The effectiveness of a peripatetic allergy nurse practitioner service in managing atopic allergy in general practice—a pilot study

Abstract

The effectiveness of an allergy nurse practitioner service operating within community health care was evaluated in terms of symptom improvement and reduction in allergy related general practitioner consultations and prescribed medication. A postal questionnaire survey of 53 allergy patients, identified from three general practices in the Norwich area during a pilot scheme, was carried out concurrently with a survey of the patients' case records at the surgeries. The questionnaire included questions concerning allergy status, general practitioner visits and the number of prescribed medications supplied. The main outcome measures were the number of general practitioner consultations and prescribed medications before and after the allergy nurse practitioner consultation and the patient's reported level of symptoms. The results showed that the intervention of an allergy nurse practitioner consultation produced significant reductions in the outcome measures. The number requiring a general practitioner consultation fell by 40% (from 133 to 80, P < 0.001) and the number of prescribed medications fell by 42% (from 153 to 89, P < 0.001). Twenty-seven (69%) of the 39 patients who responded to the questionnaire reported an improvement in symptoms, whilst 26% (n = 10) remained the same and 5% (n = 2) were worse. An additional study of 23 of the +ve skin-tested patients, over an extended period, showed greater reductions in general practitioner consultations and prescribed medication (71%, P < 0.001 and 59%, P < 0.004 respectively). In conclusion, it is apparent that the application of developed skills and expertise in allergy assessment by a nurse coupled with time can lead to improvement in symptom level in allergy patients. Such a service also has the possibility of providing savings within the National Health Service. Simply prescribing drugs without a system of self-management and avoidance measures is unlikely to improve the care available to allergy patients.