title: Effects of community based nurses specialising in Parkinson's disease on health outcome and costs: randomised controlled trial.
abstract: OBJECTIVE
  To determine the effects of community based nurses specialising in Parkinson's disease on health outcomes and healthcare costs.
  
  
  METHODS
  Two year randomised controlled trial.
  
  
  METHODS
  438 general practices in nine randomly selected health authority areas of England.
  
  
  METHODS
  1859 patients with Parkinson's disease identified by the participating general practices.
  
  
  METHODS
  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 pounds sterling during the study, although not differentially between groups: the average increase was 266 pounds sterling lower among patients attended by a nurse specialist (-981 pounds sterling to 449 pounds sterling ).
  
  
  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.
authors: Department of Primary Health Care and General Practice, Centre for Primary Care and Social Medicine, Imperial College of Science, Technology, and Medicine, London W6 8RP.
authors: Brian
authors: B
authors: Jarman
authors: Brian
authors: B
authors: Hurwitz
authors: Adrian
authors: A
authors: Cook
authors: Madhavi
authors: M
authors: Bajekal
authors: Alison
authors: A
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D003152:Community Health Nursing / Q000191:economics / Q000458:organization & administration*; D004739:England; D005194:Family Practice / Q000191:economics / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D016017:Odds Ratio; D010300:Parkinson Disease / Q000191:economics / Q000451:nursing*; D015996:Survival Rate; D016896:Treatment Outcome