Open Access Highly Accessed Research article

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Núria Fabrellas1*, Carmen Sánchez2, Eulàlia Juvé13, Eva Aurin3, Dolors Monserrat4, Esther Casanovas5 and Magali Urrea2

Author Affiliations

1 School of Nursing, University of Barcelona, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Campus de Ciències de la Salut Bellvitge, Feixa Llarga s/n Pavello de Govern, 3a planta, L’Hospitalet de Llobregat, Catalunya, 08907, Spain

2 SAP Mataró, Institut Català de la Salut, Mataró, Catalunya, Spain

3 Institut Català de la Salut, Barcelona, Catalunya, Spain

4 EAP Premià, Institut Català de la Salut, Premià de Mar, Catalunya, Spain

5 EAP Pineda de Mar, Institut Català de la Salut, Pineda de Mar, Catalunya, Spain

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BMC Family Practice 2013, 14:61  doi:10.1186/1471-2296-14-61

Published: 16 May 2013

Abstract

Background

Attention 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.

Methods

A 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.

Results

During 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%.

Conclusions

A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

Keywords:
Nurse case management; Acute diseases/nursing; Nurse practitioner; Primary health care