Monday, 15 September 2014

Nurse demand management in primary care

Nurse demand management, aims to respond, within the scope of the nursing profession, to people who go to a primary care centre with a health problem that requires special attention. This clinical activity must be differentiated from the nurse triage in the emergency services, which offers: reception, attendance and classification of the problem, without any  further clinical activity.

In 2005, the Primary Care Center Can Bou in Castelldefels, near Barcelona, launched a pioneering experience in nurse demand management and subsequently prepared a "Guide to nursing interventions" with the following groups’ classification:
  1. The health problems where the formalization allows the nurses to be the ones who finalize the clinical process and therefore they themselves are responsible for the reception of patients and resolution of health problems.
  2. Problems of possible emergency intervention in which nurses are autonomous only in the first part of the algorithm. After, there’s a protocol point where the doctor intervenes.
  3. Health problems requiring an initial assessment of severity by the nurse prior to the doctor’s intervention.
In the following article signed by a team of CASAP you can see the table of signs and symptoms according to the three groups of expected demand. Subsequently, the groups 2 and 3 were merged. For people interested a more complete and updated PDF guide can be consulted (CASAP 2013).

Jordi Varela


A clinical study (Iglesias 2013) made in several Catalan primary care areas has shown that these programs have a resolution of 86% and their users’ satisfaction level is comparable to the programs where the visits are resolved by doctors. Several British studies made in the same direction give similar results as in this Iglesias 2013 study, but added that the nurse demand management brings more health education (Rashid 2010) and, of course, is cheaper than the care provided by doctors (Hollinghurst 2006) .


Our primary care model, which has many virtues, has an imbalance in the distribution of professional functions. I mean it's too doctor-dependent. No wonder the OECD statistics say that Spain, with a ratio of 1.4 nurses per doctor, is well below the average for industrialized countries (2,8), or the more advanced countries like UK (3.6) and Canada (4.4).

Thus, having a well proportioned supply of nurses is a sign of greater professional balance for this model. The primary care teams in these two countries are characterized by the fact that the doctors’ functions are more preserved. It ensures that the administrative take charge of all administrative matters, that nurses are employed to the maximum according to their functions and capabilities, and that when a patient has access to the family doctor, he/she will go because it is considered that the performance at the doctor's clinic will be appropriate.

The model of nurse demand management that CASAP presented in this post fosters teamwork, involves the admin staff more in the clinical circuits, is operative, reduces waiting times and is more efficient. Let's see then, if we don’t get distracted and if we’re able to extend it without excuses or misunderstood corporatism.


Iglesias B, Ramos F, Serrano B, Fàbregas M, Sánchez C, García MJ, Cebrian HM, Aragonés R, Casajuana J, Esgueva N; PIPA Group. A randomized controlled trial of nurses vs. doctors in the resolution of acute disease of low complexity in primary care. J Adv Nurs. 2013.

Rashid C. Benefits and limitations of nurses taking on aspects of the clinical role of doctors in primary care: integrative literature review. J Adv Nurs. 2010;66(8):1658-70.

Hollinghurst S, Horrocks S, Anderson E, Salisbury C. Comparing the cost of nurse practitioners and GPs in primary care: modelling economic data from randomised trials. Br J Gen Pract. 2006;56(528):530-5.


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