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February 1974

Upper-Respiratory Tract Complaint Protocol for Physician-Extenders

Author Affiliations


From the Ambulatory Care Service, Department of Medicine, Beth Israel Hospital. Dr. Greenfield is currently with the UCLA School of Medicine, Dr. Bragg is in private practice in Bangor, Me, and Dr. McCraith is with Medi-Tech, Inc, Cambridge, Mass.

Arch Intern Med. 1974;133(2):294-299. doi:10.1001/archinte.1974.00320140132015

A protocol for upper-respiratory tract complaints was administered to 226 patients in a walk-in clinic. The protocol, for use by a physician-extender in conjunction with a physician, specified the collection of data necessary for management. A decision-making algorithm separated the major causes of upper respiratory infection (URI) complaints and led to one of four plans: a physician referral, a culture only, antibiotic treatment, or symptomatic treatment only. Each patient was seen by a physician following the health assistant's interview. Of 226 patients, 96 (42%) would have been sent home by the protocol without seeing the physician. None of these had a complication of URI. Sixteen (7%) of the 226 had serious complication— all would have been referred to the physician. The protocol proved to be safe and efficient, acceptable to patients, and a reliable approach to physician-extender management of URI.