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Practice nurses effective caregivers for minor illness care
A study performed among five general practices in the UK comparing nurses and physicians for acceptability and safety for the treatment of minor injuries appeared in the 15-Apri-2000 issue of BMJ. Among the most remarkable findings were that nurses performed slightly better than physicians in the area of patient satisfaction. Here's a summary:
Study Objective: To assess the acceptability and safety of a minor illness service led by practice nurses in general practice.
Design: Multi-center, randomized controlled trial. Setting: 5 general practices in southeast London and Kent representing semi-rural, suburban, and urban settings.
Participants: 1815 patients requesting and offered same day appointments by receptionists.
Intervention: either a specially trained nurse or a general practitioner assigned Patients to treatment. Patients seen by a nurse were referred to a general practitioner when appropriate.
Main outcome measures: The general satisfaction of the patients as measured by the consultation satisfaction questionnaire. Other outcome measures included the length of the consultation, number of prescriptions written, rates of referral to general practitioners, patient's reported health status, patient's anticipated behavior in seeking health care in future, and number of patients who returned to the surgery, visits to accident and emergency, and out of hours calls to doctors.
Results: Patients were very satisfied with both nurses and doctors, but they were significantly more satisfied with their consultations with nurses. Satisfaction scores for nurses ranged in the 78.6% range while that for physicians was slightly lower at 76.4%. Consultations with nurses took about 10 minutes compared with about 8 minutes for consultations with doctors. Nurses and doctors wrote prescriptions for a similar proportion of patients--nurses wrote 481/736 versus doctors 518/816 577/790 (73%) patients seen by nurses were managed without any input from doctors.
Conclusion: Practice nurses seem to offer an effective service for patients with minor illnesses who request same day appointments.
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British nurses save money by performing telephone consultations
When a patient needs help after office hours in the UK, it has been found that a telephone consultation with a nurse may reduce NHS costs. Cost reduction is found in two areas: reduced after hours physician consultation or surgery visits and in fewer emergency room visits. Here's a summary:
Objective: To undertake an economic evaluation of nurse telephone consultation using decision support software in comparison with usual general practice care provided by a general practice cooperative.
Design: Cost analysis from an NHS perspective using stochastic data from a randomized controlled trial. Setting: General practice cooperative with 55 general practitioners serving 97 000 registered patients in Wiltshire, England.
Subjects: All patients contacting the service, or about whom the service was contacted during the trial year (January 1997 to January 1998).
Main outcome measures: Costs and savings to the NHS during the trial year.
Results: The cost of providing nurse telephone consultation was £81,237 per annum. This, however determined a £94,422 reduction of other costs for the NHS arising from reduced emergency admissions to hospital. Using point estimates for savings, the cost analysis, combined with the analysis of outcomes, showed a dominance situation for the intervention over general practice cooperative care alone. If a larger improvement in outcomes is assumed (upper 95% confidence limit) NHS savings increase to £123,824 per annum. Savings of only £ 3,728 would, however, arise in a scenario where lower 95% confidence limits for outcome differences were observed. To break even, the intervention would have needed to save 138 emergency hospital admissions per year, around 90% of the effect achieved in the trial. Additional savings of £16,928 for general practice arose from reduced travel to visit patients at home and fewer surgery appointments within three days of a call.
Conclusions: Nurse telephone consultation in out of hours primary care may reduce NHS costs in the long term by reducing demand for emergency admission to hospital. General practitioners currently bear most of the cost of nurse telephone consultation and benefit least from the savings associated with it. This indicates that the service produces benefits in terms of service quality, which are beyond the reach of this cost analysis.
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UK Health secretary wants to expand nurses' duties and abilities
In a recent speech, the UK health secretary announced a package of reforms, which if implemented will put nurses at the center of the modernization of the NHS.
In the UK, primary care nurse consultants have been the most visible symbol of change in the field of nursing. Nearly 150 new positions have been approved for the consultants in the last year. Another wave is expected this year. The nursing positions are in priority areas, such as critical care, emergency medicine, and intermediate care.
Hospital nurses will receive prescribing privileges. Charge nurses will control the capital flow of their wards and higher salaries can be expected throughout the field.
The secretary called for "nurses skills to be recognized and used." He also expressed a desire for nurses to be legally allowed to engage in the following:
- Order diagnostic investigations, such as pathology tests and X ray
- Make and receive referrals to, for example, therapists and pain
- Admit and discharge patients for specified conditions and with
- Manage their own patient caseloads for example, for diabetes or rheumatology
- Run their own clinics for example, for ophthalmology or
- Prescribe medicines and treatment
- Carry out a wide range of resuscitation procedures, such as
defibrillation and intubation
- Perform minor surgery and outpatient procedures
- Use computerized decision support to triage patients to the most
appropriate health professional
- Take a lead in the way that local health services are organized and
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