title: A randomised controlled crossover trial of nurse practitioner versus doctor led outpatient care in a bronchiectasis clinic.
abstract: BACKGROUND
  With the decrease in junior doctor hours, the advent of specialist registrars, and the availability of highly trained and experienced nursing personnel, the service needs of patients with chronic respiratory diseases attending routine outpatient clinics may be better provided by appropriately trained nurse practitioners.
  
  
  METHODS
  A randomised controlled crossover trial was used to compare nurse practitioner led care with doctor led care in a bronchiectasis outpatient clinic. Eighty patients were recruited and randomised to receive 1 year of nurse led care and 1 year of doctor led care in random order. Patients were followed up for 2 years to ensure patient safety and acceptability and to assess differences in lung function. Outcome measures were forced expiratory volume in 1 second (FEV(1)), 12 minute walk test, health related quality of life, and resource use.
  
  
  RESULTS
  The mean difference in FEV(1) was 0.2% predicted (95% confidence interval -1.6 to 2.0%, p=0.83). There were no significant differences in the other clinical or health related quality of life measures. Nurse led care resulted in significantly increased resource use compared with doctor led care (mean difference pound 1497, 95% confidence interval pound 688 to pound 2674, p<0.001), a large part of which resulted from the number and duration of hospital admissions. The mean difference in resource use was greater in the first year ( pound 2625) than in the second year ( pound 411).
  
  
  CONCLUSIONS
  Nurse practitioner led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care, but may use more resources.
authors.affiliation: MRC Biostatistics Unit, University of Cambridge, Cambridge CB2 2SR, UK. linda.sharples@mrc-bsu.cam.ac.uk
authors.forename: L D
authors.initials: LD
authors.lastname: Sharples
authors.forename: J
authors.initials: J
authors.lastname: Edmunds
authors.forename: D
authors.initials: D
authors.lastname: Bilton
authors.forename: W
authors.initials: W
authors.lastname: Hollingworth
authors.forename: N
authors.initials: N
authors.lastname: Caine
authors.forename: M
authors.initials: M
authors.lastname: Keogan
authors.forename: A
authors.initials: A
authors.lastname: Exley
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration*; D001987:Bronchiectasis / Q000191:economics / Q000451:nursing* / Q000503:physiopathology; D002983:Clinical Competence; D018592:Cross-Over Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010349:Patient Compliance; D011788:Quality of Life; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology