Whitaker J, Butler A, Semlyen J K, Barnes M P
Academic Unit of Neurological Rehabilitation, Hunters Moor Regional Neurorehabilitation Centre, Newcastle upon Tyne, UK.
Arch Phys Med Rehabil. 2001 Apr;82(4):480-4. doi: 10.1053/apmr.2001.21843.
To study whether a trained outreach nurse practitioner could provide a service that is as good as, or better than, that provided at a hospital outpatient clinic for people who had been diagnosed with dystonia and required treatment with botulinum toxin.
Randomized trial.
An outpatient department of a regional neurorehabilitation center and patients' homes in northern England.
Eighty-nine patients with a clinical diagnosis of spasmodic torticollis, blepharospasm, or hemifacial spasm who had ongoing treatment of dystonia with botulinum injections.
Individuals were randomly allocated either to receive ongoing botulinum injections at home by the nurse practitioner or to continue attending the hospital outpatient clinic and be injected by medical staff.
The following measures were recorded at each visit: demographic descriptors, dosage of botulinum toxin, treatment interval, side-effect profile, external referrals, and a questionnaire to determine qualitative opinion.
Efficacy and duration of the botulinum was similar in both groups. Botulinum dosage and side-effect profiles were similar in both groups except for significantly less dysphagia (p < .018) in the home group (7 vs 24 occasions). Subjective opinion by the patients indicated statistically significant preference for home injections. Economic analysis indicated that the overall cost of the treatment was less in the home injection group (total cost per visit $36.90 [ pound 23.36] vs $79.00 [ pound 50.01]), but this difference was not statistically significant.
A trained outreach nurse practitioner provided a service that was as good as, and in certain aspects better than, that provided by a hospital outpatient clinic. The nurse practitioner provided a more flexible, much appreciated, safe, and cost-effective service for this client group. Wider use of outreach nurse practitioners for dystonia should be encouraged.
研究一名经过培训的外展护士从业者能否为已被诊断患有肌张力障碍且需要肉毒杆菌毒素治疗的患者提供与医院门诊诊所相当或更好的服务。
随机试验。
英格兰北部一家地区神经康复中心的门诊部及患者家中。
89名临床诊断为痉挛性斜颈、眼睑痉挛或半面痉挛且正在接受肉毒杆菌注射治疗肌张力障碍的患者。
将个体随机分配，要么由护士从业者在家中接受持续的肉毒杆菌注射，要么继续前往医院门诊诊所并由医务人员进行注射。
每次就诊时记录以下指标：人口统计学描述、肉毒杆菌毒素剂量、治疗间隔、副作用情况、外部转诊情况，以及一份用于确定定性意见的问卷。
两组中肉毒杆菌毒素的疗效和持续时间相似。两组的肉毒杆菌毒素剂量和副作用情况相似，但在家中治疗组吞咽困难明显较少（p < 0.018）（7次 vs 24次）。患者的主观意见表明，对在家中注射有统计学上显著的偏好。经济分析表明，在家中注射组的总体治疗成本较低（每次就诊总成本36.90美元[23.36英镑] vs 79.00美元[50.01英镑]），但这种差异无统计学意义。
一名经过培训的外展护士从业者提供的服务与医院门诊诊所相当，且在某些方面更好。该护士从业者为这一客户群体提供了更灵活、更受欢迎、更安全且更具成本效益的服务。应鼓励更广泛地使用外展护士从业者来治疗肌张力障碍。
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