Scientific evaluation of community-based Parkinson's disease nurse specialists on patient outcomes and health care costs
To determine the effects of community based nurses specialising in Parkinson's disease on health outcomes and healthcare costs.
Two year randomised controlled trial in 438 general practices in nine randomly selected health authority areas of England.
1859 patients with Parkinson's disease identified by the participating general practices.
Survival, stand-up test, dot in square test, bone fracture, global health question, PDQ-39, Euroqol, and healthcare costs.
After two years 315 (17.3%) patients had died, although mortality did not differ between those who were attended by nurse specialists and those receiving standard care from their general practitioner (hazard ratio for nurse group v control group 0.91, 95% confidence interval 0.73 to 1.13). No significant differences were found between the two groups for the stand-up test (odds ratio 1.15, 0.93 to 1.42) and dot in square score (difference -0.7, -3.25 to 1.84). Scores on the global health question were significantly better in patients attended by nurse specialists than in controls (difference -0.23, -0.4 to -0.06), but no difference was observed in the results of the PDQ-39 or Euroqol questionnaires. Direct costs for patient health care increased by an average of pound2658 during the study, although not differentially between groups: the average increase was pound266 lower among patients attended by a nurse specialist (- pound981 to pound449).
Nurse specialists in Parkinson's disease had little effect on the clinical condition of patients, but they did improve their patients' sense of wellbeing, with no increase in patients' healthcare costs.
Available from: Mary R O'Brien
- "Previous research has indicated that nurse-led services are effective, well received by patients and often regarded as a preferable option for patients compared with medical led care (Appleton & Sweeney 1995, De Broe et al. 2001, Hurwitz et al. 2005). Indeed, Specialist nurses play a vital role in trying to improve the quality of service for this group of patients. "
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ABSTRACT: The aim of this study was to explore patients and carers views and experiences of the impact of the Generic Neurology Nursing Service.
Neurological conditions are a major cause of disability and are estimated to affect up to one billion people worldwide. It is clear that this number is set to rise as the world's population is ageing. Although there are established disease specific neurological specialist nursing services that have been reported as benefitting patients and carers, not all neurological patients are captured in these services. To address this deficit and to provide a rapidly accessible service the Generic Neurology Service was established.
A qualitative study using joint and one to one semi structured interviews. A purposive sample of 20 patients and carers participated in the study.
Two broad themes emerged which are inextricably linked: longer consultation times and the benefit of seeing a knowledgeable specialist nurse.
The respondents in this study reported the benefits of a longer consultation time coupled with the opportunity to talk freely about their symptoms and to ask more questions. All the patients and carers interviewed in this study were satisfied with the care provided by the Generic Neurology Nurse Service, with the majority highlighting improvements it has made in their lives.
This study has shown how a novel approach to service design and delivery can help to bridge the gap in the provision of a bespoke service for patients with a neurological condition who currently are receiving sub optimal care. Having a service that patients can rapidly access can be suggested as preventing clinical emergencies, maintaining patients' self management and resulting in care of the level of the best.
Available from: Alison While
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ABSTRACT: Specialist nurses are being promoted as a means of improving the health care provided to people with multiple sclerosis (MS).
To identify the impact of a programme of MS specialist nurses on MS health care provision and on the health and well-being of people with MS.
A quasi-experimental design comparing an intervention group in which new MS nurse posts were installed with a control group that had no MS nurse posts.
Six neurological services in four English regions.
Seven hundred and fifty-three of the 1510 people invited to participate returned completed questionnaires at baseline. Follow-up of participants was 82% with 616 patients participating in the main outcome analysis.
Data were collected prospectively before the appointment of the MS nurses and then at 12 and 24 months. Data were collected via a postal questionnaire comprising questions related to care processes (information provision and care quality) and health outcome measures, hospital admissions, MS complications, health-related quality of life (SF36) and disease impact (MS Impact Scale-29). Analysis repeated measures in CAT MOD for process variables and ANCOVA to longest follow-up for outcome measures.
