Effects of community based nurses specialising in Parkinson's disease on health outcome and costs: randomised controlled trial - PubMed (original) (raw)

Clinical Trial

Effects of community based nurses specialising in Parkinson's disease on health outcome and costs: randomised controlled trial

Brian Jarman et al. BMJ. 2002.

Abstract

Objective: To determine the effects of community based nurses specialising in Parkinson's disease on health outcomes and healthcare costs.

Design: Two year randomised controlled trial.

Setting: 438 general practices in nine randomly selected health authority areas of England.

Participants: 1859 patients with Parkinson's disease identified by the participating general practices.

Main outcome measures: Survival, stand-up test, dot in square test, bone fracture, global health question, PDQ-39, Euroqol, and healthcare costs.

Results: 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 2658 pounds sterling during the study, although not differentially between groups: the average increase was 266 pounds sterling lower among patients attended by a nurse specialist (-981 pounds sterling to 449 pounds sterling ).

Conclusions: 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.

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Figures

Figure 1

Figure 1

Selection of health authority areas. Numbers with names of health authorities are amended underprivileged area scores (excludes under 5s component)

Figure 2

Figure 2

Area under curve method used to combine global question responses. Participants at intersection (0,0) at baseline. Participant moves one unit along x axis during year 1. Movement on y axis determined by global health response (for example, “much better” stays on axis (1,0), “better” goes up by one unit (1,1). During year 2 participants move another unit along x axis, with movement on y axis defined same as year 1. Participant much better in each year therefore stays on x axis, moving from (0,0) to (2,0) and has an area under curve of 0 units. Participant “much worse” in each year moves from (0,0) to (2,8) and has an area under curve of 8 units. Participants getting much better in year 1 and staying same in year 2 arrive at same point (2,2) as someone staying same and then getting much better. Former patient will have higher score, however, reflecting earlier benefit

Figure 3

Figure 3

Participant flow through study

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