A Program of Nurse Management for Unscheduled Consultations of Children With Acute Minor Illnesses in Primary Care.

INTRODUCTION: Attention to patients with acute minor illnesses represents a major burden for primary care. Although programs of nurse care for children with acute minor illnesses in primary care started a long time ago, there is limited information about the results of these programs in current practice. OBJECTIVES: The objective of this study was to assess the feasibility and efficacy of a program of nurse management for unscheduled consultations of children with acute minor illnesses. METHODS: Observational study of children seeking unscheduled consultations for 16 acute minor illnesses in 284 primary care practices during a 2-year period. The program of nurse management used predefined management algorithms. FINDINGS: Among 467,160 consultations performed, case resolution was achieved in 65.4%. The remaining 34.6% of cases were not solved by the primary healthcare nurse due to the existence of signs of alarm and were referred to a pediatrician. Return to consultation during a 7-day period for the same reason as the original consultation was only 2.6%. CONCLUSIONS: A program that uses management algorithms is effective for nurse care management of children with acute minor illnesses in primary care. CLINICAL RELEVANCE: Application of programs of nurse management for unscheduled consultations for children with acute minor illnesses is feasible and effective.

Using transient elastography to detect chronic liver diseases in a primary care nurse consultancy.

BACKGROUND: Chronic liver diseases (CLDs) are significant causes of death in adults in many countries and are usually diagnosed at late stages. Early detection may allow time for treatment to prevent disease progression. OBJECTIVES: The aim of this study was to assess the feasibility of screening for unrecognized CLDs in a primary care nurse consultancy and report findings from screening. METHODS: Two experienced nurses in a primary care nurse consultancy were trained to perform transient elastography (TE). Subjects aged from 18 to 70 years were identified randomly from the health registry and invited to participate in a feasibility pilot study. Exclusion criteria were past or current history of liver diseases. Nurses collected demographic and clinical data and performed TE tests using Fibroscan to measure liver stiffness; a cutoff score of 6.8 kPa or greater was used as an indicator of the presence of CLD with fibrosis. RESULTS: Accurate measurements were obtained in 495 of 502 participants (98.6%). Prevalence of elevated liver stiffness was observed in 28 of 495 subjects (5.7%). Compared to patients with normal liver stiffness, patients with increased liver stiffness were older, were more frequently male, and had higher frequency of metabolic syndrome. Nonalcoholic fatty liver was the most common cause of CLD. DISCUSSION: Following training in procedures for conducting TE, nurses in a primary care clinic were able to detect unrecognized CLDs in presumably healthy subjects. Early detection of CLDs is feasible in primary care clinics and may facilitate identification of undiagnosed CLD in adults.

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

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.