A randomised controlled crossover trial of nurse practitioner versus doctor-led outpatient care in a bronchiectasis clinic

R&D Unit, Papworth Hospital NHS Trust, Cambridge, UK.
Health technology assessment (Winchester, England) (Impact Factor: 5.03). 02/2002; 6(27):1-71. DOI: 10.3310/hta6270
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Available from: Diana Bilton
    • "The findings show that specialist nurses working on their own can effectively provide clozapine monitoring services, but that the lack of direct access to doctors in such clinics may increase demands on outpatient psychiatric consultations and use of mental health nurses in the community. This is consistent with other research that has concluded that nurses, when compared with doctors, tend to refer more (Reynolds et al. 2000, Sharples et al. 2002), even if there are few differences in patient outcomes and processes of care (Laurent et al. 2004). In general, nurses have been found to provide cost-effective care (Goryakin et al. 2011), and clinic costs per patient in this study in two of the larger sole nurse clinics (D, F) were largely comparable to those in the more efficient MDT clinics (A, B). "
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    ABSTRACT: AimTo compare sole nurse and doctor-led multidisciplinary team delivery of community clozapine services for people with treatment-resistant schizophrenia.Background Around 20% of people with schizophrenia are treatment resistant and fail to respond to front line medications. Clozapine, a second-line treatment, has potentially serious side effects requiring regular monitoring. Different models of community clozapine services are emerging in the British National Health Service, but there is little evidence about which is best.DesignQuestionnaire survey of service users.Methods All patients on the lists of seven clozapine clinics (four sole nurse, three multidisciplinary team) in one trust were invited to participate, 2009–2010. Forward stepwise regression was used to investigate associations between patient well-being, functioning, self-efficacy and satisfaction, and clinic model attended, controlling for socio-demographic and health characteristics and processes of care. Use (and costs) of other health and social services accessed was compared between models.ResultsSixty-six service users (35% participation rate) responded. Well-being and functioning were associated with patient characteristics and processes of care, not clinic model. Patients managed by sole nurses reported, over 3 months: more community psychiatric nurse visits and hospital psychiatrist appointments. Clinic list size affects costs per patient.Conclusions Multidisciplinary team delivery may reduce use of other services. Although multidisciplinary team delivery is regarded as best practice, sole nurses can effectively provide clozapine services and may be warranted in areas of low population density.
    No preview · Article · Oct 2014 · Journal of Advanced Nursing
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    ABSTRACT: Many people do not take their medication as prescribed. Our review considered trials of ways to help people follow prescriptions. For short-term drug treatments, counseling, written information and personal phone calls helped. For long-term treatments, no simple intervention, and only some complex ones, led to improvements in health outcomes. They included combinations of more convenient care, information, counseling, reminders, self-monitoring, reinforcement, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and other forms of additional supervision or attention. Even with the most effective methods for long-term treatments, improvements in drug use or health were not large. Fortunately, several studies showed that telling people about adverse effects of their medications did not affect their use of the medications.
    Full-text · Article · Feb 2005 · Cochrane database of systematic reviews (Online)
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