Information provision was higher in the intervention group (68% (n=153) compared to 53% (n=98) at 24 months) but no significant improvement was observed in information provision through time compared to the control group. There was an increase in the availability of a contact person in the intervention group, at 24 months 83% (n=42) had a contact person compared to 44% in the control (p=0.01). The only significant finding in relation to MS complications was a reduction of 17% in the incidence of pressure ulcers in the intervention sites compared to a 3% reduction in the control (p<0.001). In relation to the disease and health-related quality of life measures, the intervention group showed a small but significant (p<0.05) worsening in the physical and symptom scales of the SF36 compared to the control (mean differences: physical function -2.81, CI -5.45 to -0.1; bodily pain -4.09, CI -7.2 to -0.9; general health -5.35, CI -8.1 to -2.5; and energy and vitality -2.82, CI -5.5 to -0.1). No differences were observed in relation to disease impact or psychosocial well-being, although a relative benefit in mental health (with a 7.8 point advantage on the SF36 mental health scale, p=0.04) was observed in some of the intervention sites for people with relapsing/remitting MS.
The specialist nurse programme was found to impact positively on the provision of MS-related health care. However, there was very limited evidence that the programme led to any improvements in disease-related problems, impact or health-related quality of life, These findings were in part explained by the inherent difficulties of measuring effects in evaluations of complex phenomena such as a nursing role. The deterioration observed in the intervention group on the physical outcome measures was explained by a selection bias in which people with worsening health were more likely to seek contact with a specialist nurse. It is contended that future research in this area may be better directed toward identifying specific interventions that nurses and other health professionals might employ in addressing the many problems confronting people with MS.
Available from: Joerg Haslbeck
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ABSTRACT: Obgleich Medikamente ein Eckpfeiler der Therapie bei chronischer Krank-heit sind, ist die Arzneimittelversorgung gerade bei älteren, an multiplen Gesundheitsbeeinträchtigungen leidenden Patienten oft alles andere als optimal. Reformbemühungen konzentrieren sich bislang weitgehend auf die Verbesserung der Arzneimittelsicherheit und des ärztlichen Verordnungs-verhaltens und zielen damit vorrangig auf die Ärzte und die Apotheker. In dem Projekt, aus dem hier berichtet wird, richtet sich der Blick noch auf eine andere Profession, auf die ambulante Pflege. Gefragt wird nach ihren Potenzialen zur Optimierung der Medikamentenversorgung und danach, wie sie bei chronisch kranken Patienten zur Unterstützung der vielfältigen Herausforderungen beitragen kann, die komplexe Medikamentenregime im Alltag aufwerfen, und wie sie deren Selbstmanagement verbessern kann. Um diese Frage zu beantworten, wurde eine zweischrittige, mehr-perspektivische empirische Untersuchung durchgeführt. In einem ersten Schritt erfolgte eine Expertenbefragung, in deren Rahmen (Haus-)Ärzte, Apotheker und ambulante Pflegekräfte nach ihrer Problemwahrnehmung und ihren Interventionspotenzialen bei der Bewältigung von komplexen Medikamentenregimen befragt wurden. In einem zweiten Schritt wurden auf der Basis einer Patientenbefragung Fallverläufe von chronisch erkrank-ten Patienten mit komplexen Medikamentenregimen erhoben.
In dem vorliegenden Bericht stehen die Ergebnisse der Expertenbefra-gung im Mittelpunkt. Damit werden Teilergebnisse der ersten Phase des vom BMBF geförderten Forschungsvorhabens „Alltagsnahe Förderung der Adhärenz und des Selbstmanagements chronisch erkrankter Patienten mit komplexen Medikamentenregimen“ dargestellt. Das Projekt gehört zum Pflegeforschungsverbund NRW „Patientenorientierte Pflegekonzepte zur Bewältigung chronischer Krankheit“ (Förderkennziffer: 01GT0315).
Der Aufbau des Berichts stellt sich folgendermaßen dar: Ausgehend von einem kurzen Problemaufriss wird die jeweilige Problemwahrnehmung der niedergelassenen (Haus-)Ärzte, Apotheker und der ambulanten Pflegekräfte analysiert und danach gefragt, welches die aus ihrer Sicht wichtigsten Herausforderungen und Interventionserfordernisse des Managements kom-plexer Medikamentenregime sind, über welche Interventionspotenziale sie verfügen und welche Grenzen ihnen gesetzt sind. Die Ergebnisse werden abschließend mit Blick auf die Frage danach gebündelt, wie ein wirksames Interventionskonzept zur Adhärenz- und Selbstmanagmentförderung, das dem Bedarf und den Bedürfnissen der Patienten an Unterstützung gerecht wird, konturiert sein sollte.
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