Abstract
BackgroundAttention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area.MethodsA cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period.ResultsDuring a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%.ConclusionsA program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.
Highlights
Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care
In order to expand the role of registered nurses (RN) and still adhering with the legislation, the Catalonian Institute of Health developed a program of nurse care for patients with acute minor illnesses that uses management algorithms, which are included in the computerized health record system
Design of the study This is a cross-sectional study with retrospective analysis of data from patients attended in a program of nurse algorithm-guided care for adults with acute minor illnesses in primary care
Summary
Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. There is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Management of patients with acute delivered by GPs in most countries with little or no role for nurses. In order to expand the role of RN and still adhering with the legislation, the Catalonian Institute of Health developed a program of nurse care for patients with acute minor illnesses that uses management algorithms, which are included in the computerized health record system. This study assessed the effectiveness of this program over a two-year period in a highly populated area with approximately 6 million inhabitants
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