J Adv Nurs. 2013 Mar 21. doi: 10.1111/jan.12120. [Epub ahead of print]
A randomized controlled trial of nurses vs. doctors in the resolution of acute disease of low complexity in primary care.
Iglesias B, Ramos F, Serrano B, Fàbregas M, Sánchez C, García MJ, Cebrian HM, Aragonés R, Casajuana J, Esgueva N; PIPA Group.
EAP Baix a Mar, Consorci de Serveis a les Persones, Vilanova i la Geltrú, Spain.
To compare the effectiveness of care delivered by nurses to the usual care delivered by general practitioners, in adult patients requesting same day appointments in primary care practices in Catalonia (Spain).
Same day appointments conducted by nurses are characterized by high patient satisfaction and a high resolution index. The profile of nursing and the organization of primary care services in our country differ from other countries.
Multicentre, randomized, unblinded clinical trial with two parallel groups.
Patients were randomized to an intervention group (seen by nurses trained to respond to low complexity problems) or a control group (seen by the general practitioner) using an automatic probabilistic function. Setting: 38 primary care practices in Catalonia, 142 general practitioners and 155 nurses participated. Population study: ≥ 18-year-old patients who requested a same day consultation. Recruitment period: January-May, 2009. Of the 1,461 randomized patients, 92·5% completed the study. Main outcome measures: resolution of symptoms and patient satisfaction 2 weeks after the visit.
Seven hundred and fifty-three patients were assigned to the intervention group and 708 to the control group. Nurses successfully solved 86·3% of the cases. We did not observe any differences in resolution of symptoms or patient satisfaction between the groups.
Nurses trained specifically to resolve acute health problems of low complexity give comparable quality of care to that provided by general practitioners in terms of resolution of the problem 15 days after the visit and in patient satisfaction with the visit.