Concurrent Oral 5 – BHPR Audit/Service Delivery and Research [OP32–OP39]

Background: The aim of this systematic review was to assess the effectiveness of nurse-led care (NLC) by comparing its outcomes with those of physician-led care or multidisciplinary care in rheumatology. Methods: MEDLINE, EMBASE, CINAHL and EBM reviews (Jan 1988 - Sept 2009) were searched using the terms: (nurse led OR nurse practitioner OR nurse specialist) and (effectiveness OR treatment outcome). The inclusion criteria were: 1) Primary studies with reported patient outcome data 2) RCTs with at least 2 concurrent intervention groups comparing nurse-led care and physician-led or multidisciplinary care. Economic evaluations were excluded. The titles and abstracts identified were screened independently by two reviewers (MN and KV) for relevance and design. Heterogeneity of outcome measures prevented a meta-analysis. Effectiveness of interventions was reported based on the patients’ main outcome(s) at the end of study with corresponding effect sizes. The effect sizes were calculated and reported as standardized mean difference (SMD), relative risk (RR) and ratio of means (RoM) as appropriate. Results: The search yielded 1907 articles, 56 of which met the inclusion criteria but only 8 were in rheumatology and were chosen for a detailed review (see Table). Five studies looked into NLC effectiveness in Rheumatoid arthritis (RA), two in osteoarthritis (OA) and one in fibromyalgia. NLC was compared with care by rheumatologist (RLC), junior hospital doctor (JHD), GP and with inpatient team care or day patient team care. All studies were from the UK and Netherlands and had varying quality with sample sizes ranging from 70 to 210. The primary outcomes were disease activity, functional status, coping with OA, health status for RA patients, patients' perception of their ability to control their RA, nurse-doctor diagnosis agreement and pain control. Although only 5/9 can be considered as nurse-sensitive outcomes, between group analyses of all outcomes demonstrated non-inferiority of NLC. Conclusions: The data in the review support the effectiveness of NLC intervention for patients with RA and OA. More high quality studies are required to demonstrate or refute this observation. Disclosure statement: All authors have declared no conflicts of interest.