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 12months): (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+13.5years). Statistically significant differences were found in patients attended in sites without NCR, at some of the visits (baseline, 6 or 12months), for the following parameters: higher CRP level (5.9mg/l±8.3 vs 4.8mg/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.