title: Patient satisfaction with nursing consultations in a rheumatology outpatient clinic: a 21-month randomised controlled trial in patients with inflammatory arthritides.
abstract: OBJECTIVE
  To study the effect of individual nursing consultations in patients treated with disease-modifying antirheumatic drugs (DMARDs) in a rheumatology outpatient setting.
  
  
  METHODS
  Patients with inflammatory arthritides (IA) who had started with a DMARD regimen 3 months before were randomised to two different follow-up consultation systems: either follow-up by a clinical nurse specialist (CNS) or by a medical doctor (MD) in rheumatology 3, 9 and 21 months after randomisation. The primary outcome was patient satisfaction measured by Leeds Satisfaction Questionnaire (LSQ). Secondary outcomes included coping, disease activity, pain, fatigue, patient's global assessment of disease activity and health related quality of life. Effects at 9 and 21 months were estimated by Least Square means calculated from the final mixed model.
  
  
  RESULTS
  Of 68 patients randomised, 65 patients completed assessments at 21 months. Statistically significant improvements in favour of the CNS group were found in all LSQ subscales (all p values<0.001) and in overall satisfaction at 9 months (adjusted mean between-group difference 0.74, 95% CI -0.96 to -0.52) and at 21 months (-0.69, 96% CI -0.87 to -0.50). Disease activity Score 28 joint count (DAS-28) was improved from baseline to 9 months in both groups and improvement was maintained at 21 months, but without any group difference. No statistically significant between-group differences were found in any of the other secondary outcomes.
  
  
  CONCLUSIONS
  Patients with IA are likely to benefit from nurse consultations in terms of increased satisfaction with care compared with MD consultations and without loss of efficacy in terms of clinical outcomes. The study is registered as a clinical trial at the ClinicalTrials.gov (NCT00403676).
authors: Department of Rheumatology, University Hospital of Trondheim, Trondheim, Norway. hege.koksvik@ntnu.no
authors: Hege Svean
authors: HS
authors: Koksvik
authors: Kåre Birger
authors: KB
authors: Hagen
authors: Erik
authors: E
authors: Rødevand
authors: Petter
authors: P
authors: Mowinckel
authors: Tore K
authors: TK
authors: Kvien
authors: Heidi A
authors: HA
authors: Zangi
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001172:Arthritis, Rheumatoid / Q000451:nursing*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012219:Rheumatology / Q000379:methods*; D013041:Specialties, Nursing / Q000379:methods*; D025242:Spondylarthropathies / Q000451:nursing*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Arthritis; Disease Activity; Health services research; Nursing; Patient perspective