Letters

Safety and effectiveness of nurse telephone consultation in out of hours primary care

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7191.1137a (Published 24 April 1999) Cite this as: BMJ 1999;318:1137

Two interventions were combined as one

  1. Vikram Tanna, General practitioner.
  1. Clarendon Medical Centre, Hyde, Cheshire SK14 2AQ
  2. Department of Epidemiology and Public Health, Newcastle University Medical School, NE2 4HH
  3. University of Southampton, Health Care Research Unit, Southampton General Hospital, Southampton SO16 6YD

    EDITOR—Lattimer et al report a randomised controlled trial to show the safety and effectiveness of nurse telephone consultations in out of hours primary care.1 I accept that the results showed a reduced workload for general practitioners from the nurse intervention, probably at an increased cost. For methodological reasons, however, I am less certain whether the results show safety.

    Lattimer et al report that during intervention periods, 49.8% of the calls could be managed by the nurse alone without referral to a doctor. This implies that 50.2% of the calls were assessed twice: once by an experienced and specially trained nurse using a systematic assessment with the aid of decision support software and then by the general practitioner in attendance. I would expect that the improved diagnosis and management in this subgroup would lead to much better clinical outcomes than in the control group, which had only one assessment by the general practitioner. This improved outcome …

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