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Translating 'See-and-Treat' to primary care: opening the gates does not cause a flood
Carl Savage1, Staffan Bjessmo1, Oleg Borisenko1
1Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
Objective:
To explore how the See-and-Treat concept can be applied in primary care and its effect on volume and productivity.
Design:
An explanatory single-case study design with a mixed methods approach and presented according to the SQUIRE 2.0 guidelines.
Setting:
A publicly-funded, private primary care provider within the Stockholm County, which caters to a diverse patient population in terms of ethnicity, religion, socioeconomic status and care needs.
Participants:
CEO, center manager, four physicians, two licensed practical nurses, one medical secretary and one lab assistant.
Intervention:
A See-and-Treat unit was established to offer same-day service for acute unplanned visits. Standardized patient symptom forms were created that allowed patients to self-triage and then enter into a streamlined care process consisting of a quick diagnostic lab and a physician visit.
Main Outcome Measures:
Volume, productivity, staff perceptions and patient satisfaction were measured through data on number and type of contacts per 1000 listed patients, visits per physician, observations, interviews and a questionnaire.
Results:
A significant decrease in the acute and total number of visits, a continued trend of diminishing telephone contacts, and a non-significant increase in physician productivity. Patients were very satisfied, and staff perceived an improved quality of care.
Conclusions:
See-and-Treat appears to be a viable approach for a specific primary care patient segment interested in acute same-day-service. Opening up access and standardizing care made it possible to efficiently address these needs and engage patients.