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Treatment advice in primary care: a comparative study of nurse practitioners and general practitioners
Clive Seale1, Elizabeth Anderson, Paul Kinnersley
1School of Social Sciences and Law, Brunel University, Uxbridge, UK. clive.seale@brunel.ac.uk
Aim:
This paper reports a study comparing the content of talk about treatments by nurse practitioners and general practitioners in order to understand how this might be related to satisfaction.
Background:
Studies show that satisfaction with nurse practitioner care is high when compared with that given by general practitioners. Clinical outcomes are similar. Nurse practitioners spend statistically significantly longer on consultations, and spend more time discussing treatments as well as social and emotional aspects of patients' lives.
Methods:
Based on transcripts of audiotaped consultations, clinicians' talk about treatment was compared across 18 matched pairs of nurse practitioner and general practitioner consultations where 'same day' appointments were sought. Case studies of six paired consultations were analysed in depth. The data were collected in 1998 in the United Kingdom.
Results:
A statistically significantly greater proportion of nurse practitioners' talk concerned treatments, with talk about how to use treatments and discussion of side effects contributing most to the difference. Nurse practitioners also recommended a greater number of treatments. Qualitative comparison of case study pairs suggested that nurse practitioners demonstrated greater concern with the acceptability and cost of treatments to patients.
Conclusions:
Nurses offered more holistic care to these patients and it is likely that this, and the greater provision of information, led to the higher levels of satisfaction found by other investigators. General practitioners are more focused on gathering information directly relevant to diagnosing and treating the immediate presenting complaint. Both types of practitioner may benefit from seeing the detailed illustrations of different approaches provided.
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