Patient satisfaction with nursing consultations in a rheumatology outpatient clinic: a 21-month randomised controlled trial in patients with inflammatory arthritides
- Hege Svean Koksvik1,
- Kåre Birger Hagen2,
- Erik Rødevand1,
- Petter Mowinckel2,
- Tore K Kvien3,
- Heidi A Zangi2
- 1Department of Rheumatology, University Hospital of Trondheim, Trondheim, Norway
- 2Department of Rheumatology, National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- 3Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Correspondence to Dr Hege Svean Koksvik, Department of Rheumatology, University Hospital of Trondheim, St. Olavs Hospital, PO Box 3250, Sluppen, Trondheim 7006, Norway;
- Received 2 July 2012
- Revised 11 January 2013
- Accepted 13 January 2013
- Published Online First 7 February 2013
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.
The study is registered as a clinical trial at the ClinicalTrials.gov (NCT00403676).