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Abstract
BackgroundNurses in Denmark have been increasingly involved in general practice care, which may have implications for the role of the general practitioner (GP) and patients’ experience of primary care. The aim of this study was to explore possibilities of doctor-nurse substitution seen from GP and patient perspectives and patient preferences in regard to consultations with a personal GP.MethodsThe study was based on data from a Danish survey on disease patterns in general practice (KOS 2008). Background information on patients and GPs was linked with their responses to whether a nurse could have substituted the GP in consultations and patient-assessed importance of seeing a personal GP. Associations were measured with prevalence rate ratio (PR).ResultsDoctor-nurse substitution was a possibility in 14.8% of consultations according to GPs and in 11.7% according to patients. GP and patient agreed on substitution in 3.5% of consultations (Kappa = 0.164). Follow-up consultations were more often feasible for substitution than new episode according to GPs (adj. PR = 2.06 (1.62-2.62)), but not according to patients (adj. PR = 1.02 (0.64-1.33)). Follow-up consultations were related to high importance of seeing the personal GP (adj. PR = 1.18 (1.05-1.33). For both patients and GPs, consultations with patients with chronic conditions were not significantly associated with nurse substitution. Male and younger patients did more often suggest substitution than women and older patients. For GPs, increasing patient age was associated with relevance of substitution. Patients who found it 'very important’ to see their personal GP were less likely to consider nurse substitution a possibility (adj. PR = 0.57 (0.45-0.71).ConclusionsGPs and patients found nurse substitution relevant in more than one in ten consultations, although they rarely agreed on which consultations. Follow-up consultations and consultations with older patients were associated with GPs considering nurse substitution appropriate more often. For patients, male and younger patients most often found substitution relevant. High importance of seeing the personal GP may contribute to patient reluctance to nurse substitution, especially for follow-up consultations. The results indicate a need for involving patients’ perspective when altering the future roles of primary health care professionals.
Highlights
Nurses in Denmark have been increasingly involved in general practice care, which may have implications for the role of the general practitioner (GP) and patients’ experience of primary care
In a primary-based health care system as the Danish, where the majority of all health-related contacts are handled in primary care, the increasing demands have led to increased workload for general practitioners (GPs) [1]
For all consultations and subgroups, the agreement of nurse substitution between GPs and patients was Results A total of 404 (46.6%) of the invited GPs participated in this study
Summary
Nurses in Denmark have been increasingly involved in general practice care, which may have implications for the role of the general practitioner (GP) and patients’ experience of primary care. In a primary-based health care system as the Danish, where the majority of all health-related contacts are handled in primary care, the increasing demands have led to increased workload for general practitioners (GPs) [1]. This has prompted a rethinking of the roles of health care professionals and the organisation of care delivery in order to achieve efficient, cost-effective and highquality primary care services. Since 2003, Danish GPs have been remunerated for consultations managed by clinical staff without involvement of the GP, and increased use of practice personnel, including licensed nurse practitioners, is recommended by the Danish Ministry of Health [6]
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