Miles K, Penny N, Mercey D, Power R
Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College London, Mortimer Market Centre, UK.
Sex Transm Infect. 2002 Apr;78(2):93-7. doi: 10.1136/sti.78.2.93.
To assess the care process and clinical outcomes for two different models of GUM clinic for women: one led by specialist nurses and the other by senior house officers (SHOs).
An open randomised controlled trial was carried out in a central London genitourinary medicine (GUM) women's clinic. Of 1172 women telephoning for an appointment, 880 were randomised to provide 169 eligible patients in the specialist nurse arm and 178 in the SHO arm. Of the eligible patients a total of 224 attended their appointment. The clinical records of the randomised women were audited for adequacy of care according to local guidelines. 30 key variables were objectively assessed and recorded on a standard audit form. An overall unitary index score (%) was calculated for each patient. The main variables associated with the outcome of specialist nurse and SHO decision making (diagnostic test request, preliminary diagnosis, and treatment provided) were then analysed independently.
The median documentation audit scores for specialist nurses (n=103) and SHOs (n=121) were 92% and 85% respectively (p<0.0001). The specialist nurses' documentation was significantly (p<0.05) more complete than the SHOs' for five variables: details of menstrual cycle, physical examination, medication instructions given to patients, health promotion discussion, and provision of condoms. Specialist nurses performed equally to the SHOs with regard to requesting the correct diagnostic tests, providing the correct preliminary diagnosis, and providing the correct treatment.
A model of care using trained GUM nurses working within agreed protocols can provide comprehensive patient care for female patients that is equal to care provided by SHOs. Our results raise important issues regarding advanced GUM nursing education and training, protocol development, and accountability.
评估两种不同模式的女性泌尿生殖医学（GUM）门诊的护理过程及临床结局，一种由专科护士主导，另一种由住院医师（SHO）主导。
在伦敦市中心的一家泌尿生殖医学女性门诊进行了一项开放随机对照试验。在1172名打电话预约的女性中，880名被随机分组，专科护士组有169名符合条件的患者，住院医师组有178名。在符合条件的患者中，共有224名前来就诊。根据当地指南，对随机分组女性的临床记录进行护理充分性审核。客观评估30个关键变量，并记录在标准审核表上。为每位患者计算一个总体单一指数得分（%）。然后分别分析与专科护士和住院医师决策结果（诊断检查请求、初步诊断和提供的治疗）相关的主要变量。
专科护士（n = 103）和住院医师（n = 121）的文档审核中位数得分分别为92%和85%（p < 0.0001）。在五个变量方面，专科护士的文档记录明显（p < 0.05）比住院医师更完整：月经周期细节、体格检查、给患者的用药指导、健康促进讨论以及提供避孕套。在请求正确的诊断检查、提供正确的初步诊断和提供正确的治疗方面，专科护士与住院医师表现相当。
采用经过培训的GUM护士按照商定方案开展工作的护理模式，可为女性患者提供与住院医师提供的护理同等的全面患者护理。我们的结果提出了有关高级GUM护理教育与培训、方案制定和问责制的重要问题。
