This article is more than 5 years old. Information may no longer be current.
Nurse-led care relatively comparable to rheumatologist-led care for RA patients
Nurse-led care for patients with rheumatoid arthritis was relatively effective compared with rheumatologist-led care, with possible clinical benefits in the nurse-led program, according to recent study results
In a control trial, researchers studied 181 adults with rheumatoid arthritis (RA) at 10 rheumatology centers across the United Kingdom. Ninety-one patients were randomly assigned to nurse-led care (NLC; patient mean age, 60.2 years; 67% women; mean disease duration, 9.57 years), while 90 patients were assigned to rheumatologist-led care (RLC; mean age, 57.27 years; 67% women; mean disease duration, 10.21 years). Both groups continued normal practice.
Disease Activity Score 28 (DAS28) assessed at baseline and weeks 13, 26, 39 and 52, was primary outcome, with DAS28 change of 0.6 being the non-inferiority margin.
Per-protocol (PP) and intention-to-treat (ITT) strategies were used for analysis. EuroQoL was used for economic evaluation.
NLC and RLC patients had comparable demographics and baseline characteristics.
NLC had longer consultations (median, 20 minutes) compared with RLC (median, 15 minutes) and had fewer medication and dosage changes. PP analysis showed that overall baseline adjusted in DAS28 mean change for RLC minus NLC was -0.31 (95% CI, -0.63 to 0.02), while ITT analysis showed a change of -0.15 (95% CI, -0.45 to 0.14).
PP analysis showed that the mean difference in health care cost (RLC minus NLC) was 710 pounds (95% CI, -352 pounds to 1,773 pounds), while the mean difference was 128 pounds (95% CI, -1,263 pounds to 1,006 pounds) in ITT analysis.
Cost-effectiveness was shown in NLC in respect to cost and DAS28; however, it was not displayed in quality adjusted life years utility scores. Significance for non-inferiority of NLC was met in all secondary outcomes. “General satisfaction” scores were higher for NLC than RLC at week 26.
“The results provide robust evidence to support non-inferiority of NLC in the management of RA,” the researchers concluded. “Indeed, our findings have shown that here may be some clinical benefits of NLC, particularly in respect of disease-specific outcome and general satisfaction with care. … We are not able to draw firm conclusions on cost-effectiveness.”
Disclosure: The researchers report no relevant financial disclosures.