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.

Examination report on the City of Walnut, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Walnut, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Schaller, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Schaller, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Riverdale, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Riverdale, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Bedford, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Bedford, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of State Center, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of State Center, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Mechanicsville, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Mechanicsville, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Roland, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Roland, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Newhall, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Newhall, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Gilmore City, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Gilmore City, Iowa for the period July 1, 2012 through June 30, 2013

Loss to follow-up in an international, multicentre observational study.

OBJECTIVE: The aim of this work was to assess loss to follow-up (LTFU) in EuroSIDA, an international multicentre observational cohort study. METHODS: LTFU was defined as no follow-up visit, CD4 cell count measurement or viral load measurement after 1 January 2006. Poisson regression was used to describe factors related to LTFU. RESULTS: The incidence of LTFU in 12 304 patients was 3.72 per 100 person-years of follow-up [95% confidence interval (CI) 3.58-3.86; 2712 LTFU] and varied among countries from 0.67 to 13.35. After adjustment, older patients, those with higher CD4 cell counts, and those who had started combination antiretroviral therapy all had lower incidences of LTFU, while injecting drug users had a higher incidence of LTFU. Compared with patients from Southern Europe and Argentina, patients from Eastern Europe had over a twofold increased incidence of LTFU after adjustment (incidence rate ratio 2.16; 95% CI 1.84-2.53; P<0.0001). A total of 2743 patients had a period of >1 year with no CD4 cell count or viral load measured during the year; 743 (27.1%) subsequently returned to follow-up. CONCLUSIONS: Some patients thought to be LTFU may have died, and efforts should be made to ascertain vital status wherever possible. A significant proportion of patients who have a year with no follow-up visit, CD4 cell count measurement or viral load measurement subsequently return to follow-up.

Report on a review of the operations of certain departments of the University of Iowa Hospitals and Clinics for the period July 1, 2010 through December 31, 2012

Report on a review of the operations of certain departments of the University of Iowa Hospitals and Clinics for the period July 1, 2010 through December 31, 2012

Report on a special investigation of the University of Iowa Hospitals and Clinics, Health Care Information Systems Department, for the period January 1, 2005 through July 5, 2013

Report on a special investigation of the University of Iowa Hospitals and Clinics, Health Care Information Systems Department, for the period January 1, 2005 through July 5, 2013

Examination report on the City of Swea City, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Swea City, Iowa for the period July 1, 2012 through June 30, 2013

Report on a special investigation of the City of Kinross for the period January 15, 2008 through October 31, 2013

Report on a special investigation of the City of Kinross for the period January 15, 2008 through October 31, 2013