Kathrin Jöchner and Hans-Dieter Nolting and Hannah Haumann and on behalf of the PRIMA Study Group},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0357117},
url = {https://doi.org/10.1371/journal.pone.0357117},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Transforming GP practices into multiprofessional primary care centers: The role of nursing professionals (PRIMA) – study protocol for a multicenter non-randomized, controlled, parallel-group intervention study
AU - Philipp Naß
AU - Wiebke Schüttig
AU - Amelie Flothow
AU - Marie Coors
AU - Leonie Sundmacher
AU - Regina Stolz
AU - Anika Klein
AU - Stefanie Joos
AU - Iris an der Heiden
AU - Ann-Kathrin Jöchner
AU - Hans-Dieter Nolting
AU - Hannah Haumann
AU - on behalf of the PRIMA Study Group
PY - 2026
DA - 2026/09/09
JO - PLOS One
DO - 10.1371/journal.pone.0357117
UR - https://doi.org/10.1371/journal.pone.0357117
AB - Background: Germany faces increasing challenges in primary care due to demographic change, workforce shortages, and the growing prevalence of chronic conditions. Integrating nursing professionals into primary care teams may improve continuity, comprehensiveness, and efficiency of care, but evidence for the German setting remains limited. The PRIMA project (DRKS00039104) implements a new care model that transforms general practices into multiprofessional primary care centers integrating specially trained nursing professionals. The objective is a productivity- and quality-oriented reorganization of care for patients with chronic diseases. The intervention targets patients with high-risk chronic diseases. Core elements include extended nursing services, subsidiary task allocation within the practice team, structured organizational development, and optional use of a medical triage software. Methods: Effectiveness and health-economic outcomes are evaluated in a prospective, quasi-experimental, controlled study under real-world conditions. The intervention group includes patients from 20 participating practices; the control group is matched using routine claims data. The primary endpoint is the number of ambulatory care–sensitive emergency cases after 12 months, analyzed intention-to-treat. Secondary outcomes include healthcare utilization, mortality, continuity, and coordination of care. Statistical analyses will account for confounding and clustering at practice and patient level. The health economic evaluation will estimate incremental cost-effectiveness ratios based on ambulatory and total healthcare costs. A parallel process evaluation uses longitudinal mixed-methods. It comprises interviews, activity logs and focus groups, and surveys among patients, their relatives, practice teams and collaborators. Key aspects assessed include implementation facilitators and barriers, organizational development and interprofessional collaboration, nurse role development, and patient quality of life and treatment satisfaction. Discussion: Findings are highly relevant for strengthening primary care in Germany and internationally, where multidisciplinary primary care centers are increasingly promoted. If successful, the intervention could reduce emergencies and improve patient outcomes, serving as a scalable model and informing policy and reimbursement strategies.
SN - 1932-6203
ER -