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Effectiveness and Efficiency

Sheldon Greenfield, MD; Anthony L. Komaroff, MD; Hjalmar Anderson, MD

Arch Intern Med. 1976;136(10):1111-1116.

Abstract
To test the effectiveness and efficiency of a nurse-administered protocol for headache in a primary care setting, we conducted a prospective controlled trial. Two hundred three randomly allocated patients were evaluated by nurses using the protocol who managed independently 55.2% of the patients and received physician consultation on the others. A total of 193 patients were randomly allocated to the physician-control group. Nurse-protocol group patients experienced equivalent symptomatic relief and expressed significantly greater satisfaction with the care they had received than did patients in the physician-control group. A retrospective study of the presenting findings in patients with serious disease of the CNS provided evidence supporting the safety of the protocol logic. We conclude that nurse-protocol management of headache in this primary care practice was effective and efficient.

(Arch Intern Med 136:1111-1116, 1976)

Author Affiliations
From the Department of Medicine, Schools of Medicine and Public Health, University of California, Los Angeles (Dr Greenfield); the Ambulatory Care Project of the Department of Medicine, Beth Israel Hospital, Harvard Medical School, Boston (Dr Komaroff); the Massachusetts Institute of Technology, Lincoln Laboratory, Lexington, Mass; and the Southern California Kaiser Permanente Medical Group, Los Angeles (Dr Anderson).

Footnotes
Accepted for publication April 14, 1976.

Read in part before the American College of Physicians, San Francisco, April 8, 1975.

Reprint requests to UCLA School of Public Health, Room 73-274, Center for the Health Sciences, Los Angeles, CA 90024 (Dr Greenfield).

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