Nurse management of patients with minor illnesses in general practice: multicentre randomised controlled trial
Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting "same day" consultations in primary care
Two studies in this week's BMJ show that patients requesting same day consultations are as happy to be seen by a nurse as their general practitioner, and in some cases, prefer the experience.
In a trial of five general practices across South East London and Kent, Shum and colleagues show that patients were significantly more satisfied with consultations given by practice nurses than those given by GPs. Patients scored nurse consultations an average of two to six points higher. Around 1800 patients with minor illnesses who requested, and were offered, same day appointments took part in the study.
The nurse consultations lasted around two minutes longer; length of time spent with a patient has traditionally predicted greater satisfaction scores. But, say the authors, patients still rated their nurse consultations more highly even after adjusting for this. Nurses and doctors wrote prescriptions for a similar proportion of patients and there was no difference in clinical outcome between the two groups of patients. Around three-quarters of patients were treated without any input from the GP.
Another trial conducted by Kinnersley and colleagues from the Department of General Practice, University College of Wales College of Medicine, compared the outcomes of consultations given by GPs and nurse practitioners in 10 general practices in South Wales and South West England. Over 1300 patients requesting same day appointments were involved.
Generally, patients consulting nurse practitioners were significantly more satisfied with their care, having been given longer consultations and more information about their illnesses. There was no difference in the rate at which symptoms cleared up, the resolution of concerns, or the amount of drugs prescribed between doctors and nurses. Although satisfaction scores were significantly higher for children seeing nurse practitioners, there was some variation among the adults, which, the authors suggest, indicates the impact of individual doctors.
Dr Chau Shum, Walderslade Village Surgery, Kent.
Tel: +44 (0)1634 687 250
Fax: +44 (0)1634 687 253
Dr Paul Kinnersley, Department of General Practice, University of Wales College of Medicine, Cardiff.
Tel: +44 (0)29 2054 1133
Fax: +44 (0)29 2054 0129