Avaluació de la gestió infermera de la demanda en el maneig de les visites urgents a l'atenció primària.

Student thesis: Doctoral thesis


The Nurse Demand Management (GID) is the care of the emergencies of low complexity pathology by nursing based on protocols of action that explains: anamnesis, physical examination, reasons for exclusion (which are derived directly to the doctor), the treatment (prescribed pharmacological validated by doctors) and the rules of reconsider (when the patient must return). Since 2008, the Catalan Institute of Health (ICS) has started the GID based on satisfactory experiences from other providers. Operational protocols were included in the computerized Clinical Station (ECAP) in low complexity pathology, allowing autonomous management by nursing. Objectives: To evaluate the effectiveness of the GID in the resolution of urgent visits to Primary Care (AP) and the degree of patient satisfaction in 5CAP of the ICS Girona. Material and methods: First work (pilot): observational and transversal study Second work: Observational study, transversal and multicentre Main measures: Socio-demographic variables (age, sex and origin of patients) and care (CAP, Basic Unit of Assistance (UBA) of the patient, cause of consultation and antiquity of nursing in the CAP). The effectiveness was assessed by analyzing new consultations for the same reason of health (reconsider), during the first 48 hours for the first pilot work and during the first 72 hours for the second, and for referrals to the medical professional. Satisfaction was valued through a telephone survey. Results: First work (pilot): 296 consultations were analyzed. The median age was 34.4 ± 25.5 years, 53.3% women and 25.3% immigrants. The main reason for consultation were wounds (12.5%). 77.4% did not reconsider during the first 48 hours (80.5% protocolized queries vs. 73.2% non-protocolized p = 0.14). The protocolized reasons (57.1% of the consultations) had a lower percentage of referral to the doctor (33.1% protocolized vs 64.6% non-protocolized p 36 years, OR 2.32 (95% CI: 1.07-5.03; p = 0.033). The average global satisfaction was 9/10, being higher in the group that did not reconsider (9.07 vs 8.55, p = 0.025). 93.3% of patients would be treated again by nursing for the same health problem. Conclusion: The GID is effective in resolving urgent visits for protocols in the AP with a high degree of patient satisfaction.
Date of Award27 Nov 2019
Original languageCatalan
SupervisorEmilio Miguel Gene Tous (Director), Albert Selva O Callaghan (Tutor) & Rafael Azagra Ledesma (Director)

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