An evaluation of a nurse-led ear care service in primary care: benefits and costs.
BACKGROUND
Nurses trained in ear care provide a new model for the provision of services in general practice, with the aim of cost-effective treatment of minor ear and hearing problems that affect well-being and quality of life.


OBJECTIVE
To compare a prospective observational cohort study measuring health outcomes and resource use for patients with ear or hearing problems treated by nurses trained in ear care with similar patients treated by standard practice.


METHODS
A total of 438 Rotherham and 196 Barnsley patients aged 16 years or over received two self-completion questionnaires: questionnaire 1 (Q1) on the day of consultation and questionnaire 2 (Q2) after three weeks. Primary measured outcomes were changes in discomfort and pain; secondary outcomes included the effect on normal life, health status, patient satisfaction, and resources used.


RESULTS
After adjusting for differences at Q1, by Q2 there was no statistical evidence of a difference in discomfort and pain reduction, or differential change in health status between areas. Satisfaction with treatment was significantly higher (P = 0.0001) in Rotherham (91%) than in Barnsley (82%). Average total general practitioner (GP) consultations were lower in Rotherham at 0.4 per patient with an average cost of 6.28 Pounds compared with Barnsley at 1.4 per patient and an average cost of 22.53 Pounds (P = 0.04). Barnsley GPs prescribed more drugs per case (6% of total costs compared with 1.5%) and used more systemic antibiotics (P = 0.001).


CONCLUSIONS
Nurses trained in ear care reduce costs, GP workload, and the use of systemic antibiotics, while increasing patient satisfaction with care. With understanding and support from GPs, such nurses are an example of how expanded nursing roles bring benefits to general practice. Nurses trained in ear care reduce treatment costs, reduce the use of antibiotics, educate patients in ear care, increase patient satisfaction, and raise ear awareness.
Fall
M
M
University of Sheffield.
Walters
S
S
Read
S
S
Deverill
M
M
Lutman
M
M
Milner
P
P
Rodgers
R
R
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004427:Ear Diseases / Q000451:nursing*; D004739:England; D005260:Female; D006311:Hearing Disorders / Q000451:nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies; D011788:Quality of Life