title: Transfer of care for outpatients with stable chronic obstructive pulmonary disease from respiratory care physician to respiratory nurse--a randomized controlled study.
abstract: OBJECTIVE
  To assess effects on patient outcomes when care for patients with stable chronic obstructive pulmonary disease (COPD) is transferred from respiratory care physician to respiratory nurse.
  
  
  METHODS
  A randomized controlled trial was used with a follow-up period of 9 months. Of 720 patients from the respiratory outpatient clinic of the general and teaching hospital in Alkmaar (The Netherlands), 187 were eligible for randomization and gave informed consent. Ninety-three patients received care from the nurse, and 87 received usual care. Outcomes measured were: clinical parameters, health status, self-care behaviour (including knowledge), patient satisfaction, and consultations with key care providers.
  
  
  RESULTS
  The respiratory nurse reported more consultations than the respiratory care physician [mean (standard deviation)]: number of consultations 3.1 (0.7) by nurse and 2.0 (0.9) by physician (p = 0.007). Patients cared for by the nurse showed worsening in mean forced vital capacity [-5.5% (13.3%) v. +2.9% (18.2%) with physician; p = 0.004], and no difference in self-assessed condition, while improvements were found for subjective knowledge (p = 0.017), self-assessed rate for coping with COPD (p = 0.045), overall satisfaction (p = 0.003), and the majority of individual indicators of satisfaction. Groups showed no differences for forced expiratory volume in 1 s, body mass index, smoking status, health status, objective knowledge, other items of self-care behaviour, and consultations with key care providers.
  
  
  CONCLUSIONS
  Assignment of care for outpatients with stable COPD to the respiratory nurse, working under a protocol, seems to be justified in terms of patient outcomes.
authors: University Maastricht, Faculty of Health, Medicine & Life Sciences, Department of Health Care Studies, PO Box 616, 6200 MD Maastricht, The Netherlands. b.vrijhoef@zw.unimaas.nl
authors: H J M
authors: HJ
authors: Vrijhoef
authors: J H A M
authors: JH
authors: Van Den Bergh
authors: J P M
authors: JP
authors: Diederiks
authors: I
authors: I
authors: Weemhoff
authors: C
authors: C
authors: Spreeuwenberg
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D010819:Physician's Role; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D012648:Self Care; D013147:Spirometry; D011795:Surveys and Questionnaires