title: Evaluation of the impact of nursing clinics in the rheumatology services.
abstract: Nursing clinics in rheumatology (NCRs) are organisational care models that provide care centred within the scope of a nurse's abilities. To analyse the impact of NCR in the rheumatology services, national multicenter observational prospective cohort studied 1-year follow-up, comparing patients attending rheumatology services with and without NCR. NCR was defined by the presence of: (1) office itself; (2) at least one dedicated nurse; and (3) its own appointment schedule. Variables included were (baseline, 6 and 12 months): (a) test to evaluate clinical activity of the disease, research and training, infrastructure of unit and resources of NCR and (b) tests to evaluate socio-demographics, work productivity (WPAI), use of services and treatments and quality of life. A total of 393 rheumatoid arthritis and ankylosing spondylitis patients were included: 181 NCR and 212 not NCR, corresponding to 39 units, 21 with NCR and 18 without NCR (age 53 + 11.8 vs 56 + 13.5 years). Statistically significant differences were found in patients attended in sites without NCR, at some of the visits (baseline, 6 or 12 months), for the following parameters: higher CRP level (5.9 mg/l ± 8.3 vs 4.8 mg/l ± 7.8; p < 0.005), global disease evaluation by the patient (3.6 ± 2.3 vs 3.1 ± 2.4), physician (2.9 ± 2.1 vs 2.3 ± 2.1; p < 0.05), use of primary care consultations (2.7 ± 5.4 vs 1.4 ± 2.3; p < 0.001) and worse work productivity. The presence of NCR in the rheumatology services contributes to improve some clinical outcomes, a lower frequency of primary care consultations and better work productivity of patients with rheumatic diseases.
authors.affiliation: Rheumatology Section, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes (Madrid), Universidad Europea de Madrid, Paseo de Europa 34. San Sebastián de los Reyes, 28702, Madrid, Spain. santiago.munoz@salud.madrid.org.
authors.forename: Santiago
authors.identifier: http://orcid.org/0000-0002-2758-2085
authors.initials: S
authors.lastname: Muñoz-Fernández
authors.affiliation: , Madrid, Spain.
authors.forename: Ma Dolores
authors.initials: MD
authors.lastname: Aguilar
authors.affiliation: Rheumatology Section, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes (Madrid), Universidad Europea de Madrid, Paseo de Europa 34. San Sebastián de los Reyes, 28702, Madrid, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Rodríguez
authors.affiliation: Rheumatology Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Almodóvar
authors.affiliation: Rheumatology Clinical Management Unit, Málaga Institute of Biomedical Research (Instituto de Investigación biomédica de Málaga, IBIMA), Hospital Regional de Málaga, Universidad de Málaga, Málaga, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Cano-García
authors.affiliation: Rheumatology Section, Hospital de Sagunto, Valencia, Spain.
authors.forename: Luís Antonio
authors.initials: LA
authors.lastname: Gracia
authors.affiliation: Research Unit from the Rheumatology Service, Hospital Universitario y Politécnico La Fe, Universidad Católica, Valencia, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Román-Ivorra
authors.affiliation: Rheumatology Unit, Hospital General de Vic, Vic, Barcelona, Spain.
authors.forename: J Ramón
authors.initials: JR
authors.lastname: Rodríguez
authors.affiliation: Rheumatology Section, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Navío
authors.affiliation: , Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lázaro
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D011446:Prospective Studies; D011788:Quality of Life; D012216:Rheumatic Diseases / Q000451:nursing*; D012219:Rheumatology; D016896:Treatment Outcome
keywords: Ankylosing spondylitis; Health services research; Nursing; Quality indicators; Rheumatoid arthritis