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Evidence summaries

Nurse Specialist Care for Bronchiectasis

There may not be any significant differences in clinical outcomes between nurse-led and doctor-led care in the management of bronchiectasis within a specialist clinic setting, but there may be increased cost implications in nurse-led care. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 1 randomised crossover study with a total of 80 subjects. There was no statistical difference in lung function and exercise capacity parameters nor in the health related quality of life between the groups. The number of patient-reported infective exacerbations was 262 in 79.4 patient-years of follow up during nurse practitioner-led care, compared with 238 in 77.8 years during doctor led care (relative rate of exacerbations 1.09, 95% CI 0.91 to 1.30, p=0.34). There was a statistically higher proportion of hospital admissions in nurse-led care (66 vs. 42 admissions in doctor-led care; relative rate 1.52, 95% CI 1.03 to 2.23, p=0.03). Of these, there were 23 and 43 readmissions respectively attributable to bronchiectasis (relative rate 1.59, 95% CI 0.75 to 3.39, p=0.22). Nurse-led care resulted in significantly higher costs per patient; this was largely due to the difference in the number of hospital admissions and intravenous and nebulised antibiotic costs.

Comment: The quality of evidence is downgraded by limitations in study quality and by imprecise results (few patients).

    References

    • French J, Bilton D, Campbell F. Nurse specialist care for bronchiectasis. Cochrane Database Syst Rev 2003;(3):CD004359 [Assessed as up-to-date: 2 July 2008]. [PubMed]

Primary/Secondary Keywords