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IBD PATIENT FOLLOW UP: A RANDOMIZED TRIAL OF NURSE SPECIALIST VERSUS STANDARD GASTROENTEROLOGIST CARE
M Stewart1, K Phalen-Kelly2, D MacIntosh2, D Leddin2, D Farina2
1University of Calgary, Calgary, Alberta; 2Dalhousie University, Halifax, Nova Scotia
Aims: Canada has the highest rate of IBD in the world and the second lowest number of physicians per 100,000 population. Patients with IBD need ongoing access to medical care since this lifelong illness is characterized by significant potential morbidity and frequent flares. We wished to determine if follow up care provided by a nurse practitioner (NP) would be comparable to that provided by a physician (MD).
Methods: Patients presenting to an IBD clinic were randomized to receive either standard care provided by an MD or care provided by a NP specializing in IBD. The primary outcomes were differences in Crohn's and Colitis Knowledge Score (CCKNOW), IBD Quality of Life Score (IBDQ), and a Satisfaction Survey developed through patient focus groups. These were compared at randomization and 12 months later. T-tests and Pearson chi-squares were used to evaluate differences within and between groups. All tests were considered statistically significant at the 0.05 level.
Results: Eighty-six patients were randomized to either NP or standard MD care. Twenty-seven patients were lost to follow-up. There were no differences in baseline characteristics between the two groups. The mean CCKNOW, IBDQ, and Satisfaction scores are shown in Table 1. There were no differences between initial IBDQ scores and 12 month scores within either the NP or MD groups (p=0.3 and p=0.596). There were no differences in IBDQ scores between the two groups initially or at 12 months (p=0.690 and p=0.639). Both the NP and MD groups showed significant improvement in CCKNOW scores at 12 months (p=0.002 and p=0.023). The CCKNOW scores did not differ between the groups at enrollment or at 12 months (p=0.483 and p=0.871). There were no differences between mean satisfaction scores at enrollment and at 12 months in either the NP or MD groups (p=0.085 and p=0.563). There were no differences in satisfaction scores between the groups at enrollment or at 12 months (p=0.274 and p=0.420).
Conclusions: Confirmation of equivalence between IBD follow-up care provided by a nurse specialist or an MD will require extension of the study to larger numbers of IBD patients. However, quality of life, disease related knowledge scores and patient satisfaction are comparable regardless of whether patients are seen in follow-up by an MD or by a nurse specialist trained in IBD. This model of care may represent an alternative to MD care especially in areas with a shortage of GI MD's.
Mean Scores