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

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.

Figures

Figure 1

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

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

Participant flow through study