Scientific evaluation of community-based Parkinson's disease nurse specialists on patient outcomes and health care costs
Version of Record online: 15 MAR 2005
Journal of Evaluation in Clinical Practice
Volume 11, Issue 2, pages 97–110, April 2005
How to Cite
Hurwitz, B., Jarman, B., Cook, A. and Bajekal, M. (2005), Scientific evaluation of community-based Parkinson's disease nurse specialists on patient outcomes and health care costs. Journal of Evaluation in Clinical Practice, 11: 97–110. doi: 10.1111/j.1365-2753.2005.00495.x
- Issue online: 15 MAR 2005
- Version of Record online: 15 MAR 2005
- Accepted for publication: 26 January 2004
- community nursecare;
- nurse specialists;
- Parkinson's disease;
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 in 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 during the study, although not differentially between groups: the average increase was £266 lower among patients attended by a nurse specialist (−£981 to £449).
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.