Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial
Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial
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DOI：
10.1016/s0140-6736(18)32158-5
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发表时间：
2018-10-20
期刊：
影响因子：
168.9
通讯作者：
Zhang, Weiya
中科院分区：
文献类型：
--
作者：
Doherty, Michael;Jenkins, Wendy;Zhang, Weiya
背景在英国，痛风的治疗是次优的，只有40%的患者接受降尿酸治疗，通常没有滴定以达到目标血清尿酸盐浓度。护士在初级保健中成功地管理了许多疾病。我们将护士主导的痛风护理与全科医生（GP）为社区居民主导的常规护理进行了比较。方法研究护士接受了痛风最佳实践管理的培训，包括提供个性化信息和让患者参与共同决策。在过去12个月内经历过痛风发作的成年人被随机分配1：1接受护士领导的护理或继续GP领导的常规护理。我们在基线和1年和2年后对患者进行了评估。主要结局是2年时血清尿酸盐浓度低于360 μ mol/L（6 mg/dL）的受试者百分比。次要结果是第2年的发作频率、痛风石的存在、生活质量和获得的每质量调整生命年（QALY）成本。基于意向治疗计算风险比（RR）和95% CI，采用多重插补。本研究已在www. ClinicalTrials.结果517例患者入组，其中255例被分配为护士主导的护理，262例为常规护理。以护士为主导的护理与高摄取率和坚持降尿酸治疗相关。与接受常规护理的患者相比，接受护士引导护理的患者在2年时血清尿酸浓度低于360 μ mol/L的患者更多（95% vs 30%，RR 3.18，95% CI 2.42-4.18，p< 0.0001）。2年时，所有次要结局均有利于护士领导组。每QALY获得的成本为护士主导的干预是5066磅在2 years.Interpretation护士主导的痛风护理是有效的，成本效益比通常的护理。我们的研究结果说明了教育和让患者参与痛风管理的好处，并重申了以目标为目标的降尿酸治疗策略对改善以患者为中心的结局的重要性。版权所有（c）2018作者。爱思唯尔有限公司出版
Background In the UK, gout management is suboptimum, with only 40% of patients receiving urate-lowering therapy, usually without titration to achieve a target serum urate concentration. Nurses successfully manage many diseases in primary care. We compared nurse-led gout care to usual care led by general practitioners (GPs) for people in the community.Methods Research nurses were trained in best practice management of gout, including providing individualised information and engaging patients in shared decision making. Adults who had experienced a gout flare in the previous 12 months were randomly assigned 1: 1 to receive nurse-led care or continue with GP-led usual care. We assessed patients at baseline and after 1 and 2 years. The primary outcome was the percentage of participants who achieved serum urate concentrations less than 360 mu mol/L (6 mg/dL) at 2 years. Secondary outcomes were flare frequency in year 2, presence of tophi, quality of life, and cost per quality-adjusted life-year (QALY) gained. Risk ratios (RRs) and 95% CIs were calculated based on intention to treat with multiple imputation. This study is registered with www. ClinicalTrials. gov, number NCT01477346.Findings 517 patients were enrolled, of whom 255 were assigned nurse-led care and 262 usual care. Nurse-led care was associated with high uptake of and adherence to urate-lowering therapy. More patients receiving nurse-led care had serum urate concentrations less than 360 mu mol/L at 2 years than those receiving usual care (95% vs 30%, RR 3.18, 95% CI 2.42-4.18, p< 0.0001). At 2 years all secondary outcomes favoured the nurse-led group. The cost per QALY gained for the nurse-led intervention was 5066 pound at 2 years.Interpretation Nurse-led gout care is efficacious and cost-effective compared with usual care. Our findings illustrate the benefits of educating and engaging patients in gout management and reaffirm the importance of a treat-to-target urate-lowering treatment strategy to improve patient-centred outcomes. Copyright (c) 2018 The Author(s). Published by Elsevier Ltd.