Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting "same day" consultations in primary care

Abstract

cause for concern. Reviewing the service after the nurses have more experience running it and estimating the real cost effectiveness outside the artificial restrictions of a trial would be useful. It would also be interesting to study the longer term effects of the nurses' service on patients' attitudes to their illnesses and behaviour in seeking health care.Various members of the South Thames Research Network provided invaluable support during all stages of this study, in particular Dr Sarah Clement. The network is funded by the South East and London regions of the NHS Executive. Statistical analysis was supervised by Dr Pak Sham. Thanks are also owed to the staff of the five practices, to the nurses who volunteered to participate in the study, and to the patients who took part.Contributors: CS initiated and coordinated the formulation of the hypothesis, discussed core ideas, designed the study protocol and questionnaires, analysed the data, acted as overall coordinator for the trial, and participated in writing the paper. CS is guarantor for the paper. AH helped formulate the core ideas and the study protocol, participated in data collection, and contributed to writing the paper. DW helped formulate the core ideas and study protocol and participated in writing the paper. MAC helped formulate the hypothesis and protocol and participated in writing the paper. SK participated in collecting the data and coordinating the day to day running of the study. SC helped formulate the hypothesis and core ideas, designed the protocol for data analysis, and participated in writing the paper.Funding: This project was funded by the project grant scheme of the South Thames region of the NHS Executive.Competing interests: None declared. AbstractObjective To ascertain any differences between care from nurse practitioners and that from general practitioners for patients seeking "same day" consultations in primary care.

Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): a cluster-randomised controlled trial and cost-consequence analysis

“…Secondary outcomes were occurrences of each of the 20 individual consultation types contributing to the primary outcome; the profi le of patient contacts and their distribution by health professionals; patient safety (ie, deaths, the occurrence and duration of any emergency hospital admissions within 7 days of the index request, and the number of patients with any attendances to accident and emergency departments within 28 days); patient-reported outcomes obtained via postal question naire, including participants' experience of care after the same-day request (with questions modifi ed from the national GP Patient Survey 14 ), problem resolution 15,16 (5-point Likert scale), overall satisfaction with care provided on the day of the consultation request, and health status (with the EuroQol Group 5-Dimension Self-Report Questionnaire [EQ-5D]). 17 An independent adjudication committee reviewed the circumstances of any deaths that happened during follow up, and their association with trial processes.…”

The nursing contribution to chronic disease management: A case of public expectation? Qualitative findings from a multiple case study design in England and Wales

“…However, whilst the wealth of research on service user's responses to nurse practitioners indicates a positive response (Bonsall and Cheater, 2008, Horrocks et al, 2002, Kinnersley et al, 2000, the data from PEARLE suggests that this positive response does not always increase with extended nursing roles within CDM. All the nurse respondents in the PEARLE study had undertaken significant further training and were experts in their field of CDM including the biomedical aspects (table 1), and yet a significant number of patients had reservations about some of the roles and the changes within CDM.…”

Nurse practitioner management of acute in-hours home visit or assessment requests: a pilot study

“…Studies of nurse practitioners seeing same-day patients in practice premises similarly suggest high patient satisfaction scores, generally in excess of those achieved by GPs. 1,[3][4] These studies did not observe any increase in prescribing from nurse practitioners. The increased prescription rate seen in the present study might reflect the individual practitioner involved, or the fact that the clinical and demographic characteristics of the patients she was seeing in their homes differed from patients studied in a surgery.…”

“…1,2 Randomised controlled trials suggest that nurses who are solely responsible for the diagnosis and management of these patients achieve equivalent clinical outcomes to GPs, 3,4 with possibly higher levels of patient satisfaction, although their consultations are longer. 5 To date, none of these studies has examined the feasibility of nurse practitioners extending their activity to home visits of patients who are acutely ill.…”