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

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 trained practitioners made many more signs and symptoms diagnoses and asked for help more frequently. The nurses did much of the preventive measures and made more diagnoses in the supplementary diagnostic class. Physicians diagnosed medically sophisticated conditions more frequently. The physicians did considerable reassuring, suggesting that many cases referred to them were adequately handled. They were also more likely to order investigations.