Community nurses specialising in Parkinson's disease may improve patients' feelings of well-being, but not clinical outcomes
- Wilson-Barnett, Professor Jenifer
BACKGROUND
Around two-thirds of people with Parkinson's disease in the United Kingdom do not have regular contact with a consultant, but rely instead on general practitioners for medical care. Most general practitioners care for only a small number of people with Parkinson's disease and may find it difficult to keep up to date with complex and changing treatment options. Nurses specialising in Parkinson's disease have been used to counsel and educate patients, monitor clinical well-being, instigate respite and hospital care and liaise with multidisciplinary primary care teams.
OBJECTIVE
To compare the impact of community-based nurse specialists and general practitioners on health outcomes and costs for people with Parkinson's disease.
SETTING
Four hundred and thirty-eight general practices in nine Health Authority areas in England; 1995 to December 1999.
METHOD
Randomised controlled trial.
PARTICIPANTS
Eighteen hundred and fifty-nine people diagnosed by their doctor or hospital with Parkinson's disease. All were taking one or more antiparkinsonian drugs. People with severe mental illness or cognitive impairment were excluded.
INTERVENTION
Two years of care by community nurses specialising in Parkinson's disease or usual care by a general practitioner. Nine nurses were employed by a university and completed a course on the needs of people with Parkinson's disease and their carers. These nurses visited participants to offer advice and assessment.
OUTCOMES
Survival; bone fracture; quality of life; health-care costs; physical functioning.
MAIN RESULTS
There was no difference in survival, physical functioning or health-care costs between those attended by specialist nurses compared to general practitioners. Global health question scores were higher among those treated by nurse specialists (difference 0.23; 95% CI 0.06 to 0.4).
AUTHORS' CONCLUSIONS
Nurse specialists have little impact on the clinical condition of people with Parkinson's disease.