Acute respiratory infections: can a non-physician practitioner triage and treat patients by using an algorithm? Experience in a military primary care clinic.
BACKGROUND
Acute respiratory viral infections are minor self-limited diseases. Studies have shown that patients with ARVI can be treated as effectively by non-physician practitioners as by physicians.


OBJECTIVE
To examine whether a military medic, using a structured questionnaire and an algorithm, can appropriately triage patients to receive over-the-counter medications and refer more complicated cases to a physician.


METHODS
The study group comprised 190 consecutive soldiers who presented to a military primary care clinic with symptoms of ARVI. Using a questionnaire, a medic recorded the patient's history and measured oral temperature, pulse rate and blood pressure. All patients were referred to a doctor. Physicians were "blind" to the medic's anamnesis and to the algorithm diagnosis. We compared the medic's anamnesis and therapeutic decisions with those of the doctors.


RESULTS
Patients were young (21.1 +/- 3.7 years) and generally healthy (93% without background illness). They usually had a minor disease (64% without fever) that was mostly diagnosed as viral ARVI (83% of cases). Ninety-nine percent were also examined by a physician. According to the patients' data, the medics showed high overall agreement with the doctors (83-97.9%). The proposed algorithm could have saved 37% of referrals to physicians, with a sensitivity of 95.2%. Had the medics been allowed to examine the pharynx for an exudate, the sensitivity might have been 97.6%.


CONCLUSIONS
Medics, equipped with a questionnaire and algorithm but without special training and without performing a physical examination, can appropriately triage patients and thereby reduce the number of referrals to physicians.
Golan
Danie
D
Israel Naval Medical Department and Medical Corps, Israel Defense Forces, Ramat Aviv, Israel. golan_dl@zahav.net.il
Zagetzki
Michael
M
Vinker
Shlomo
S
D000208:Acute Disease; D000328:Adult; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006801:Humans; D007557:Israel; D008297:Male; D008889:Military Personnel; D010823:Physician Assistants; D012017:Referral and Consultation; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000188:drug therapy; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents