title: A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care.
abstract: 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.
authors.affiliation: School of Nursing, University of Barcelona, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Campus de Ciències de la Salut Bellvitge, Feixa Llarga s/n Pavello de Govern, 3a planta, L'Hospitalet de Llobregat, Catalunya, 08907, Spain. nfabrellas@ub.edu.
authors.forename: Núria
authors.initials: N
authors.lastname: Fabrellas
authors.forename: Carmen
authors.initials: C
authors.lastname: Sánchez
authors.forename: Eulàlia
authors.initials: E
authors.lastname: Juvé
authors.forename: Eva
authors.initials: E
authors.lastname: Aurin
authors.forename: Dolors
authors.initials: D
authors.lastname: Monserrat
authors.forename: Esther
authors.initials: E
authors.lastname: Casanovas
authors.forename: Magali
authors.initials: M
authors.lastname: Urrea
mesh_terms: D000208:Acute Disease / Q000451:nursing*; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001071:Appointments and Schedules; D019090:Case Management; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D006801:Humans; D008875:Middle Aged; D009722:Nurse Practitioners / Q000592:standards / Q000706:statistics & numerical data; D009730:Nursing Assessment; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013030:Spain; D017748:Time Management