ORIGINAL ARTICLE

A randomised controlled crossover trial of nurse practitioner versus doctor led outpatient care in a bronchiectasis clinic

L D Sharples^1,2, J Edmunds³, D Bilton³, W Hollingworth⁴, N Caine^2,4, M Keogan^3,5, A Exley³

¹ MRC Biostatistics Unit, University of Cambridge, Cambridge CB2 2SR, UK
² R&D Unit, Papworth Hospital NHS Trust, Papworth Everard, Cambridge CB3 8RE, UK
³ Lung Defence Unit, Papworth Hospital NHS Trust
⁴ Department of Public Health and Primary Care, University of Cambridge
⁵ Department of Immunology, Beaumont Hospital, Dublin 9, Ireland

Correspondence to:
Correspondence to:
Dr L D Sharples, MRC Biostatistics Unit, University Forvie Site, Cambridge CB2 2SR, UK;
linda.sharples{at}mrc-bsu.cam.ac.uk

Background: With the decrease in junior doctor hours, the advent of specialist registrars, and the availability of highly trained and experienced nursing personnel, the service needs of patients with chronic respiratory diseases attending routine outpatient clinics may be better provided by appropriately trained nurse practitioners.

Methods: A randomised controlled crossover trial was used to compare nurse practitioner led care with doctor led care in a bronchiectasis outpatient clinic. Eighty patients were recruited and randomised to receive 1 year of nurse led care and 1 year of doctor led care in random order. Patients were followed up for 2 years to ensure patient safety and acceptability and to assess differences in lung function. Outcome measures were forced expiratory volume in 1 second (FEV₁), 12 minute walk test, health related quality of life, and resource use.

Results: The mean difference in FEV₁ was 0.2% predicted (95% confidence interval –1.6 to 2.0%, p=0.83). There were no significant differences in the other clinical or health related quality of life measures. Nurse led care resulted in significantly increased resource use compared with doctor led care (mean difference £1497, 95% confidence interval £688 to £2674, p<0.001), a large part of which resulted from the number and duration of hospital admissions. The mean difference in resource use was greater in the first year (£2625) than in the second year (£411).

Conclusions: Nurse practitioner led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care, but may use more resources.

Keywords: bronchiectasis; nurse practitioner

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