Could the patient have been seen by a nurse; a questionnaire based survey of GP and patient views in Danish general practice.
BACKGROUND
Nurses in Denmark have been increasingly involved in general practice care, which may have implications for the role of the general practitioner (GP) and patients' experience of primary care. The aim of this study was to explore possibilities of doctor-nurse substitution seen from GP and patient perspectives and patient preferences in regard to consultations with a personal GP.


METHODS
The study was based on data from a Danish survey on disease patterns in general practice (KOS 2008). Background information on patients and GPs was linked with their responses to whether a nurse could have substituted the GP in consultations and patient-assessed importance of seeing a personal GP. Associations were measured with prevalence rate ratio (PR).


RESULTS
Doctor-nurse substitution was a possibility in 14.8% of consultations according to GPs and in 11.7% according to patients. GP and patient agreed on substitution in 3.5% of consultations (Kappa = 0.164). Follow-up consultations were more often feasible for substitution than new episode according to GPs (adj. PR = 2.06 (1.62-2.62)), but not according to patients (adj. PR = 1.02 (0.64-1.33)). Follow-up consultations were related to high importance of seeing the personal GP (adj. PR = 1.18 (1.05-1.33). For both patients and GPs, consultations with patients with chronic conditions were not significantly associated with nurse substitution. Male and younger patients did more often suggest substitution than women and older patients. For GPs, increasing patient age was associated with relevance of substitution. Patients who found it 'very important' to see their personal GP were less likely to consider nurse substitution a possibility (adj. PR = 0.57 (0.45-0.71).


CONCLUSIONS
GPs and patients found nurse substitution relevant in more than one in ten consultations, although they rarely agreed on which consultations. Follow-up consultations and consultations with older patients were associated with GPs considering nurse substitution appropriate more often. For patients, male and younger patients most often found substitution relevant. High importance of seeing the personal GP may contribute to patient reluctance to nurse substitution, especially for follow-up consultations. The results indicate a need for involving patients' perspective when altering the future roles of primary health care professionals.
Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark, Bartholins Alle 2, Aarhus C 8000, Denmark. karen.busk@alm.au.dk.
Karen Busk
KB
Nørøxe
Grete
G
Moth
Helle Terkildsen
HT
Maindal
Peter
P
Vedsted
D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003718:Denmark; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D009726:Nurses / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D011795:Surveys and Questionnaires; D000078329:Workforce; D055815:Young Adult