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A Randomized Controlled Trial of Follow-up of Patients Discharged From the Hospital Following Acute Asthma^*

Best Performed by Specialist Nurse or Doctor?

^* From the Department of Respiratory Medicine (Drs. Nathan and Laroche, Ms. Pearce, Ms. Field, and Ms. Dotesio-Eyres), West Suffolk Hospital NHS Trust, Suffolk; Medical Research Council Biostatistics Unit (Dr. Sharples), Institute of Public Health, Cambridge; and Research & Development Unit (Ms. Cafferty), Papworth Hospital NHS Trust, Papworth Everard, Cambridge, UK.

Correspondence to: Clare M. Laroche, FRCP, Department of Respiratory Medicine, West Suffolk Hospital NHS Trust, Bury St Edmunds, Suffolk, IP33 2QZ, UK; e-mail: clare.laroche{at}wsh.nhs.uk

Abstract

Objective: To evaluate whether follow-up of patients recently discharged from the hospital as a result of acute asthma can be adequately provided by a respiratory specialist nurse compared to a respiratory doctor.

Design: Single center, prospective, randomized controlled trial.

Setting: District general hospital in the United Kingdom.

Participants: One hundred fifty-four of 373 eligible patients admitted with acute asthma were enrolled into the study from October 2000 to October 2003. All patients > 16 years of age were eligible for the study. Patients with COPD were excluded.

Intervention: Patients were randomly assigned to receive an initial 30-min follow-up clinic appointment within 2 weeks of hospital discharge with either a specialist nurse or respiratory doctor. This comprised a medical review, patient education, and a self-management asthma plan. Further follow-up was then arranged as was deemed appropriate by the corresponding doctor or nurse. All patients were asked to attend a 6-month appointment.

Measurements: The primary outcome was the number of exacerbations within 6 months of hospital admission. Secondary outcome variables were change in peak flow, quality of life (using the St. George Respiratory Questionnaire (SGRQ) and the Asthma Questionnaire 20 [AQ20]), and clinic attendance.

Results: Outcome data were available for 66 patients in the doctor group and 70 patients in the nurse group. There was no difference in the number of patients with exacerbations in the nurse group compared to the doctor group (45.6% vs 49.2%; odds ratio, 0.86; 95% confidence interval [CI], 0.44 to 1.71; p = 0.674). However, a significant proportion of patients in both groups had exacerbations despite hospital outpatient follow-up. There was no difference in quality of life (p = 0.285; mean difference, 0.78; 95% CI, – 0.64 to 2.19 for the AQ20; and p = 0.891; mean difference, 1.08; 95% CI, – 5.05 to 7.21 for SGRQ) or change in peak flow (mean difference between nurse and doctor groups, 1.39 (95% CI, – 3.84 to 6.63; p = 0.122) at 6 months.

Conclusions: Follow-up care by a nurse specialist for patients admitted with acute asthma can be delivered equivocally with comparable safety and effectiveness to that given by a doctor.

Key Words: asthma • randomized controlled trial • respiratory nurse specialist

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