Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting "same day" consultations in primary care

Objective To ascertain any differences between care from nurse practitioner s and that from general practitioners for patients seeking "same day" consu ltations in primary care. Design Randomised controlled trial with patients allocated by one of two ra ndomisation schemes (by day or within day). Setting 10 general practices in south Wales and south west England. Subjects 1368 patients requesting same dap consultations. Main outcome measures Patient satisfaction, resolution of symptoms and conc erns, care provided (prescriptions, investigations, referrals, recall, and length of consultation), information provided to patients, and patients' in tentions for seeking care in the future. Results Generally patients consulting nurse practitioners were significantl y more satisfied with their care, although for adults this difference was n ot observed in all practices. For children, the mean difference between gen eral and nurse practitioner in percentage satisfaction score was -4.8 (95% confidence interval -6.8 to -2.8), and for adults the differences ranged fr om -8.8 (-13.6 to -3.9) to 3.8 (-3.3 to 10.8) across the practices. Resolut ion of symptoms and concerns did not differ between the two groups (odds ra tio 1.2 (95% confidence interval 0.8 to 1.8) for symptoms and 1.03 (0.8 to 1.4) for concerns). The number of prescriptions issued, investigations orde red, referrals to secondary care, and reattendances were similar between th e two groups. However, patients managed by nurse practitioners reported rec eiving significantly more information about their illnesses and, in all but one practice, their consultations were significantly longer. Conclusion This study supports the wider acceptance of the role of nurse pr actitioners in providing care to patients requesting same day consultations .