Health problems encountered by three levels of providers in a remote setting.

Abstract

A study conducted in the Sioux Lookout Health Zone in northwestern Ontario, Canada analyzed the diagnoses and managements for 139,618 patient visits to three levels of practitioners: physicians, nurse practitioners, and minimally trained health aides. There were major differences between providers in their diagnostic and management patterns. Some of these differences were the result of administrative policy (e.g., physicians and nurses do preventive medicine) but even when adjustment had been made for these differences there was still considerable variation. The minimally IntroductionPrimary health care is becoming increasingly available to people in underdeveloped countries and remote areas. A major factor in this development is an increase in the use of nonphysician providers. These providers vary from welltrained nurse practitioners and paramedics to minimally trained indigenous workers. Valid and as yet unanswered questions relate to the practice patterns and competence of these practitioners. There is an extensive literature concerning the practice aind performance of nonphysician providers. For two excellent reviews see Sox' and Yankauer and

A Historical Overview of the Development of Advanced Practice Nursing Roles in Canada

“…Using a descriptive survey, Chenoy et al (1973) found that patients had favourable views about nurses being involved in health promotion activities, but they preferred physicians in "worry-inducing" situations. In isolated settings such as northern Newfoundland or Ontario, outpost nurses were responsible for providing primary care to the entire community and for seeing patients in clinics for preventative health, prescription refills or common problems such as upper and lower respiratory infections (Black et al 1976;Dunn and Higgins 1986;Graydon and Hendry 1977). A pilot evaluation of four NPs working in rural Saskatchewan showed that role implementation varied according to community needs (Cardenas 1975).…”

Comparisons of Two Types of Nonphysician Providers Using Episode Based Data*

“…For these two conditions the nurses and health aides handled most of the episodes without help. We have also found (Dunn and Higgins, 1986) that for all medical problems both the nurses and the health aides manage more than 90% of the patients that present. Thus, much of the daily health care delivery is adequately provided by nonphysician providers.…”

“…For several years we have been collecting patient care data in all 27 communities in the Sioux Lookout Health Zone (Dunn and Higgins, 1986). The data reported here is an analysis for the period from January 1 , 1978, to the end of December 1980.…”