Abstract
<title>Abstract</title> <p> <bold>Background</bold> Multimorbidity poses a significant challenge for primary care. In Germany shortage of primary care physicians hinders comprehensive assessments of patients and home visits. We aim to investigate the impact of incorporating Advanced Practice Nurses (APNs) into primary care in rural areas for patients with multiple chronic conditions on care quality, healthcare utilization and satisfaction. <bold>Methods</bold> We used a non-randomized, two-arm, multicentre intervention design. Nine APNs in nine general practices provided care to multimorbid patients in the Intervention Group (IG), while the Control Group (CG) received standard care. Quantitative and health economic analysis investigated the differences in utilization of the primary endpoints <italic>outpatient emergency contacts</italic> and <italic>unplanned hospitalizations</italic> between the IG and CG. Qualitative analysis was used for process evaluation based on semi-structured interviews with general practitioners, APNs, and patients. <bold>Results</bold> A total of 705 IG patients and 1410 CG patients were included. Both groups showed a similar average amount of out-of-hours emergency services (IG: 0.27; 95%CI 0.21–0.33; CG: 0.27; 95%CI 0.16;0.33) and of out-of-hours general practitioner contacts (IG: 0.23; (CG: 0.17). After adjusting for confounders, no statistically significant differences in the costs for emergency hospital stays (IG: 2592.76€; CG: 1537.89€), regular hospital stays (IG: 1399.23€; CG: 1054.33€), and home visits (IG: 59.88€; CG: 41.54€) were found between the two groups. <bold>Trial registration</bold> DRKS00026172 on DRKS (Deutsches Register Klinische Studien) </p>