期刊
ANNALS OF THE RHEUMATIC DISEASES
卷 72, 期 6, 页码 836-843出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/annrheumdis-2012-202296
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资金
- Pahle Legacy, National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo
- St. Olavs Hospital, Trondheim, Norway
- Liason Committee Central Norway Regional Health Authority-NTNU
- Abbott
- Amgen
- Aventis
- BMS
- Roche
- MSD/Schering-Plough/Centocor
- Pfizer/Wyeth
- Norwegian Directorate for Health and Social Affairs
Objective To study the effect of individual nursing consultations in patients treated with disease-modifying antirheumatic drugs (DMARDs) in a rheumatology outpatient setting. Methods Patients with inflammatory arthritides (IA) who had started with a DMARD regimen 3 months before were randomised to two different follow-up consultation systems: either follow-up by a clinical nurse specialist (CNS) or by a medical doctor (MD) in rheumatology 3, 9 and 21 months after randomisation. The primary outcome was patient satisfaction measured by Leeds Satisfaction Questionnaire (LSQ). Secondary outcomes included coping, disease activity, pain, fatigue, patient's global assessment of disease activity and health related quality of life. Effects at 9 and 21 months were estimated by Least Square means calculated from the final mixed model. Results Of 68 patients randomised, 65 patients completed assessments at 21 months. Statistically significant improvements in favour of the CNS group were found in all LSQ subscales (all p values <0.001) and in overall satisfaction at 9 months (adjusted mean between-group difference 0.74, 95% CI -0.96 to -0.52) and at 21 months (-0.69, 96% CI -0.87 to -0.50). Disease activity Score 28 joint count (DAS-28) was improved from baseline to 9 months in both groups and improvement was maintained at 21 months, but without any group difference. No statistically significant between-group differences were found in any of the other secondary outcomes. Conclusions Patients with IA are likely to benefit from nurse consultations in terms of increased satisfaction with care compared with MD consultations and without loss of efficacy in terms of clinical outcomes.
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