FAMOUS

FAMOUS is short for "Fallbezogene Versorgung multimorbider Patienten und Patientinnen in der Hausarztpraxis durch Advanced Practice Nurses (APNs)" (Case-based care of multimorbid patients in general practice by Advanced Practice Nurses) and is an innovative research project led by the Catholic University of Applied Sciences in Mainz, implemented in the Rhineland-Palatinate.

Multimorbidity as an increasing challenge in General Practitioner (GP) practices
Actors in the German healthcare system are struggling with constantly changing challenges. The number of patients requiring treatment is growing, and the severity of illnesses is increasing, with the presence of multiple chronic illnesses becoming more common. This increasing number of people with chronic illnesses comes at the same time as the existing and increasing shortage of GPs.

Advanced Practice Nurses in primary care
The project aims to test a new form of care to improve the healthcare of multimorbid patients, particularly in rural and structurally weak regions.

To achieve this goal, nine APNs are employed in the ambulatory, primary care of multimorbid patients. APNs are professional nurses with at least two years of nursing experience, and a master's degree in a nursing specialty. In addition, the APNs are required to complete a project-specific training program beforehand.

Nine GP practices in rural areas of the Rhineland-Palatinate are involved in the FAMOUS project. The APNs employed in the GP practices provide a large part of the case-related and person-centred care of chronically ill patients. The APNs conduct a detailed assessment to determine the individual support needed by the patients. Based on this assessment, they develop a care plan, which they implement and evaluate in consultation with the GP and, if necessary, continuously adapt. The main focus is on the patients' autonomy, needs, and values. If necessary, the social environment is also considered and incorporated into the care plan. Optimal medical care is linked to the promotion of a patient's ability to cope with daily life. Furthermore, the APNs support the information transfer between all actors involved in the care, contributing to improved care continuity. APNs and participating GPs work closely together (delegation model) and meet regularly for case discussions.

New form of care under evaluation
We expect that this approach will stabilize the health and home care situation of multimorbid patients, reduce emergency contacts and reduce the need for further care institutions (e.g. hospitals). In addition, we expect a high level of satisfaction among all parties involved in the new care model and a reduction in the workload of general practitioners.

The study design of FAMOUS is an intervention study which investigates the benefits of the new care model. An APN cares for around 850 patients over a period of 12 months (intervention group) and are compared with around 1,700 patients receiving standard care (control group). The Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) at the University Medical Center of the Johannes Gutenberg University Mainz (consortium partner) will conduct the evaluation under the direction of Dr Emilio Gianicolo. The project will take 4.25 years (51 months) and is funded by the Innovation Fund of the Federal Joint Committee, which supports the development of new forms of care.

Academic qualification of nursing
The FAMOUS project focuses on the field of healthcare research and aims to contribute to the further development of regional healthcare in Germany as well as to coping with the shortage of GPs.

The expanding academic potential of nursing professionals meets the increasing demand of healthcare services due to growing multimorbidity combined with a progressive shortage of GPs. FAMOUS strives for an innovation in nursing, so that in the future patients can benefit more from the academic nursing development. Additionally, this effort aims to establish a new field of practice for advanced nursing in Germany, known as Advanced Nursing Practice (ANP).

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