Mills N, Bachmann M O, Campbell R, Hine I, McGowan M
Department of Social Medicine, University of Bristol, Bristol, BS8 2PR, UK.
Seizure. 1999 Aug;8(5):291-6. doi: 10.1053/seiz.1999.0307.
Epilepsy specialist nurses have the potential to improve the quality of care of community-based patients with epilepsy, although evidence of their effectiveness is limited by the lack of formal or long-term evaluation. Results of a controlled trial that assessed the effectiveness of a primary care based specialist nurse-led service suggested improvements in communication and satisfaction but not health status at one-year follow-up. A second follow-up was conducted to assess the effects after two years. Patients who reported having seen the nurse at least once in the two years ('users') were compared with those who had not ('non-users'). Comparisons between users and non-users were adjusted for baseline differences. Results were based on 40% of all 595 adult patients known to have epilepsy in 14 general practices and who answered questionnaires at baseline and two years later. The new epilepsy service was used more by those with greatest needs for care. Users of the new service were significantly more likely than non-users to have discussed 8 of 11 topics asked about epilepsy [odds ratios (ORs) ranging from 2.42 to 7.91] with their general practitioner (GP), and 2 of the 11 topics with the hospital doctor (ORs 5.59, 5. 74). Service users were significantly less likely than non-users to feel their GP knew enough about epilepsy [OR 0.27, 95% confidence intervals (CI) 0.74-0.98], and significantly more likely to report epilepsy as having an adverse impact on 3 of 10 areas of everyday life (ORs ranging from 2.09 to 2.50). Users were more likely than non-users to have seen their GP for any reason in the previous year and to change their medication from use of more than one antiepileptic drug to monotherapy, although findings were not significant. Results suggest that the epilepsy specialist nurse service is not a cost-reducing substitute, particularly for general practitioner care, but it appears to improve communication and prescribing of monotherapy, and increases access for the most needy. The service may, however, have an adverse impact on patients' perceptions of the effects of epilepsy on aspects of everyday life.
癫痫专科护士有潜力改善社区癫痫患者的护理质量，尽管由于缺乏正式或长期评估，其有效性的证据有限。一项对照试验评估了以初级保健为基础、由专科护士主导的服务的有效性，结果表明在一年随访时沟通和满意度有所改善，但健康状况没有改善。进行了第二次随访以评估两年后的效果。将报告在两年内至少见过一次护士的患者（“使用者”）与未见过的患者（“非使用者”）进行比较。对使用者和非使用者之间的比较进行了基线差异调整。结果基于14家全科诊所中已知患有癫痫的595名成年患者中的40%，这些患者在基线和两年后回答了问卷。新的癫痫服务被最需要护理的人更多地使用。新服务的使用者比非使用者更有可能与他们的全科医生（GP）讨论所询问的11个癫痫主题中的8个[优势比（OR）范围从2.42到7.91]，与医院医生讨论11个主题中的2个（OR为5.59、5.74）。服务使用者比非使用者更不太可能觉得他们的全科医生对癫痫了解足够[OR 0.27，95%置信区间（CI）0.74 - 0.98]，并且更有可能报告癫痫对10个日常生活领域中的3个有不利影响（OR范围从2.09到2.50）。使用者比非使用者更有可能在上一年因任何原因看过他们的全科医生，并且更有可能将他们的药物治疗从使用多种抗癫痫药物改为单一疗法，尽管结果并不显著。结果表明，癫痫专科护士服务不是一种降低成本的替代方案，特别是对于全科医生护理而言，但它似乎改善了单一疗法的沟通和处方，并增加了最需要者的就医机会。然而，该服务可能会对患者对癫痫对日常生活各方面影响的认知产生不利影响。
