A randomized controlled trial of nurses vs. doctors in the resolution of acute disease of low complexity in primary care.

AIMS: 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). BACKGROUND: 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. DESIGN: Multicentre, randomized, unblinded clinical trial with two parallel groups. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

¿Conocen los varones de 50-70 años la efectividad, los beneficios y los riesgos del cribado del cáncer de próstata? / What do men between 50 and 70 know about the effectiveness, the benefits, and the risks of prostate cancer screening

Objetivo. Valorar los conocimientos de la población sobre el cribado del cáncer de próstata. Diseño. Estudio descriptivo. Emplazamiento. Equipos de atención primaria (EAP) de la provincia de Barcelona, durante el período comprendido entre abril y septiembre de 2005. Participantes y contexto. Participaron varones de 50-70 años de edad atendidos en las consultas de 12 EAP, sin sintomatología prostática. Método. Se realizó una muestra sistemática. Las variables analizadas fueron: edad, estado civil, nivel de estudios y estado de salud autopercibido. Se llevó a cabo una valoración de los conocimientos mediante un cuestionario de 14 preguntas referidas a las ideas clave (previamente definidas por un grupo de expertos) que son necesarias para poder decidir sobre el cribado del cáncer de próstata. Resultados. Se incluyó a 221 varones. Su edad media era de 59,9 años (desviación estándar [DE] = 5,9); el 63,4% tenía un nivel de estudios primario o inferior. El 89,1% (intervalo de confianza del 95%, 84,4-92,6) no tienen conocimientos suficientes sobre el cribado del cáncer de próstata. En las preguntas referentes a qué es y para qué sirve el antígeno prostático específico, más del 50% responde que no lo saben. El 63,3% reconoce que el cáncer de próstata es una enfermedad con una alta prevalencia. El 84,6% responde que la detección precoz del cáncer de próstata evita muertes. El 49,8% no sabe si el médico tiene dudas sobre este tema y el 38,9% cree que no las tiene. No existen diferencias en los conocimientos para ninguna de las variables estudiadas. Conclusiones. A pesar de la amplia extensión del cribado del cáncer de próstata, la información que tiene la población es muy escasa y a menudo errónea. La incertidumbre científica existente sobre la utilidad del cribado es el aspecto más desconocido por los usuarios

Objective. To evaluate the understanding of the population on prostate cancer screening. Design. Descriptive study. Setting. Primary care teams in the province of Barcelona, Spain, from april to september 2005. Participants and context. Men between 50 and 70 years old without prostate symptoms and seen in the clinics of 12 primary care teams. Method. Systematic sample. Variables: age, marital status, educational level, and self-perceived health status. Appraisal of knowledge through a 14-question questionnaire referring to the key ideas, previously defined by a group of experts, requisite before deciding on prostate cancer screening. Results. N=221. Mean age, 59.9 (SD, 5.9); educational level, primary or lower: 63.4%; 89.1% (95% CI, 84.4-92.6) did not have sufficient knowledge about prostate cancer screening. In the questions on what PSA is and what it is for, over 50% said they did not know; 63.3% recognised that prostate cancer was a highly prevalent illness; 84.6% replied that early detection of prostate cancer avoids deaths; 49.8% did not know whether the doctor had doubts on this question; and 38.9% thought he didn't. There were no differences in knowledge for any of the variables studied. Conclusions. Although prostate cancer screening is widely known about, the information of the population is scant and often wrong. Existing scientific uncertainty on the use of screening is the aspect that is least known by users

Safety of intramuscular influenza vaccine in patients receiving oral anticoagulation therapy: a single blinded multi-centre randomized controlled clinical trial.

BACKGROUND: Influenza vaccines are recommended for administration by the intramuscular route. However, many physicians use the subcutaneous route for patients receiving an oral anticoagulant because this route is thought to induce fewer hemorrhagic side effects. Our aim is to assess the safety of intramuscular administration of influenza vaccine in patients on oral anticoagulation therapy. DESIGN: Randomised, controlled, single blinded, multi-centre clinical trial. SETTING: 4 primary care practices in Barcelona, Spain. PARTICIPANTS: 229 patients on oral anticoagulation therapy eligible for influenza vaccine during the 2003-2004 season. INTERVENTIONS: intramuscular administration of influenza vaccine in the experimental group (129 patients) compared to subcutaneous administration in the control group (100 patients). PRIMARY OUTCOME: change in the circumference of the arm at the site of injection at 24 hours. SECONDARY OUTCOMES: appearance of local reactions and pain at 24 hours and at 10 days; change in INR (International Normalized Ratio) at 24 hours and at 10 days. Analysis was by intention to treat using the 95% confidence intervals of the proportions or mean differences. RESULTS: Baseline variables in the two groups were similar. No major side effects or major haemorrhage during the follow-up period were reported. No significant differences were observed in the primary outcome between the two groups. The appearance of local adverse reactions was more frequent in the subcutaneous administration group (37,4% vs. 17,4%, 95% confidence interval of the difference 8,2% to 31,8%). CONCLUSION: This study shows that the intramuscular administration route of influenza vaccine in patients on anticoagulant therapy does not have more side effects than the subcutaneous administration route. REGISTRATION NUMBER: NCT00137579 at clinicaltrials.gov.